Improving Patients´ Safety by Improving Patients´ Safety by Clinical Skills Training: a Clinical Skills Training: a

Central Venous Line Central Venous Line Simulation ModelSimulation Model

Michael Schmidts, Michael Schmidts, HenrietteHenrietteJurasszovichJurasszovich, Wolfgang , Wolfgang MatzekMatzek, ,

Martin LischkaMartin Lischka

StudienzentrumStudienzentrumUniversity of Vienna, AustriaUniversity of Vienna, Austria

Central venous line model Overview

•• Our motivationOur motivation•• The mannequinThe mannequin•• Training objectivesTraining objectives•• Usage and maintenanceUsage and maintenance•• Students’ feedbackStudents’ feedback•• 6 good reasons for teaching CVL 6 good reasons for teaching CVL

manipulations in a clinical skills coursemanipulations in a clinical skills course

Motivation

•• ManipulationManipulation of a central venous line of a central venous line (CVL) is a (CVL) is a dangerous proceduredangerous procedure --lethal complications are possiblelethal complications are possible–– sepsissepsis–– air embolismair embolism

•• AustriaAustria -- CVL manipulation is the duty CVL manipulation is the duty of medical doctorsof medical doctors

0%10%20%30%40%50%60%70%80%90%

100%

draw bloodfrom CVL

connectingInfusion to

CVL

removing infusion from

CVL

peripheralvenipuncture

never performed seldom performed frequently performed

Frequencies of CVL manipulations and venipuncture in the first clerkship following the

skills-course (n=79)

CVL manipulation -Training objectives

•• Procedural knowledge and technical Procedural knowledge and technical skills regardingskills regarding–– hygienic precautionshygienic precautions

•• sepsissepsis

–– correct manipulation of the adapter systemcorrect manipulation of the adapter system•• air embolismair embolism

–– basic communication skillsbasic communication skills

Construction of the Construction of the mannequinmannequin

•• Life/form Central Venous Life/form Central Venous cannulationcannulationsimulator LF 1087UAsimulator LF 1087UA

Construction of the Construction of the mannequinmannequin

Usage of the model

•• Implemented in a “practical clinical Implemented in a “practical clinical skills” courseskills” course

•• CVL skills taught :CVL skills taught :–– connection and removal of an infusion at connection and removal of an infusion at

the CVLthe CVL–– drawing blood from the CVL drawing blood from the CVL

•• Up to 200 students each semesterUp to 200 students each semester•• standardised examination (Ministandardised examination (Mini--OSCE)OSCE)

Students’ feedback

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10

connectingInfusion to CVL

removing infusion from

CVL

draw bloodfrom CVL

peripheralvenipuncture

course end (n=159) following clerkship (n =97)

Training ratings

Maintenance

•• 3 semesters experience (600 students)3 semesters experience (600 students)•• system checksystem check--up at the end of every up at the end of every

semestersemester–– fluid changefluid change–– cleaning of containerscleaning of containers–– control permeability of the tube system for control permeability of the tube system for

fluidfluid–– control control impermeabilityimpermeability of the tube of the tube

connections forconnections for airair

6 good reasons for teaching CVL manipulations in a clinical

skills course

1.1. Use of simulations is a Use of simulations is a established established methodmethod to teach competency in to teach competency in technical skillstechnical skills

2.2. potentially life threatening potentially life threatening procedureprocedures make the use of s make the use of simulations mandatorysimulations mandatory

3.3. low rate of traininglow rate of training CVL CVL manipulations manipulations in clerkshipsin clerkships

6 good reasons for teaching CVL manipulations in a clinical

skills course

4.4. high acceptance byhigh acceptance by the the students students (also following clinical experience on (also following clinical experience on the wards)the wards)

5.5. low costslow costs6.6. easy to maintaineasy to maintain