The Impact of a Comprehensive Simulation-Based Training and Certification Program on Resident Central Venous Catheter Complication Rates

Background: Central venous catheter (CVC) complication rates reflecting the application of modern insertion techniques to a clinically heterogeneous patient populations are needed to better understand procedural risk attributable to the 3 common anatomic insertion sites: internal jugular, subclavian, and femoral veins. We sought to define site-specific mechanical and duration-associated CVC complication rates across all hospital inpatients. Methods: A retrospective chart review was conducted over 9 months at Georgetown University Hospital and Washington Hospital Center. Peripherally inserted central catheters and tunneled or fluoroscopically placed CVC’s were excluded. Mechanical complications (retained guidewire, arterial injury, and pneumothorax) and duration-associated complications (deep vein thrombosis or pulmonary embolism, and central line-associated bloodstream infections) were identified. Results: In all, 1179 CVC insertions in 801 adult patients were analyzed. Approximately 32% of patients had multiple lines placed. Of 1179 CVCs, 73 total complications were recorded, giving a total rate of one or more complications occurring per CVC of 5.9%. There was no statistically significant difference between site-specific complications. A total of 19 mechanical complications were documented, with a 1.5% complication rate of one or more mechanical complications occurring. A total of 54 delayed complications were documented, with a 4.4% complication rate of 1 or more delayed complications occurring. There were no statistically significant differences between anatomic sites for either total mechanical or total delayed complications. Conclusions: These results suggest that site-specific CVC complication rates may be less common than previously reported. These data further inform on the safety of modern CVC insertion techniques across all patient populations and clinical settings.

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SUN-057 Reducing Central Venous Catheter Burden in Haemodialysis Patients: The Impact of Changing Practice within an Australian Renal Unit

Kidney International Reports ◽

10.1016/j.ekir.2019.05.453 ◽

2019 ◽

Vol 4 (7) ◽

pp. S178

Author(s):

B. TALBOT ◽

R. Lin ◽

P. Sagar ◽

S. Sen ◽

M. Jun ◽

...

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Renal Unit ◽

Central Venous ◽

Changing Practice ◽

The Impact

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Linezolid lock prophylaxis of central venous catheter infection

Journal of Medical Microbiology ◽

10.1099/jmm.0.47665-0 ◽

2008 ◽

Vol 57 (4) ◽

pp. 534-535 ◽

Cited By ~ 4

Author(s):

Jérôme Patrick Fennell ◽

Martin O'Donohoe ◽

Martin Cormican ◽

Maureen Lynch

Keyword(s):

Central Venous Catheter ◽

Hospital Admissions ◽

Blood Stream Infection ◽

Central Venous Access ◽

Venous Catheter ◽

Venous Access ◽

Blood Stream ◽

Central Venous ◽

Central Venous Catheter Infection ◽

The Impact

Central venous catheter (CVC)-related infections are a major problem for patients requiring long-term venous access and may result in frequent hospital admissions and difficulties in maintaining central venous access. CVC-related blood stream infections are associated with increased duration of inpatient stay and cost approximately \#8364;13 585 per patient [Blot, S. I., Depuydt, P., Annemans, L., Benoit, D., Hoste, E., De Waele, J. J., Decruyenaere, J., Vogelaers, D., Colardyn, F. & Vandewoude, K. H. (2005). Clin Infect Dis 41, 1591–1598]. Antimicrobial lock therapy may prevent CVC-related blood stream infection, preserve central venous access and reduce hospital admissions. In this paper, the impact of linezolid lock prophylaxis in a patient with short bowel syndrome is described.

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1175: DO CENTRAL VENOUS CATHETER MECHANICAL COMPLICATION RATES DIFFER BY PROVIDER TYPE?

Critical Care Medicine ◽

10.1097/01.ccm.0000509849.62570.3b ◽

2016 ◽

Vol 44 (12) ◽

pp. 369-369

Author(s):

Jared Katz ◽

Zachary Winchester ◽

Jake Bell ◽

Anagha Kumar ◽

Munish Goyal

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Mechanical Complication ◽

Complication Rates ◽

Provider Type ◽

Central Venous

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Ipsilateral vocal fold paralysis: An unusual complication of internal jugular tunnelled dialysis catheter insertion

The Journal of Vascular Access ◽

10.1177/1129729819856967 ◽

2019 ◽

Vol 21 (1) ◽

pp. 116-119 ◽

Cited By ~ 2

Author(s):

Sreekanth Koduri ◽

Alvin Kok Heong Ng ◽

Debajyoti Roy ◽

Edmund Chiu Kit Wong

Keyword(s):

Central Venous Catheter ◽

Vocal Fold ◽

Venous Catheter ◽

Vocal Fold Paralysis ◽

Catheter Insertion ◽

Unusual Complication ◽

Complication Rates ◽

Dialysis Catheter ◽

Central Venous Catheter Insertion ◽

Central Venous

Background: Central venous catheters are extensively used in critical care units and in dialysis centres to gain access to the blood stream for the purpose of invasive monitoring, drug administration, parenteral nutrition and to perform renal replacement therapy. One of the common areas of central venous catheter insertion is right internal jugular vein due to its anatomical continuity with the superior vena cava. The complication rates of central venous catheter insertion can be more than 15%, including early and late complications. Case report: We present an unusual complication of recurrent laryngeal nerve palsy, leading to right vocal fold paralysis, following insertion of a right internal jugular tunnelled dialysis catheter. The vocal fold paralysis improved over next 8 months with conservative management alone. Conclusion: This case illustrates an unusual complication of central venous catheter insertion and the importance of recognizing the possibility of such complications, to prevent them from happening and also to manage them appropriately.

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Pre- and post-review of a standardized ultrasound-guided central venous catheterization curriculum evaluating procedural skills acquisition and clinician confidence

The Journal of Vascular Access ◽

10.1177/1129729819882602 ◽

2019 ◽

Vol 21 (4) ◽

pp. 440-448 ◽

Cited By ~ 1

Author(s):

Timothy R Spencer ◽

Amy J Bardin-Spencer

Keyword(s):

Central Venous Catheter ◽

Central Venous Catheterization ◽

Venous Catheter ◽

Catheter Insertion ◽

Central Venous Catheter Insertion ◽

Ultrasound Guided ◽

Central Venous ◽

Clinical Simulation ◽

Venous Catheterization ◽

Simulation Based

Background: To evaluate novice and expert clinicians’ procedural confidence utilizing a blended learning mixed fidelity simulation model when applying a standardized ultrasound-guided central venous catheterization curriculum. Methods: Simulation-based education and ultrasound-guided central venous catheter insertion aims to provide facility-wide efficiencies and improves patient safety through interdisciplinary collaboration. The objective of this quality improvement research was to evaluate both novice (<50) and expert (>50) clinicians’ confidence across 100 ultrasound-guided central venous catheter insertion courses were performed at a mixture of teaching and non-teaching hospitals across 26 states within the United States between April 2015 and April 2016. A total of 1238 attendees completed a pre- and post-survey after attending a mixed method clinical simulation course. Attendees completed a 4-h online didactic education module followed by 4 h of hands-on clinical simulation stations (compliance/sterile technique, needling techniques, vascular ultrasound assessment, and experiential complication management). Results: The use of a standardized evidence-based ultrasound-guided central venous catheter curriculum improved confidence and application to required clinical tasks and knowledge across all interdisciplinary specialties, regardless of level of experience. Both physician and non-physician groups resulted in statistically significant results in both procedural compliance ( p < 0.001) and ultrasound skills ( p < 0.001). Conclusion: The use of a standardized clinical simulation curriculum enhanced all aspects of ultrasound-guided central venous catheter insertion skills, knowledge, and improved confidence for all clinician types. Self-reported complications were reported at significantly higher rates than previously published evidence, demonstrating the need for ongoing procedural competencies. While there are growing benefits for the role of simulation-based programs, further evaluation is needed to explore its effectiveness in changing the quality of clinical outcomes within the healthcare setting.

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