Novel educational module for subclavian central venous catheter insertion

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Abstract:

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.

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.

Reference:

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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