Evaluating Surgical Resident Needle Insertion Skill Gains in Central Venous Catheterization Training

Abstract

Background: Training for ultrasound-guided Central Venous Catheterization (CVC) is typically conducted on static manikin simulators with real-time feedback from a skilled observer. Dynamic haptic robotic trainers (DHRT) are an alternative method that simulates various patient anatomies and provides consistent feedback for each insertion. This study evaluates CVC needle insertion efficiency and skill gains of both methods. Materials and Methods: Fifty-two first-year surgical residents were trained by placing Internal Jugular (IJ) CVC needles in manikins (N=26) or robots (N=26). Manikin-trained participants received verbal feedback from an experienced observer, while robotically-trained participants received quantitative feedback from the personalized DHRT learning interface. All participants were pre-tested on a Blue Phantom manikin; participants completed post-testing on a Blue-Phantom manikin (N=26) or a novel manikin (N=26) with different vessel depth and position. During pre- and post-tests residents were timed, motion-tracked, and scored on an IJ CVC checklist. Results: (1) All skills on the IJ CVC checklist showed significant (p<0.014) improvements from pre- to post-test; (2) Average angle of insertion, path length, and jerk improved significantly (p<0.005); (3) Average procedural completion time for pre- and post-tests significantly decreased from pre-test (M = 3.516 min, SE = 0.277) to post-test (M = 1.997, SE = 0.409). Conclusion: No significant group differences were observed in overall skill gains, but residents’ average procedural completion time decreased significantly from pre- to post-test. Overall results support DHRT as an effective method for training IJ CVC skills.

Biomechanical analysis of expert anesthesiologists and novice residents performing a simulated central venous access procedure

“…Considering the overall procedure, the experts took less time to complete the procedure and its stages, which coincides with the differences found between experts and novices regarding the procedural time [ 10 , 15 , 17 , 18 ]. Furthermore, although it is expected that novices become faster as they receive training [ 25 ], we believe that the improvement in this variable is not sufficient to provide feedback to novices on the relevant aspects to become CVA experts, making it necessary to determine the performance of other objective indicators such as biomechanical variables. Moreover, shorter procedural times are a consequence of higher expertise, and taken alone, they do not predict performance in itself.…”

“…Meanwhile, stage 4 (catheter placement and guide-wire removal) presented similar biomechanical values between hands, but with notable differences between groups. This stage highlights that expertise allowed the experts to accomplish specific tasks more efficiently and more quickly [ 25 ].…”

Low-Cost Haptic Force Needle Insertion Simulator With Advanced Personalized Learning System

“…For the first half of the survey participants were tasked with reading statements about the usefulness of specific LCNIS GUI features and answering how true they felt a statement was on a scale of 1-7, 1 being "not true at all" and 7 being "very true". In the second half of the survey, participants were asked more general questions about the usefulness of their experience [12].…”

Extracting Subtask-specific Metrics Toward Objective Assessment of Needle Insertion Skill for Hemodialysis Cannulation

“…These metrics also identified subjects who struggled with needle insertion, whereas commonly used checklists for rating skills were not able to identify this deficiency. Similarly, Chen et al used an EM sensor for analyzing surgery residents' skill during central venous catheterization (CVC) procedures [17]. Results from their study demonstrated a significant increase in the average pass rate for the procedure while significant decreases were noted in the average angle of insertion, path length, and jerk after training.…”