Central Line

The University of Illinois College of Medicine at Peoria (UICOMP) in partnership with OSF HealthCare and Jump Sim have completed a more than 15 month central venous catheter (CVC) training study. The project looked to determine whether simulated central line training could lower rates of complications that are common with this procedure and lower health care costs.

The Background

A central line placement is an invasive technical skill that is frequently performed in the hospital. Central lines may be placed in the neck, shoulder or groin area for lack of peripheral access, monitoring or introduction of multiple fluids.

Historically, resident physicians are trained by the "See one, Do one, Teach one" method. This means a resident typically watches one being performed by either an attending physician or a senior resident before doing one him or herself. Using this traditional method, trainees learn procedures vicariously through observation of their peers. If their peers have not been properly trained, mistakes are handed down from generation to generation of resident trainees. In addition, the use of ultrasound to place central lines could potentially minimize these risks.

If not done correctly, complications associated with central lines include pneumothorax (punctured lung), bleeding, hematoma, arterial puncture and infection. One study notes central venous catheter infections in the U.S. are associated with increased hospital length of stay and excess health care costs, ranging up to $56,000 per infection episode.

Simulation-Based Training

The research study, which began in September 2012, examined two educational approaches to simulation training - Group Training and Mastery Training. Both types of training utilized simulation on a manikin to teach four key components of CVC line placement: 1. sterile preparation (of the patient and physician), 2. consent, 3. use of ultrasound and 4. the procedure itself - placement of the central line.

Residents were randomized to either Group or Mastery approach. Residents randomized to Mastery Training were provided a one-hour didactic lecture followed by one-on-one guidance with a faculty member. Those in Group Training received the same didactic lecture and then paired off in groups where ultrasound and practical instruction on the procedure were guided by 2-3 faculty. 89 residents at UICOMP participated in the study, and more than 300 central lines were explored in the span of 18 months. That information was compared to 18 months of data where no formal training programs were in place.

The Results

Both the Group and Mastery Training models have demonstrated marked results in improving residents' ability and confidence in successfully placing CVC lines in the Medical Intensive Care Unit (MICU) through OSF Saint Francis Medical Center.

An economic study performed by the Center for Outcomes Research at UICOMP shows there have been more than one-million dollars in savings resulting from residents being taught CVC line placement using simulation-based training.

The majority of the savings comes from a reduction in both length of stay, and in the utilization of critical care resources at the hospital. The cost to implement simulation-based training on each resident also showed a high return on investment compared to traditional training. This indicates simulation-based training for CVC insertion is a cost-effective approach that can be widely implemented.

The study showed no difference in educational approach or mortality rates between traditional and simulation-based training.

OSF HealthCare is now mandating that all Internal Medicine, Emergency Medicine and Medicine/Pediatrics residents are trained using simulation before MICU rotation.