Assessment of a New Model for Femoral Ultrasound-guided Central Venous Access Procedural Training: A Pilot Study

Authors

  • Michael C. Wadman MD,

    1. From the Department of Emergency Medicine (MCW, LHH, WGZ, RAW) and the Department of Genetics, Cell Biology, and Anatomy (CSL), University of Nebraska College of Medicine, Omaha NE; and the Department of Epidemiology (LL), University of Nebraska College of Public Health, Omaha, NE.
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  • Carol S. Lomneth PhD,

    1. From the Department of Emergency Medicine (MCW, LHH, WGZ, RAW) and the Department of Genetics, Cell Biology, and Anatomy (CSL), University of Nebraska College of Medicine, Omaha NE; and the Department of Epidemiology (LL), University of Nebraska College of Public Health, Omaha, NE.
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  • Lance H. Hoffman MD,

    1. From the Department of Emergency Medicine (MCW, LHH, WGZ, RAW) and the Department of Genetics, Cell Biology, and Anatomy (CSL), University of Nebraska College of Medicine, Omaha NE; and the Department of Epidemiology (LL), University of Nebraska College of Public Health, Omaha, NE.
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  • Wesley G. Zeger DO,

    1. From the Department of Emergency Medicine (MCW, LHH, WGZ, RAW) and the Department of Genetics, Cell Biology, and Anatomy (CSL), University of Nebraska College of Medicine, Omaha NE; and the Department of Epidemiology (LL), University of Nebraska College of Public Health, Omaha, NE.
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  • Lina Lander ScD,

    1. From the Department of Emergency Medicine (MCW, LHH, WGZ, RAW) and the Department of Genetics, Cell Biology, and Anatomy (CSL), University of Nebraska College of Medicine, Omaha NE; and the Department of Epidemiology (LL), University of Nebraska College of Public Health, Omaha, NE.
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  • Richard A. Walker MD

    1. From the Department of Emergency Medicine (MCW, LHH, WGZ, RAW) and the Department of Genetics, Cell Biology, and Anatomy (CSL), University of Nebraska College of Medicine, Omaha NE; and the Department of Epidemiology (LL), University of Nebraska College of Public Health, Omaha, NE.
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  • Presented at the Fourth Mediterranean Emergency Medicine Congress, Sorrento, Italy, September, 2007.

Address for correspondence and reprints: Michael C. Wadman, MD; e-mail: mwadman@unmc.edu.

Abstract

Objectives:  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.

ACADEMIC EMERGENCY MEDICINE 2010; 17:88–92 © 2009 by the Society for Academic Emergency Medicine

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