超音波ガイド下中心静脈バスキュラーアクセス穿刺訓練におけるシミュレーション医学の応用

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  • Simulation program for ultrasound-guided central venous access procedural training
  • チョウオンパ ガイド カ チュウシン ジョウミャク バスキュラーアクセス センシ クンレン ニ オケル シミュレーション イガク ノ オウヨウ

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Purpose: To help novice doctors perform ultrasound-guided central venous access insertion, we introduced a novel simulation program. Participants and methods: Between April 2008 and April 2012, 10 novice doctors performed ultrasound-guided central venous access insertion in our nephrology department. The training program was as follows: 1) Lecture on the theory of ultrasound-guided puncture, 2) Repeated watching of an instructional DVD showing an instructor's performance with a patient, 3) Training using a self-made simulator and catheter kit, 4) On-the-job training with the instructor after watching the instructor's performance with patients: the instructor held an ultrasound probe together with the trainee, and directed the trainee on how to proceed for introducing the needle. The ultrasound image was recorded with a digital video recorder. 5) The trainee reflected with the instructor while watching the video after the on-the-job training. The recorded ultrasound video was given to the trainee as a CD-R. 6) The contents of the reflection were summarized as a portfolio by both the trainee and instructor, which was reviewed later from time to time. 7) The trainee performed the procedure by him or herself. 8) The impressions of the simulation program were obtained by interview. Results: After introducing the program, about 25 double lumen catheter insertions/year and 50 femoral central venous punctures with a long hemodialysis needle/year were all successfully performed under ultrasound guidance without serious complications. All trainees felt that the simulation program had been useful. The instructor's stress was lower than that before introducing the program. Conclusion: Introducing the simulation program was effective to increase the safety in learning the central venous catheter procedure by novice doctors.

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