The Development of a Holistic Central Venous Catheterization Simulator for Medical Education
TimeWednesday, April 143:50pm - 4:10pm EDT
LocationEducation and Simulation
DescriptionCentral Venous Catheterization (CVC) is a medical procedure where a medical professional inserts a catheter into the internal jugular vein (IJCVC), subclavian vein or femoral vein for venous access, with the IJ being the most common site due to access and location. The IJCVC procedure starts with initiating a sterile environment which is done by cleaning the patient’s skin with an antiseptic and putting on clean gloves and other medical wear. The mechanical components of the procedure can be broken down into two parts, needle insertion and post needle insertion. The needle insertion portion is when the doctor uses ultrasound to locate the position of the patient’s IJ, which changes based on patient anatomy, and then first gains venous access using a needle and syringe. Once the vein is accessed, the second portion of the procedure is using that venous access to dilate the vein and position the catheter into place. Mechanical complications can generally arise at any point, and the procedure is not considered complete until an X-ray is ordered to ensure proper catheter positioning. The catheter is then monitored daily to watch for infections or complications. In many cases, the infections and mechanical complications surrounding IJCVC are avoidable, and one way to target this problem is through increasing robustness of training.
Simulation-based training is a commonly used method in teaching medical procedures, as it allows the medical resident to get hands-on practice without harming a patient. There are many forms of simulation-based training, but the most commonly used for IJCVC is a manikin trainer which includes a low-fidelity, plastic replica of the human body, in the case of IJCVC just the top half, that can be used for training and education. While these manikins allow for multiple insertion attempts without consequence and have self-healing skin, there are several drawbacks such as the necessity of a proctor to score manikin testing, lack of durability of the material, and lack of variability in patient anatomy. Only practicing on one patient anatomy limits the exposure of the doctors in training to what they would actually be seeing in a clinical environment.
To respond to some of these drawbacks, a dynamic, haptic robotic trainer (DHRT) was developed. The DHRT is made up of a robotic arm, a soft pad scanning surface made of a faux tissue plastic blend, an ultrasound probe, a computer screen, and a retractable needle and plunger. This system provides a variety of patient anatomies by changing the ultrasound images shown on the screen, and the forces that are provided by the haptic robotic arm. The DHRT was developed to improve the mechanical skills associated with the needle insertion portion of IJCVC, where the doctor is first gaining access to the vein. The DHRT system has been tested and validated with medical residents, and proven to be as effective as traditional manikin training for mechanical skills associated with verifying the proficiency of IJCVC, but does not train the skills needed for the entire procedure -including the steps of the procedure related to infectious complications.
To integrate both mechanical and procedural skills which relate to infections complications, a DHRT+ system was developed to holistically simulate the procedure form start to finish. The DHRT+ includes the components of the original DHRT system with an added medical tray with the tool used in the procedure, testing surface that can be used to practice actual catheter insertion and surrounding steps, and a graphical user interface that utilizes personalized learning to test a trainee throughout the procedure. The main goals of the DHRT+ are to be able to verify the proficiency of medical residents more efficiently and easily than current methods by eliminating the needs for a preceptor, to standardize IJCVC training, and to holistically simulate IJCVC. This is especially beneficial in the time of a pandemic because hands-on training and the number of people allowed in training rooms has been limited; it is necessary to develop alternate ways to teach hands-on skills. This presentation will present the device and early evidence of its utility for IJCVC simulation education.