Ocala Regional Medical Center, Ocala, Florida. E-mail:
Northwest Permanente Consultant, G&G Anesthesia LLC, Acute Surgical Pain Management Fellow, Middle Tennessee School of Anesthesia, Portland, Oregon. E-mail:
AANA J. 2023 Feb;91(1):31-38.
Simulation manikins provide anesthetists a training modality to practice ultrasound-guided central venous catheter (CVC) insertion safely without the risk of patient harm. The goals of this quality improvement (QI) project were to increase technical skills and reduce procedure time among anesthesia providers during CVC placement by implementing an ultrasoundguided, simulated CVC insertion workshop. A primary benefit of simulation-based education is the provision of a safe learning environment-one in which learners and providers may practice and increase skillsets. This QI project utilized a pretest-posttest design for which anesthesia providers completed a CVC insertion educational session and three formally evaluated simulated CVC placements: preworkshop, immediate postworkshop, and 3 months postworkshop. CVC insertion skills were evaluated by two experienced raters who established interrater reliability using a validated checklist and recorded procedure time in minutes. When comparing preworkshop median checklist score (33.74/52 [65%]), significant improvement was found in the immediate postworkshop (46.32/52 [89%]) and 3-month follow-up (44.26/52 [85%]). Time for CVC insertion significantly improved immediately postworkshop (15.7 minutes) and 3-month follow-up (15.9 minutes) when compared with preworkshop (21.5 minutes). An ultrasound-guided CVC simulation workshop can appreciably advance anesthesia providers' technical skills and decrease procedure time when performing insertion of a simulated internal jugular CVC.
模拟人模型为麻醉师提供了一种培训模式，使他们能够安全地练习超声引导下的中心静脉导管 (CVC) 置管术，而不会对患者造成伤害。本质量改进 (QI) 项目的目标是通过实施超声引导的模拟 CVC 插入工作坊，提高麻醉师在 CVC 置管术中的技术技能并减少操作时间。基于模拟的教育的主要好处是提供了一个安全的学习环境——学习者和提供者可以在其中练习和提高技能。本 QI 项目采用了预测试-后测试设计，麻醉师完成了 CVC 插入教育课程，并进行了三次正式评估的模拟 CVC 放置：工作坊前、工作坊后即刻和工作坊后 3 个月。CVC 插入技能由两名经验丰富的评估员进行评估，他们使用经过验证的检查表建立了评估者间的可靠性，并记录了分钟数的操作时间。在比较工作坊前中位数检查表评分（33.74/52 [65%]）时，工作坊后即刻（46.32/52 [89%]）和 3 个月随访（44.26/52 [85%]）时发现显著改善。与工作坊前（21.5 分钟）相比，工作坊后即刻（15.7 分钟）和 3 个月随访（15.9 分钟）的 CVC 插入时间显著缩短。超声引导的 CVC 模拟工作坊可以显著提高麻醉师的技术技能，并在进行模拟颈内静脉 CVC 插入时缩短操作时间。
