Assessment of a new model for femoral ultrasound-guided central venous access procedural training

A pilot study

Michael Charles Wadman, Carol S. Lomneth, Lance H. Hoffman, Wesley G Zeger, Lina Lander, Richard Walker

Research output: Contribution to journalArticle

21 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)88-92
Number of pages5
JournalAcademic Emergency Medicine
Volume17
Issue number1
DOIs
StatePublished - Jan 1 2010

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Thigh
Veins
Needles
Cadaver
Popliteal Vein
Popliteal Artery
Gels
Physicians
Blood Vessels
Catheters
Endovascular Procedures
Central Venous Catheters
Emergency Medicine
Methylene Blue
Clinical Medicine
Elasticity
Internship and Residency
Dissection
Arteries
Skin

Keywords

  • Cadaver
  • Central venous access
  • Procedural training
  • Residency education

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Assessment of a new model for femoral ultrasound-guided central venous access procedural training : A pilot study. / Wadman, Michael Charles; Lomneth, Carol S.; Hoffman, Lance H.; Zeger, Wesley G; Lander, Lina; Walker, Richard.

In: Academic Emergency Medicine, Vol. 17, No. 1, 01.01.2010, p. 88-92.

Research output: Contribution to journalArticle

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AU - Lander, Lina

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