- 期刊
Composite Training Program for Central Venous Catheter Placement
運用跨領域教學以提升住院醫師 中心靜脈導管置放技能的培訓計畫
摘要
Objective: Central venous catheter (CVC) placement is an important invasive procedure to maintain hemodynamic and to monitor right heart pressure for critical patients. However, CVC insertion may complicate with air leak, bleeding, infection, or even mortality when performed by in-experienced duty residents. Since complications of CVC placement are adversely associated with operator experience, traditional bed-side teaching can expose patients to great risk. It is crucial for the teaching hospital to well train their in-house junior residents. Lately, there are trends of evolution related to CVC placement, including the advocacy of bundle care, the use of echoguided CVC insertion, the emphasis of team work, and the use of simulator in medical education. Methods: We took multi-discipline approach to involve clinicians, quality managers, infection control specialist, ultrasound technicians in a simulation-based resident CVC placement training program. We evaluate the resident satisfaction with training and also the efficacy of this new training module. Results: Thirty-six (57.1%) out of 63 residents in the hospital (16 training group, 20 control group) participated; all (100%) participants completed pre-and post-training evaluation. The median performance composite scores and instrument knowledge scores were higher in training group (0.83 vs. 0.63 of control, p = 0.007; 0.92 vs 0.50 of control, p＜ 0.001, respectively). The first-pass CVC insertion success rate was higher in training group (75% vs 50%). Mean procedure time was reduced following training (20.5±3.6 vs 26.1±5.6 minutes, p =0.03). Conclusion: The data pr oves that the multi-discipline approach was a safe and effective education module for resident CVC placement training.
並列摘要
中央靜脈導管(Central venous catheter, CVC)置入術是屬急重症病房日常業務的一種醫療行為，也是各種大手術及麻醉管理不可或缺的基本技術。近年來，CVC置放趨勢顯示：(1)加入CVC的組合式照護及最大無菌面操作可以降低感染率；(2)利用超音波導引的CVC置入可以提高準確性；(3)運用擬真教學來提高學習過程的安全性。我們組織一個跨領域的團隊，包括心臟內科、內科加護病房、品管中心、感管室及超音波技術人員，設計一套住院醫師CVC置入培訓計劃(Resident CVC placement training program, RCVCPTP)。本研究共有36位住院醫師(16位實驗組，20位對照組)參與。我們將操作過程進行評比發現總體分數及儀器認知分數，實驗組均高於對照組(0.83 vs. 0.63, p = 0.007; 0.92 vs 0.50, p＜ 0.001)；第一次就成功置入的比率，實驗組(75%)高於對照組(50%)；整體手術時間，實驗組則少於對照組(20.5±3.6 VS 26.1±5.6 分鐘，P = 0.03)。此跨團隊的住院醫師CVC置入培訓計劃有效提升置入準確性及安全性，為有效的教育模式。