Simulation Training for Ultrasound Guided Central Venous Catheter Insertion

超声引导中心静脉导管置入模​​拟训练

• 批准号: 7289755
• 负责人: LEIGH V EVANS
• 金额: $ 29.93万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-30 至 2008-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7289755
• 关键词: Simulation; Training; Ultrasound; Guided; Central

DESCRIPTION (PROVIDED BY APPLICANT): Resident education has traditionally devoted itself to knowledge acquisition rather than defined levels of clinical competence. Currently, inexperienced physicians are trained to perform invasive procedures such as central venous catheter (CVC) insertion according to the bedside, apprenticeship model, gaining expertise on real patients in neither a rigorous nor standardized manner. Simulators may ease trainees' transition to actual patients and avoid adverse events. The proposed project aims to investigate the efficacy of a structured simulation training protocol in ultrasound guided CVC insertion for resident physicians. The specific aims are to compare: (1) the failure rate of CVC insertion, and (2) the number of attempts at venous cannulation, rates of technical errors and complications of CVC insertion, and time to CVC insertion on actual patients between residents who have completed a structured, hands-on simulation training protocol (intervention group) and those who are trained according to the traditional, bedside apprenticeship model (control group). We hypothesize that the intervention group will obtain superior skills at CVC insertion on actual patients as compared to the control group as measured by: (1) a reduced failure rate at CVC insertion, (2) a) a reduced number of attempts at venous cannulation b) a decreased rate of technical errors and complications and c) a decreased time to insertion based on an independent rater's evaluation using a procedure checklist. This prospective, randomized observational study will include 1st and 2nd postgraduate year residents over a 21 month period at a tertiary care teaching hospital who rotate through the Emergency Department, Medical Intensive Care Unit and/or Surgical Intensive Care Unit. The intervention group will complete a hands-on ultrasound guided simulation training protocol on a partial task training simulator until competence is achieved as measured by (1) knowledge - a score of > 90% on a written post-training exam, (2) performance - a) the ability to cannulate a simulated vein under ultrasound guidance on first pass in 4/5 consecutive attempts, and b) correct insertion of a CVC on a partial task training simulator with no technical errors as observed by an independent rater. The potential long-term benefit of this research project is the establishment of a structured simulation training protocol for ultrasound guided CVC insertion by resident physicians which will improve patient safety and be applicable to teaching hospitals at a national level.

描述（由申请人提供）：传统上，居民教育专门用于知识获取，而不是定义的临床能力水平。目前，没有经验的医生接受了根据床边，学徒模型进行侵入性手术，例如中央静脉导管（CVC）插入，并以严格的和标准化的方式获得了对真实患者的专业知识。模拟器可以简化学员向实际患者的过渡并避免不良事件。拟议的项目旨在调查在超声引导的CVC插入中为常驻医师进行结构化模拟训练方案的功效。具体目的是比较：（1）CVC插入的故障率，以及（2）静脉插管的尝试数，技术错误率和CVC插入的并发症以及CVC插入的时间插入CVC对已经完成了结构性的，动手的模拟协议（干预小组）的居民之间的实际患者插入实际的患者，并根据培训了这些模型，并根据该培训的批准（居住在待命（居住）中，该组合。我们假设与对照组相比，干预组将在CVC插入实际患者时获得较高的技能：（1）（1）CVC插入时的失败率降低，（2）a）静脉插管的尝试减少了静脉插入的尝试降低b）降低的技术错误和复杂性的速度降低了基于独立插入的时间，而对插入的时间则减少了一项独立的评估。这项前瞻性，随机的观察性研究将包括在21个月内在三级护理教学医院进行的第一年和第二年级居民，该医院旋转急诊科，医疗重症监护室和/或手术重症监护病房。干预组将在部分任务培训模拟器上完成动手超声指导的模拟培训协议，直到通过（1）知识衡量的能力达到能力 - 在书面培训后考试中的得分> 90％> 90％，（2）性能 - a）在4/5的任务中毫不及格地进行模拟的静脉指导，并在4/5的任务中毫不及格地训练，并在4/5的任务中进行be notion sim notion a sim n/be n a n/b），并在4/5的任务中插入了b）a notion and a n/5独立评估者观察到的技术错误。该研究项目的潜在长期好处是，由常驻医生建立了超声指导的CVC插入的结构化模拟培训方案，这将提高患者的安全性并适用于国家一级的教学医院。

项目成果

Use of ultrasound guidance improves central venous catheter insertion success rates among junior residents.

使用超声引导可提高初级住院医师的中心静脉导管插入成功率。

• DOI: 10.7863/jum.2012.31.10.1519
• 发表时间: 2012
• 期刊: Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
• 作者: Dodge,KellyL;Lynch,CatherineA;Moore,ChristopherL;Biroscak,BrianJ;Evans,LeighV
• 通讯作者: Evans,LeighV