Central line simulation: a new training algorithm

Recent development of a partial task simulator for central line placement has altered the training algorithm from one of supervised learning on patients to mannequin-based practice to proficiency before patient interaction. There are little data published on the efficacy of this type of simulator. We reviewed our initial resident experience with central line simulation. Education to proficiency using the CentralLine Man simulator is completed by all interns during orientation. At the completion of training, te residents were asked to complete a voluntary, anonymous questionnaire with a 5-point Likert scale as well as open-ended questions. Additionally, the residents were asked to maintain a log of the initial 10 central lines placed. Retrospective review of the questionnaire and logs were done with analysis of simulator experience as well as initial line experience. Seventeen trainees completed the central line simulation course and returned the initial survey. Before the course, the trainees had placed an average of 0.4 internal jugular (IJ) and 1 subclavian (SC) line. On the simulator, an average of 3 SC attempts and 2.5 IJ attempts led to resident comfort with the procedure. On the first attempt, the vessel was accessed after an average of 1.5 SC and 1.9 IJ needlesticks, which improved to 1 SC and 1.3 IJ by the fifth simulated attempt. A total of 4 pneumothorax and 5 carotid sticks were done. Overall, the residents were highly satisfied with the course with an average score of 4.8 for didactics, 4.8 for equipment, 4.5 for the mannequin, and 4.8 for practice opportunity. Nine of the 11 residents who completed logs felt the simulation improved performance on the patient. On the first patient attempt, an average of 1.8 needlesticks was done with an average of 1.3 by the tenth line. For the first patient line documented in the logs, comfort with the anatomy was rated 3.8 with comfort with the procedure rated 2.8. Central line simulation before actual performance on patients is useful and well regarded by the trainees, suggestive of a transference effect. Prospective evaluation is needed to further determine the impact of simulation on resident performance as well as patient outcomes.