Firm-based trial to improve central venous catheter insertion practices. Academic Article uri icon

Overview

MeSH

  • Chicago
  • Clinical Competence
  • Femoral Vein
  • Hospitals, Teaching
  • Humans
  • Internal Medicine
  • Jugular Veins
  • Manikins
  • Prospective Studies
  • Subclavian Vein

MeSH Major

  • Catheterization, Central Venous
  • Health Knowledge, Attitudes, Practice
  • Infection Control
  • Internship and Residency
  • Teaching

abstract

  • Central venous catheters placed in femoral veins increase the risk of complications. At our institution, residents place most catheters in the femoral vein. Determine whether a hands-on educational session reduced femoral venous catheterization and improved residents' confidence and adherence to recommendations for infection control. Firm-based clinical trial between November 2004 and March 2005. General medical wards of Cook County (Stroger) Hospital (Chicago, IL), a public teaching hospital. Internal medicine residents (n = 150). Before their 4-week rotation, intervention-firm residents received a lecture and practiced placing catheters in mannequins; control-firm residents received the usual training. Venous insertion site, adherence to recommendations for infection control, knowledge and confidence about catheter insertion, and catheter-associated complications 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. 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. (c) 2007 Society of Hospital Medicine.

publication date

  • May 2007

has subject area

  • Catheterization, Central Venous
  • Chicago
  • Clinical Competence
  • Femoral Vein
  • Health Knowledge, Attitudes, Practice
  • Hospitals, Teaching
  • Humans
  • Infection Control
  • Internal Medicine
  • Internship and Residency
  • Jugular Veins
  • Manikins
  • Prospective Studies
  • Subclavian Vein
  • Teaching

Research

keywords

  • Controlled Clinical Trial
  • Journal Article

Identity

Language

  • eng

Digital Object Identifier (DOI)

  • 10.1002/jhm.168

PubMed ID

  • 17549773

Additional Document Info

start page

  • 135

end page

  • 142

volume

  • 2

number

  • 3