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Original Research
Firm-based trial to improve central venous catheter insertion practices
Article first published online: 4 JUN 2007
DOI: 10.1002/jhm.168
Copyright © 2007 Society of Hospital Medicine
1553-5606/asset/cover.gif?v=1&s=8729fe1294bef26ef738b268ce3f4bb104727c08 "Journal of Hospital Medicine")
Additional Information
How to Cite
Miranda, J. A., Trick, W. E., Evans, A. T., Charles-Damte, M., Reilly, B. M. and Clarke, P. (2007), Firm-based trial to improve central venous catheter insertion practices. Journal of Hospital Medicine, 2: 135–142. doi: 10.1002/jhm.168
Publication History
- Issue published online: 4 JUN 2007
- Article first published online: 4 JUN 2007
- Manuscript Accepted: 26 OCT 2006
- Manuscript Revised: 12 SEP 2006
- Manuscript Received: 9 JUL 2006
- Abstract
- Article
- References
- Cited By
Keywords:
- central venous catheterization;
- medical education;
- internship and residency;
- infection control;
- patient simulation
Abstract
BACKGROUND
Central venous catheters placed in femoral veins increase the risk of complications. At our institution, residents place most catheters in the femoral vein.
OBJECTIVE
Determine whether a hands-on educational session reduced femoral venous catheterization and improved residents' confidence and adherence to recommendations for infection control.
DESIGN
Firm-based clinical trial between November 2004 and March 2005.
SETTING
General medical wards of Cook County (Stroger) Hospital (Chicago, IL), a public teaching hospital.
PARTICIPANTS
Internal medicine residents (n = 150).
INTERVENTION
Before their 4-week rotation, intervention-firm residents received a lecture and practiced placing catheters in mannequins; control-firm residents received the usual training.
MEASUREMENTS
Venous insertion site, adherence to recommendations for infection control, knowledge and confidence about catheter insertion, and catheter-associated complications
RESULTS
Residents inserted 54 catheters, or 0.24 insertions per resident per 4-week rotation. There was a nonsignificant decrease in femoral insertions for nondialysis catheters in the intervention group compared to the control group (44% vs. 58%), difference: −14% (95% CI, −52% to 24%). The intervention significantly increased residents' knowledge of complications related to femoral vein catheterization and temporarily increased their confidence about placing internal jugular or subclavian venous catheters. Intervention-group residents were more likely to use masks during catheterization (risk ratio, 2.2; 95% CI, 1.3-2.7), but other practices were similar.
CONCLUSIONS
Our intervention improved residents' knowledge of complications and use of masks during catheter insertion; however, it did not significantly change venous insertion sites. Catheter insertions on our general medicine wards are infrequent, and the skills acquired during the skills-building session may have deteriorated given the few clinical opportunities for reinforcement. Journal of Hospital Medicine 2007;2:135–142. © 2007 Society of Hospital Medicine.