title: Developing a Tool to Assess Placement of Central Venous Catheters in Pediatrics Patients.
abstract: BACKGROUND
  Pediatric critical care medicine requires the acquisition of procedural skills, but to date no criteria exist for assessing trainee competence in central venous catheter (CVC) insertion.
  
  
  OBJECTIVE
  The goal of this study was to create and demonstrate validity evidence for a direct observation tool for assessing CVC insertion.
  
  
  METHODS
  Ten experts used the modified Delphi technique to create a 15-item direct observation tool to assess 5 scripted and filmed simulated scenarios of CVC placement. The scenarios were hosted on a dedicated website from March to May 2013, and respondents recruited by e-mail completed the observation tool in real time while watching the scenarios. The goal was to obtain 50 respondents and a total of 250 scenario ratings.
  
  
  RESULTS
  A total of 49 pediatrics intensive care faculty physicians (6.3% of 780 potential subjects) responded and generated 188 scenario observations. Of these, 150 (79.8%) were recorded from participants who scored 4 or more on the 5 scenarios. The tool correctly identified the expected reference standard in 96.8% of assessments with an interrater agreement kappa (standard error) = 0.94 (0.07) and receiver operating characteristic = 0.97 (95% CI 0.94-0.99).
  
  
  CONCLUSIONS
  This direct observation assessment tool for central venous catheterization demonstrates excellent performance in identifying the reference standard with a high degree of interrater reliability. These assessments support a validity construct for a pediatric critical care medicine faculty member to assess a provider placing a CVC in a pediatrics patient.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Fleming
authors.forename: Richard B
authors.initials: RB
authors.lastname: Mink
authors.forename: Christoph
authors.initials: C
authors.lastname: Hornik
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Emke
authors.forename: Michael L
authors.initials: ML
authors.lastname: Green
authors.forename: Katherine
authors.initials: K
authors.lastname: Mason
authors.forename: Toni
authors.initials: T
authors.lastname: Petrillo
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schuette
authors.forename: M Hossein
authors.initials: MH
authors.lastname: Tcharmtchi
authors.forename: Margaret
authors.initials: M
authors.lastname: Winkler
authors.forename: David A
authors.initials: DA
authors.lastname: Turner
mesh_terms: D000293:Adolescent; D002405:Catheterization, Central Venous / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards*; D003422:Critical Care; D003697:Delphi Technique; D004521:Educational Measurement / Q000379:methods; D006801:Humans; D007223:Infant; D010372:Pediatrics / Q000193:education; D015203:Reproducibility of Results; D014741:Video Recording