title: Firm-based trial to improve central venous catheter insertion practices.
abstract: BACKGROUND
  Central venous catheters placed in femoral veins increase the risk of complications. At our institution, residents place most catheters in the femoral vein.
  
  
  OBJECTIVE
  Determine whether a hands-on educational session reduced femoral venous catheterization and improved residents' confidence and adherence to recommendations for infection control.
  
  
  METHODS
  Firm-based clinical trial between November 2004 and March 2005.
  
  
  METHODS
  General medical wards of Cook County (Stroger) Hospital (Chicago, IL), a public teaching hospital.
  
  
  METHODS
  Internal medicine residents (n = 150).
  
  
  METHODS
  Before their 4-week rotation, intervention-firm residents received a lecture and practiced placing catheters in mannequins; control-firm residents received the usual training.
  
  
  METHODS
  Venous insertion site, adherence to recommendations for infection control, knowledge and confidence about catheter insertion, and catheter-associated complications
  
  
  RESULTS
  Residents inserted 54 catheters, or 0.24 insertions per resident per 4-week rotation. There was a nonsignificant decrease in femoral insertions for nondialysis catheters in the intervention group compared to the control group (44% vs. 58%), difference: -14% (95% CI, -52% to 24%). The intervention significantly increased residents' knowledge of complications related to femoral vein catheterization and temporarily increased their confidence about placing internal jugular or subclavian venous catheters. Intervention-group residents were more likely to use masks during catheterization (risk ratio, 2.2; 95% CI, 1.3-2.7), but other practices were similar.
  
  
  CONCLUSIONS
  Our intervention improved residents' knowledge of complications and use of masks during catheter insertion; however, it did not significantly change venous insertion sites. Catheter insertions on our general medicine wards are infrequent, and the skills acquired during the skills-building session may have deteriorated given the few clinical opportunities for reinforcement.
authors.affiliation: Department of Medicine, Cook County (Stroger) Hospital, Chicago, Illinois, USA. Julio.A.Miranda@Hitchcock.org
authors.forename: Julio A
authors.initials: JA
authors.lastname: Miranda
authors.forename: William E
authors.initials: WE
authors.lastname: Trick
authors.forename: Arthur T
authors.initials: AT
authors.lastname: Evans
authors.forename: Marjorie
authors.initials: M
authors.lastname: Charles-Damte
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Reilly
authors.forename: Peter
authors.initials: P
authors.lastname: Clarke
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002641:Chicago; D002983:Clinical Competence; D005268:Femoral Vein; D007722:Health Knowledge, Attitudes, Practice; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D007601:Jugular Veins; D008348:Manikins; D011446:Prospective Studies; D013350:Subclavian Vein; D013663:Teaching / Q000379:methods*