Prepackaged central line kits reduce procedural mistakes during central line insertion: a randomized controlled prospective trial

BMC Med Educ. 2013 Apr 30:13:60. doi: 10.1186/1472-6920-13-60.

Abstract

Background: Central line catheter insertion is a complex procedure with a high cognitive load for novices. Providing a prepackaged all-inclusive kit is a simple measure that may reduce the cognitive load. We assessed whether the use of prepackaged all-inclusive central line insertion kits reduces procedural mistakes during central line catheter insertion by novices.

Methods: Thirty final year medical students and recently qualified physicians were randomized into two equal groups. One group used a prepackaged all-inclusive kit and the other used a standard kit containing only the central vein catheter and all other separately packaged components provided in a materials cart. The procedure was videotaped and analyzed by two blinded raters using a checklist. Both groups performed central line catheter insertion on a manikin, assisted by nursing students.

Results: The prepackaged kit group outperformed the standard kit group in four of the five quality indicators: procedure duration (26:26 ± 3:50 min vs. 31:27 ± 5:57 min, p = .01); major technical mistakes (3.1 ± 1.4 vs. 4.8 ± 2.6, p = .03); minor technical mistakes (5.2 ± 1.7 vs. 8.0 ± 3.2, p = .01); and correct steps (83 ± 5% vs. 75 ± 11%, p = .02). The difference for breaches of aseptic technique (1.2 ± 0.8 vs. 3.0 ± 3.6, p = .06) was not statistically significant.

Conclusions: Prepackaged all-inclusive kits for novices improved the procedure quality and saved staff time resources in a controlled simulation environment. Future studies are needed to address whether central line kits also improve patient safety in hospital settings.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Catheterization, Central Venous / adverse effects
  • Catheterization, Central Venous / instrumentation
  • Catheterization, Central Venous / methods*
  • Central Venous Catheters* / adverse effects
  • Education, Medical / methods*
  • Female
  • Humans
  • Male
  • Manikins
  • Medical Errors / prevention & control*
  • Single-Blind Method
  • Video Recording