Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 27:18:11276.
doi: 10.15766/mep_2374-8265.11276. eCollection 2022.

Simulation-Based Training for Ultrasound-Guided Central Venous Catheter Placement in Pediatric Patients

Ryan J Good  1 , Danielle Mashburn  2 , Erika Jekich  2 , Kristen Miller  3 , Matthew K Leroue  1 , Jason Woods  4 , Angela S Czaja  5
Affiliations

Simulation-Based Training for Ultrasound-Guided Central Venous Catheter Placement in Pediatric Patients

Ryan J Good et al. MedEdPORTAL. .

Abstract

Introduction: Central venous catheter (CVC) placement in pediatric patients is lifesaving but associated with complications. To standardize training and decrease complications, we developed a simulation-based ultrasound-guided CVC placement training program for pediatric critical care providers.

Methods: We implemented our CVC placement training program with several groups of learners, including pediatric critical care medicine (PCCM) fellows, pediatric emergency medicine fellows, and PCCM advanced practice providers. Learners completed prework assignments and a knowledge test before participation. The session started with group activities including a learner-led CVC site-selection debate and a team-based competition to list the steps in CVC placement. Next, the learners rotated between four stations for deliberate practice on separate components of CVC placement. Finally, they performed CVC placement on a task trainer. Evaluation included assessment of learner confidence, a knowledge test, and measurement of procedure time before and after training.

Results: Twenty-seven learners participated in the training. Learner confidence in CVC placement increased significantly after participation (median confidence level: 1.5 vs. 4.0, p < .001). Learner CVC knowledge also increased significantly after participation (median test score: 68% vs. 88%, p < .001). CVC placement procedure time, a marker for skill in CVC placement, decreased significantly after participation (median procedure time: 264 seconds vs. 146 seconds, p < .001).

Discussion: Our simulation-based training program effectively increased knowledge, skill, and confidence in CVC placement for a variety of learners. Future work should evaluate the optimal frequency and structure of maintenance training and the impact of training on clinical outcomes.

Keywords: Central Venous Catheter; Clinical/Procedural Skills Training; Pediatric Critical Care Medicine; Pediatric Emergency Medicine; Pediatrics; Simulation; Ultrasound Skills.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.. Percentage of questions answered correctly on the knowledge test before and after participation in the simulation-based training session (p < .001 by Wilcoxon matched-pairs signed rank test, n = 16).
Figure 2.
Figure 2.. Central venous catheter procedure time, in seconds, before and after participation in the simulation-based training session (p < .001 by Wilcoxon matched-pairs signed rank test, n = 20).
See this image and copyright information in PMC

References

    1. Ares G, Hunter CJ. Central venous access in children: indications, devices, and risks. Curr Opin Pediatr. 2017;29(3):340–346. 10.1097/MOP.0000000000000485 - DOI - PubMed
    1. Affolter JT, Huskins WC, Moss M, Kuhn EM, Gedeit R, Rice TB. The association of central-line–associated bloodstream infections with central-line utilization rate and maintenance bundle compliance among types of PICUs. Pediatr Crit Care Med. 2016;17(7):591–597. 10.1097/PCC.0000000000000736 - DOI - PubMed
    1. Costello JM, Clapper TC, Wypij D. Minimizing complications associated with percutaneous central venous catheter placement in children: recent advances. Pediatr Crit Care Med. 2013;14(3):273–283. 10.1097/PCC.0b013e318272009b - DOI - PubMed
    1. Barsuk JH, McGaghie WC, Cohen ER, O'Leary KJ, Wayne DB. Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit. Crit Care Med. 2009;37(10):2697–2701. 10.1097/CCM.0b013e3181a57bc1 - DOI - PubMed
    1. Froehlich CD, Rigby MR, Rosenberg ES, et al. Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. Crit Care Med. 2009;37(3):1090–1096. 10.1097/CCM.0b013e31819b570e - DOI - PubMed

LinkOut - more resources