Skip to main content
Log in

The use of tissue models for vascular access training

Phase I of the procedural patient safety initiative

  • Innovations In Education
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

INTRODUCTION: Following the Institute of Medicine report “To Err is Human,” the Agency for Healthcare Research and Quality identified proper central venous catheter (CVC) insertion techniques and wide sterile barriers (WSB) as 2 major quality indicators for patients safety. However, no standard currently exists to teach proper procedural techniques to physicians.

AIM: To determine whether our nonhuman tissue model is an effective tool for teaching physicians proper wide sterile barrier technique, ultrasound guidance for CVC placement, and sharps safety.

PARTICIPANTS: Educational sessions were organized for physicians at Cedars-Sinai Medical Center. Participants had a hands-on opportunity to practice procedural skills using a nonhuman tissue model, under the direct supervision of experienced proceduralists.

PROGRAM EVALUATION: An anonymous survey was distributed to participants both before and after training, measuring their reactions to all aspects of the educational sessions relative to their prior experience level.

DISCUSSION: The sessions were rated highly worthwhile, and statistically significant improvements were seen in comfort levels with ultra-sound-guided vascular access and WSB (P<.001). Given the revitalized importance of patient safety and the emphasis on reducing medical errors, further studies on the utility of nonhuman tissue models for procedural training should be enthusiastically pursued.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err is Human: Building A Safer Health System. Washington, DC: National Academy Press; 1999. www.nap.edu/catalog/9728.html.

    Google Scholar 

  2. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Summary. July 2001. AHRQ Publication No. 01-E057. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/ptsafety/summary.htm.

  3. Randolph AG, Cook DJ, Gonzales CA, Pribble CG. Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med. 1996;24:2053–8.

    Article  PubMed  CAS  Google Scholar 

  4. Rothschild JM. Ultrasound guidance of central vein catheterization. Making health care safer: a critical analysis of patient safety practices. Evidence Report/Technology Assessment: Number 43. AHRQ Publication No. 01-E058, July 2001: Chapter 21. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/ptsafety/chap21.htm.

  5. American Board of Internal Medicine. Policies and Procedures for Certification, July 2004. Philadelphia: American Board of Internal Medicine; 2004.

    Google Scholar 

  6. Wigton RS. A method for selecting which procedural skills should be learned by internal medicine residents. J Med Educ. 1981;56:512–7.

    PubMed  CAS  Google Scholar 

  7. Wigton RS, Blank LL, Nicolas BA, Tape TG. Procedural skills training in internal medicine residencies: a survey of program directors. Ann Intern Med. 1989;111:932–8.

    PubMed  CAS  Google Scholar 

  8. Hicks CM, Gonzales R, Morton MT, Gibbons RV, Wigton RS, Anderson RJ. Procedural experience and comfort level in internal medicine trainces. J Gen Intern Med. 2000;15:716–22.

    Article  PubMed  CAS  Google Scholar 

  9. Huang GC, Smith CC, Gordon CE, Weingart SN. Residents’ comfort performing inpatient medical procedures. J Gen Intern Med. 2005;20(Supp 1):162–3.

    Google Scholar 

  10. Mandel JH, Rich EC, Luxenberg MG, Spilane MT, Kern DC, Parrino TA. Preparation for practice in internal medicine. A study of ten years of residency graduates. Arch Intern Med. 1988;148:853–6.

    Article  PubMed  CAS  Google Scholar 

  11. Wigton RS, Nicolas JA, Blank LL. Procedural skills of the general internist. A survey of 2500 physicians. Ann Intern Med. 1989;111:1023–34.

    PubMed  CAS  Google Scholar 

  12. Wigton RS, Alguire PC. Procedural skills of the general internist 18 y later: a re-survey of ACP members. J Gen Intern Med. 2005;20:162.

    Google Scholar 

  13. Smith CC, Gordon CE, Feller-Kopman D, et al. Creation of an innovative inpatient medical procedure service and a method to evaluate house staff competency. J Gen Intern Med. 2004;19:510–3.

    Article  PubMed  Google Scholar 

  14. Powers LR, Draeger SK. Using workshops to teach residents primary care procedures. Acad Med. 1992;67:743–5.

    Article  PubMed  CAS  Google Scholar 

  15. Oxentenko AS, Ebbert JO, Ward LE, Pankratz VS, Wood KE. A multidimensional workshop using human cadavers to teach bedside procedures. Teach Learn Med. 2003;15:127–30.

    Article  PubMed  Google Scholar 

  16. Eason MP, Goodrow MS, Gillespie JE. A device to stimulate central venous cannulation in the human patient simulator. Anesthesiology. 2003;99:1245–6.

    Article  PubMed  Google Scholar 

  17. Macnab AJ, Macnab M. Teaching pediatric procedures: the Vancouver model for instructing Seldinger’s technique of central venous access via the femoral vein. Pediatrics. 1999;103:E8.

    Google Scholar 

  18. Bruce NC. Evaluation of procedural skills of internal medicine residents. Acad Med. 1989;64:213–6.

    Article  PubMed  CAS  Google Scholar 

  19. Mansfield PF, Hohn DC, Fornage BD, Gregurich MA, Ota DM. Complications and failures of subclavian-vein catheterization. N Engl J Med. 1994;331:1735–8.

    Article  PubMed  CAS  Google Scholar 

  20. Sznajder JI, Zveibi FR, Bitterman H, Weiner P, Bursztein S. Central vein catheterization. Failure and complication rates by three percutaneous approaches. Arch Intern Med. 1986;146:259–61.

    Article  PubMed  CAS  Google Scholar 

  21. Bold RJ, Wsinchester DJ, Madary AR, Gregurich MA, Mansfield PF. Prospective, randomized trial of Doppler assisted subclavian vein catheterization. Arch Surg. 1998;133:1089–93.

    Article  PubMed  CAS  Google Scholar 

  22. Rosen BT, Ng PT, Ault MJ. The proceduralist: an emerging specialty for general internists. J Gen Intern Med. 2005;20:50–1.

    Google Scholar 

  23. Bailey RP, Ault M, Greengold NL, Rosendahl T, Cossman D. Ultrasonography performed by primary care residents for abdominal aortic aneurysm screening. J Gen Intern Med. 2001;16:845–9.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mark J. Ault MD, FACEP.

Additional information

The authors have no conflicts of interest to declare.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ault, M.J., Rosen, B.T. & Ault, B. The use of tissue models for vascular access training. J GEN INTERN MED 21, 514–517 (2006). https://doi.org/10.1111/j.1525-1497.2006.00440.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00440.x

Key words

Navigation