title: Assessment of a new model for femoral ultrasound-guided central venous access procedural training: a pilot study.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, University of Nebraska College of Medicine, Omaha, NE, USA. mwadman@unmc.edu
authors.forename: Michael C
authors.initials: MC
authors.lastname: Wadman
authors.forename: Carol S
authors.initials: CS
authors.lastname: Lomneth
authors.forename: Lance H
authors.initials: LH
authors.lastname: Hoffman
authors.forename: Wesley G
authors.initials: WG
authors.lastname: Zeger
authors.forename: Lina
authors.initials: L
authors.lastname: Lander
authors.forename: Richard A
authors.initials: RA
authors.lastname: Walker
mesh_terms: 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