Posted: February 2, 2015

Reducing Complications of Central Venous Catheterizations by Hardwiring Checklists and Implementation of an Inter-disciplinary Simulation Based Curriculum

Description

Central venous catheters are commonly placed for management of critically ill patients and are associated with serious complications. In response to a sentinel event after central line placement procedure, hospital administration and the internal medicine residency program conducted a root cause analysis (RCA), reviewed best practice evidence and re-designed the central line curriculum and insertion process for residents. A key opportunity identified in the root-cause analysis was the importance of embedding safety, team work and closed loop communication principles in the central line training and insertion process. A multi-disciplinary team of residents, faculty, nursing and quality personnel revised the central line checklist to incorporate safety parameters and developed a process for concurrent checklist completion. A pre-procedure risk assessment section was added to the checklist to alert residents to a potential "high risk" line or a complicated insertion process.

Based on lessons learned from the RCA, we integrated safety and team work principles in our mandatory four hour procedure curriculum for incoming interns. In addition to the mechanics of ultrasound guided line placement, interns received didactics on catheter associated blood stream infections and importance of using checklists during "every procedure" to hard wire safe insertion practices. Using inter-disciplinary simulated scenarios, residents were assessed and coached on maintaining a sterile field, manipulating and troubleshooting guide wires, and teamwork.

Keywords

Central Line Placement, CLABSI, Iatrogenic Infections, Simulation Training

Authors

Lakshmi Swaminathan, MD, Oakwood Hospital

Zulfiqar Ahmed, MD

John Fath, MD

Falgu Patel, MD

John Kish, PHD

Vera Cigan, DHA


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