OBJECTIVE: Given increasing evidence supporting a real-time ultrasound (US)-guided approach for subclavian vein (SCV) central venous catheter (CVC) insertion as compared with the traditional landmark approach, we sought to develop a standardized curriculum to offer healthcare providers a means to attain increased competency and confidence in US-guided SCV CVC insertion.
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DESIGN: Retrospective review of prospectively collected data.
SETTING: Single institution’s American College of Surgeons Level 1 Accredited Education Institute within an academic tertiary care center.
SUBJECTS: A total of 77 residents and midlevel providers working in our surgical intensive care unit.
INTERVENTIONS: Providers participated in a tiered educational module designed to teach safe US-guided SCV CVC insertion. The education consisted of a multimedia didactic presentation and a hands-on simulation session, including US anatomy on live subjects and anatomical model-based SCV CVC insertion.
MEASUREMENTS AND MAIN RESULTS: Assessment of the effect of education included a written examination and confidence survey, administered pre- and postintervention, and videotaped simulation session graded by blinded expert evaluators. Of the 77 participants, 70 participants completed a posttest with a median 5-point increase in score compared with that of the pretest score (p < 0.0001). Confidence ratings based on a 5-point Likert scale demonstrated an increase in confidence in SCV CVC insertion (p < 0.0001), using the landmark approach (p < 0.0001), using US-guided approach (p < 0.0001), and in use of US to image the SCV (p < 0.0001). Postgraduate year-1 residents had lower mean global rating score (p = 0.010) than any other participants.
CONCLUSIONS: This comprehensive hands-on teaching module-based curriculum enhanced learner knowledge of and confidence in US-guided SCV CVC insertion. This module can be implemented in simulation centers for teaching safe and successful SCV CVC insertion.
Bayci, A.W., Mangla, J., Jenkins, C.S., Ivascu, F.A. and Robbins, J.M. (2015) Novel Educational Module for Subclavian Central Venous Catheter Insertion Using Real-Time Ultrasound Guidance. Journal of Surgical Education. October 15th. [epub ahead of print].
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