Simulation as a strategy to improve training in central venous catheter placement
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Abstract
Objective. To evaluate the impact of a simulation-based intervention on technical success and complication rates in central venous catheter (CVC) placement performed by medical residents.
Design. Pre-post intervention study without randomization, conducted between January 2022 and December 2023. Follow-up included all procedures performed by residents before and after the intervention.
Setting. The study was conducted in the intensive care unit of a public hospital.
Patients or participants. Eight residents from first to third year of training in intensive care, internal medicine, and emergency medicine participated. A total of 510 CVC placement procedures performed during residency training were included. The sample was consecutive, including all procedures recorded in the institutional system.
Interventions. The intervention consisted of an intermediate-fidelity clinical simulation training session, focused on supervised deliberate practice, structured feedback, and training in ultrasound-guided vascular access.
Main outcome measures. Primary outcomes were CVC placement success rate and overall complication rate. Additional variables analyzed included number of punctures, ultrasound use, anatomical site, year of residency, and specialty.
Results. A total of 266 CVCs were placed pre-intervention and 244 post-intervention. No statistically significant difference was found in the success rate (p=0.156; RR 1.743; 95% CI: 0.843–3.603), but a significant reduction in complications was observed (p<0.001; RR 0.106; 95% CI: 0.037–0.304).
Discussion. Findings suggest that simulation improves technical performance and reduces complications, supporting its implementation as an educational strategy. The main limitation was the small sample size. Further studies with greater statistical power are needed to evaluate effects on success rates.
Conclusions. Clinical simulation enhances procedural safety and should be systematically incorporated into residency training programs.
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