Longitudinal trends using a point-of-care gelatin-based model for ultrasound-guided central venous catheter insertion

Abstract

Ultrasound (US)-guided central venous catheter (CVC) insertion is a procedure that carries the risk of significant complications. Simulation provides a safe learning atmosphere, but most CVC simulators are not available outside of simulation centers. To explore longitudinal trends in US-guided CVC insertion competency in internal medicine (IM) interns, we studied the use of a low-fidelity, gelatin-based, US-guided CVC insertion simulation model combined with a simulation curriculum. This prospective observational study of IM interns was performed over the course of one academic year. Interns (n = 56) underwent model-based, US-guided procedure simulation training program and a repeated training course prior to their intensive care unit (ICU) rotation. CVC insertion competency at different timepoints was recorded. Survey data about intern experience and attitudes were also collected. Out of the 56 interns initially trained, 40 were included in the final analysis. Across all outcomes, interns experienced skill atrophy between initial training and the beginning of their ICU month. However, by the end of the month, there was a significant improvement in competency as compared to initial procedural training, which then waned by the end of the intern year. Attitudes toward the model were generally positive and self-reported confidence improved throughout the course of the year and correlated with objective measures of competency. Over the course of their intern year, which included simulation training using a gelatin-based model, interns demonstrated consistent competency trends. The use of a gelatin-based CVC insertion simulation model warrants further study as an adjunctive aid to existing simulation training.

Keywords: Simulation training; central venous catheters; gelatin; internal medicine; medical education; point-of-care ultrasound.

Figure 1.

Study design and timeline

Figure 2.

Images of the gelatin-based model

Figure 3.

US-guided CVC insertion competency data. Intern (n = 40) CVC insertion competency as measured by median time between the start of the procedure and successful vessel cannulation (a), median number of needle sticks prior to successful venous access (b), percentage of interns using appropriate needle tracking with ultrasound (c), and percentage of interns accurately recognizing vessels using ultrasound (d) at four time points. Error bars indicate IQR in Figure 3a and 3b and 95% confidence interval in Figures 3 C and 3D. * = p < 0.05, ** = p < 0.01, *** = p < 0.001, **** = p. < 0.0001

Figure 4.

Survey responses. Interns (n = 52) were surveyed at the conclusion of their US-guided CVC insertion ‘boot camp’ training session about perceived utility of the initial training (a). In addition, interns were surveyed about subjective confidence in CVC procedural competency at three time points (c): at the end of the boot camp training session, at the end of their ICU month (n = 50), and at the end of their intern year (n = 48). Interns were also surveyed about self-reported use of the gelatin vascular models at the conclusion of their ICU month (D)