Assessment of a new model for femoral ultrasound-guided central venous access procedural training: a pilot study.
OBJECTIVE
Repetitive practice with feedback in residency training is essential in the development of procedural competency. Lightly embalmed cadaver laboratories provide excellent simulation models for a variety of procedures, but to the best of our knowledge, none describe a central venous access model that includes the key psychomotor feedback elements for the procedure, namely intravascular contents that allow for determination of correct needle position by either ultrasonographic imaging and/or aspiration or vascular contents.


METHODS
A cadaver was lightly embalmed using a technique that preserves tissue texture and elasticity. We then performed popliteal fossa dissections exposing the popliteal artery and vein. Vessels were ligated distally, and 14-gauge catheters were introduced into the lumen of each artery and vein. The popliteal artery and vein were then infused with 200 mL of icterine/gel and 200 mL of methylene blue/gel, respectively. Physician evaluators then performed ultrasound (US)-guided femoral central venous line placements and rated the key psychomotor elements on a five-point Likert scale.


RESULTS
The physician evaluators reported a median of 10.5 years of clinical emergency medicine (EM) experience with an interquartile range (IQR) of 16 and a median of 10 central lines placed annually (IQR = 10). Physician evaluators rated the key psychomotor elements of the simulated procedure as follows: ultrasonographic image of vascular elements, 4 (IQR = 0); needle penetration of skin, 4.5 (IQR = 1); needle penetration of vein, 5 (IQR = 1); US image of needle penetrating vein, 4 (IQR = 2); aspiration of vein contents, 3 (IQR = 2); passage of dilator into vein, 4 (IQR = 2); insertion of central venous catheter, 5 (IQR = 1); US image of catheter insertion into vein, 5 (IQR = 1); and overall psychomotor feedback of the simulated procedure compared to the evaluators' actual patient experience, 4 (IQR = 1).


CONCLUSIONS
For the key psychomotor elements of central venous access, the lightly embalmed cadaver with intravascular water-soluble gel infusion provided a procedural model that closely simulated clinicians' experience with patients.
Wadman
Michael C
MC
Department of Emergency Medicine, University of Nebraska College of Medicine, Omaha, NE, USA. mwadman@unmc.edu
Lomneth
Carol S
CS
Hoffman
Lance H
LH
Zeger
Wesley G
WG
Lander
Lina
L
Walker
Richard A
RA
D002102:Cadaver; D002405:Catheterization, Central Venous / Q000379:methods*; D002408:Catheters, Indwelling; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004635:Emergency Medicine / Q000193:education*; D005268:Femoral Vein / Q000000981:diagnostic imaging; D006801:Humans; D007396:Internship and Residency; D016014:Linear Models; D010865:Pilot Projects; D011597:Psychomotor Performance; D014463:Ultrasonography