Background

The use of ultrasound (US) in placement of CVCs to raise success rate and to reduce complication rate. Simulation-based training for US-guided CVC access was known to improve CVC insertion skills for non-skilled physicians.

Objectives

We purposed to develop and validate a simple simulation model for ultrasound-guided central venous catheter insertion which can reproduce arterial and venous blood flow

Methods

The simulation model was constructed with chicken breast, two type of tubes, two type of motors and controller. A 4mm sized rubber tourniquet of high elasticity was connected to DWP-385 water pump which generated pulsatile water flow like physiologic flow rate of pediatric carotid artery. A 6mm sized silicon tube (HSUU Inc., Korea) was connected to DC peristaltic pump which generate continuous water flow like physiologic flow rate of pediatric jugular vein. Both tube were inserted into a piece of chicken breast and connected to controller part.

Then, we provided simulation program of ultrasound-guided central venous catheter insertion using our novel simulation model to resident physicians of emergency medicine.

Results

A total of 11 resident physicians are enrolled. All except one residents had no experience of pediatric central catheter insertion. The knowledge and confidence of discrimination of artery and vein using probe compression method and Doppler image were significantly improved after training with our simulation model (p = 0.003).

Conclusion

Our novel simulation model is very useful and realistic for ultrasound-guided central venous catheter insertion training. This controlled motor system can be applied to many simulation models which implement artery and vein circulation.

Background

Successful Intravenous (IV) catheter placement plays vital roles in the treatment of medical and traumatic patients in the pediatric emergency department (PED).

Objectives

We assessed PED-related factors associated with difficult IV catheter placement in PED.

Methods

We retrospectively reviewed electronic medical records of the patients younger than 18 years old who visited the PED with IV catheter placement attempt during PED stay. Difficult IV access was defined as placement of IV catheter by more than one attempts. Logistic regression analysis was used to evaluate factors associated with difficult IV access.

Results

A total of 925 patients were enrolled, and 77 (8.32%) cases were difficult IV access. The median age of patients was 3.0 [interquartile range 1-9], and male were 496 (53.6%). We found that age (OR 0.92, 95% CI [0.85-0.98], p=0.016), history of prematurity (OR 2.69, 95% CI [1.22-5.89], p=0.014), IV catheter insertion site (foot versus hand OR 5.6, 95% CI [2.91-10.79], p<0.001), high crowdedness of PED (OR 0.50, 95% CI [0.28-0.92], p=0.025) and the experience of provider (<6 months versus ≥12 months OR 4.21, 95% CI [1.74-10.15], p=0.001) were associated with the success rate of IV catheter insertion. However, sex, acuity of disease, vein visibility, vein palpability, IV catheter size, patients’ experience of IV access, and time of day did not show significant correlation with difficult IV access.

Conclusion

Early use of assist device or change of provider to the more skilled person should be considered when difficult IV access is anticipated by proposed factors.