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Original Research: CRITICAL CARE |

A Prerotational, Simulation-Based Workshop Improves the Safety of Central Venous Catheter InsertionCentral Venous Catheter Insertion Simulation: Results of a Successful Internal Medicine House Staff Training Program

Hiroshi Sekiguchi, MD; Joji Erik Tokita, MD; Taro Minami, MD; Lewis Ari Eisen, MD, FCCP; Paul Henry Mayo, MD, FCCP; Mangala Narasimhan, DO, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Sekiguchi), Mayo Clinic, Rochester, MN; Division of Nephrology (Dr Tokita), Mount Sinai School of Medicine, New York, NY; Division of Pulmonary, Critical Care and Sleep Medicine (Dr Minami), Memorial Hospital of Rhode Island, Pawtucket, RI; Division of Critical Care Medicine (Dr Eisen), Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; and the Division of Pulmonary, Critical Care and Sleep Medicine (Drs Mayo and Narasimhan), North Shore Long Island Jewish Medical Center, New Hyde Park, NY.

Correspondence to: Hiroshi Sekiguchi, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: sekiguchi.hiroshi@mayo.edu


The abstract of this article was presented at CHEST 2008, Philadelphia, Pennsylvania, on October 27, 2008.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(3):652-658. doi:10.1378/chest.10-3319
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Background:  The purpose of this study was to evaluate the effectiveness of a simulation-based workshop with ultrasonography instruction in reducing mechanical complications associated with central venous catheter (CVC) insertion.

Methods:  A single-center prospective cohort study was conducted in the medical ICU and respiratory step-down unit of an urban teaching hospital. Fifty-six medical house staff members were trained prior to their rotations over a 6-month period. The data on mechanical complication rates after the implementation of the workshop were compared with previous experience when no structured educational program existed.

Results:  There were 334 procedures in the preeducation period compared to 402 procedures in the posteducation period. The overall complication rate, including placement failure, in the preeducation and posteducation period was 32.9% and 22.9%, respectively (P < .01). Placement failure rate decreased from 22.8% to 16.2% (P = .02), and arterial punctures decreased from 4.2% to 1.5% (P = .03). Ultrasonography usage increased from 3.0% to 61.4% (P < .01). Multivariate analysis demonstrated that interns were more likely to cause overall mechanical complications compared with fellows and attending physicians in the preeducation period (P = .02); however, this trend was not observed in the posteducation period. Catheter site and ultrasonography usage significantly affected the overall complication rate in both periods, and ultrasound-guided femoral CVC was the safest procedure in the posteducation period.

Conclusions:  Implementation of a prerotational workshop significantly improved the safety of CVC insertion, especially for CVCs placed by inexperienced operators. We suggest that simulation-based training with ultrasonography instruction should be conducted if house staff members are responsible for CVC placement.

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