Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists

Abstract

Background and objectives Concerns have been raised about nephrology fellows' skills in inserting temporary hemodialysis catheters. Less is known about temporary hemodialysis catheter insertion skills of attending nephrologists supervising these procedures. The aim of this study was to compare baseline temporary hemodialysis catheter insertion skills of attending nephrologists with the skills of nephrology fellows before and after a simulation-based mastery learning (SBML) intervention.Design, setting, participants, & measurements This pre-post-intervention study with a pretest-only comparison group was conducted at the University of Toronto in September of 2014. Participants were nephrology fellows and attending nephrologists from three university-affiliated academic hospitals who underwent baseline assessment of internal jugular temporary hemodialysis catheter insertion skills using a central venous catheter simulator. Fellows subsequently completed an SBML intervention, including deliberate practice with the central venous catheter simulator. Fellows were expected to meet or exceed a minimum passing score at post-test. Fellows who did not meet the minimum passing score completed additional deliberate practice. Attending nephrologist and fellow baseline performance on the temporary hemodialysis catheter skills assessment was compared. Fellows' pre-and post-test temporary hemodialysis catheter insertion performance was compared to assess the effectiveness of SBML. The skills assessment was scored using a previously published 28-item checklist. The minimum passing score was set at 79% of checklist items correct.Results In total, 19 attending nephrologists and 20 nephrology fellows participated in the study. Mean attending nephrologist checklist scores (46.1%; SD=29.5%) were similar to baseline scores of fellows (41.1% items correct; SD=21.4%; P=0.55). Only two of 19 attending nephrologists (11%) met the minimum passing score at baseline. After SBML, fellows' mean post-test score improved to 91.3% (SD=6.9%; P,0.001). Median time between pre-and post-test was 24 hours.Conclusions Attending nephrologists' baseline temporary hemodialysis catheter insertion skills were highly variable and similar to nephrology fellows' skills, with only a small minority able to competently insert a temporary hemodialysis catheter. SBML was extremely effective for training fellows and should be considered for attending nephrologists who supervise temporary hemodialysis catheter insertions.

Current practice in dialysis central venous catheter management: Multi‐disciplinary renal team perspectives

“…De‐skilling of medical professionals whether by limited opportunities to learn insertion skills or by lack of practice for skilled professionals is a consequence of the increased use of technology to aid insertion. This increase in the use of guided insertion and the use of simulation training for these procedures reduces complications and improves patient outcomes . A negative consequence may be that in emergency situations, catheter insertion and site selection may be a higher risk procedure because skilled insertion staffs are limited and not always available.…”

The use of nurse‐administered vascular access audit in home hemodialysis patients: A quality initiative

“…As patients received directed feedback from their primary nurses after completion of audit, this interaction may reinforce the need of aseptic cannulation or connection techniques. Impact of such feedback is well known and utilized widely in education field such as medicine . We were also able to implement procedural changes; such as reduction in the number of steps and the use of pre‐filled saline syringes.…”

Healthcare Providers’ Awareness and Perceptions of Competency Requirements in Central Venous Catheter Insertion

“…Past research shows that residents, fellows, and attending physicians demonstrate uneven simulated skills performance in CVC insertion despite reporting a high number of CVC insertions in actual patient care (Barsuk, Ahya, et al, 2009;Barsuk et al, 2016;Barsuk, McGaghie, Cohen, Balachandran, et al, 2009;Barsuk, McGaghie, Cohen, O'Leary, et al, 2009;McQuillan et al, 2015). A recent research synthesis noted weak positive associations between self-reported experience and simulated procedure performance; overall performance was poor even among the most experienced residents (Barsuk, Cohen, Feinglass, McGaghie, & Wayne, 2017).…”

“…As an example, CVC insertion is an invasive procedure where residents, fellows and attending physicians have consistently demonstrated uneven skills (Barsuk, Ahya, et al, 2009;Barsuk et al, 2016;Barsuk, McGaghie, Cohen, Balachandran, & Wayne, 2009;Barsuk, McGaghie, Cohen, O'Leary, & Wayne, 2009;McQuillan et al, 2015). As CVC insertion is associated with life threatening complications including pneumothorax, arterial puncture, and central line-associated bloodstream infection, this skill variability has the potential to cause significant morbidity and mortality (McGee & Gould, 2003).…”