Performance of central venous catheterization by medical students: a retrospective study of students’ logbooks

Central venous catheterization (CVC) is a medical procedure where a surgeon attempts to place a catheter in the jugular, subclavian, or femoral vein. While useful, this procedure places patients at risk of a wide variety of adverse effects. Traditionally, training is performed on CVC mannequins, but these mannequins cannot vary patient anatomy. This work describes the development of a mobile training platform utilizing a haptic robotic arm and electromagnetic tracker to simulate a CVC needle insertion. A haptic robotic arm with custom syringe attachment used force feedback to provide the feeling of a needle insertion. A virtual ultrasound environment was created and made navigable by a mock ultrasound probe containing a magnetic tracking device. The effectiveness of the system as a training tool was tested on 12 medical students without CVC experience. An average increase in successful first insertion of 4.2% per practice scenario was seen in students who trained exclusively on the robotic training device. The robotic training device was able to successfully vary the difficulty of the virtual patient scenarios which in turn affected the success rates of the medical students. These results show that this system has the potential to successfully train medical residents for future CVC insertions.

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Objective Assessment Metrics for Central Line Simulators: An Exploration of Causal Factors

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1071181320641487 ◽

2020 ◽

Vol 64 (1) ◽

pp. 2008-2012

Author(s):

Jessica M. Gonzalez-Vargas ◽

Dailen C. Brown ◽

Jason Z. Moore ◽

David C. Han ◽

Elizabeth H. Sinz ◽

...

Keyword(s):

Central Venous Catheterization ◽

Objective Assessment ◽

Central Line ◽

Expert Interviews ◽

Central Venous ◽

Patient Case ◽

Causal Factors ◽

Venous Catheterization ◽

Assessment Metrics ◽

Automated Feedback

The Dynamic Haptic Robotic Trainer (DHRT) was developed to minimize the up to 39% of adverse effects experienced by patients during Central Venous Catheterization (CVC) by standardizing CVC training, and provide automated assessments of performance. Specifically, this system was developed to replace manikin trainers that only simulate one patient anatomy and require a trained preceptor to evaluate the trainees’ performance. While the DHRT system provides automated feedback, the utility of this system with real-world scenarios and expertise has yet to be thoroughly investigated. Thus, the current study was developed to determine the validity of the current objective assessment metrics incorporated in the DHRT system through expert interviews. The main findings from this study are that experts do agree on perceptions of patient case difficulty, and that characterizations of patient case difficulty is based on anatomical characteristics, multiple needle insertions, and prior catheterization.

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