title: A prerotational, simulation-based workshop improves the safety of central venous catheter insertion: results of a successful internal medicine house staff training program.
abstract: 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.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address: sekiguchi.hiroshi@mayo.edu.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sekiguchi
authors.affiliation: Division of Nephrology, Mount Sinai School of Medicine, New York, NY.
authors.forename: Joji Erik
authors.initials: JE
authors.lastname: Tokita
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Memorial Hospital of Rhode Island, Pawtucket, RI.
authors.forename: Taro
authors.initials: T
authors.lastname: Minami
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
authors.forename: Lewis Ari
authors.initials: LA
authors.lastname: Eisen
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, North Shore Long Island Jewish Medical Center, New Hyde Park, NY.
authors.forename: Paul Henry
authors.initials: PH
authors.lastname: Mayo
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, North Shore Long Island Jewish Medical Center, New Hyde Park, NY.
authors.forename: Mangala
authors.initials: M
authors.lastname: Narasimhan
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D008348:Manikins; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies