By Dr. Kimberly Brown

Registered nurses from the surgical intensive care unit (SICU) and the burn intensive care unit (BICU), alongside resident physicians from those units, participated in an innovative, new team-training workshop for ultrasound-guided central venous catheter placement. This simulation-based team training education was designed and led by Dr. Kimberly Brown, assistant professor in the Department of Surgery and director of the Surgical Simulation Center, and Tammy Young, assistant professor in the School of Nursing, and faculty in the Nursing Inter-professional Simulation Center. 

Faculty for the course represented both professions:

Nursing:  Dr. Charlotte Wisnewski, Undergraduate Program director, associate Professor, Patricia Lea, assistant professor, Tiffany Boysen, assistant professor, from the School of Nursing; Jamie Hefferman, nurse manager Blocker Burn Unit, and Odette Comeau, adult critical care clinical nurse specialist from Nursing Services at UTMB.

Medicine: Kimberly M. Brown, Department of Surgery, Zulfiqar Cheema, Division of Vascular Surgery, Charlie Cheng, Division of Vascular Surgery, Sara Demola, Department of Surgery and William Whitehead, Department of Anesthesia.

This is the first time RNs and physicians have participated in this kind of team training here at UTMB, which grew out of a similar educational activity created for UTMB undergraduate nursing and medical students that was piloted in last April. The goals for the RN/physician workshop encompass knowledge of informed consent, proper sterile technique for insertions and dressing changes, familiarity with the ultrasound machine, and developing individual behaviors that contribute to high-performing team function. RNs participating received 3 CNEs.

Prior to the workshop, participants completed surveys about their experiences with central lines, read articles on the impact of proper sterile technique and team behaviors, and watched a video detailing proper ultrasound-guided internal jugular venous catheter insertion. There was a multiple-choice pre-test to assess baseline knowledge on these topics.
The workshop consisted of an interactive introductory discussion, then the participants were divided into small groups that rotated through different stations that included:
  •  how to use the ultrasound machine for internal jugular central line placement
  •  how to perform a sterile dressing change
  •  a hands-on interaction with the different central line kits encountered in the ICU
  •  two simulated central-line insertion scenarios.
In the scenarios, nurses and physicians performed their usual roles in a central line placement and worked together to manage a complication. In the course of the simulations and through debriefing participants learned about many aspects of central venous catheter placement including maintaining sterile technique, how to communicate effectively as a team, how to resolve a breach in sterile technique, how to recognize and diagnose a complication, and a deeper understanding of and respect for the roles of other team members in achieving the shared goal of a safe line placement.
The average score for the pre-test was 72 percent which increased to 90 percent on the post-test. Participants rated the effectiveness as good or excellent in achieving the educational goals. In narrative feedback, participants appreciated the opportunity to learn alongside members of a different profession. There was clearly an interest in learning about the ultrasound machine and the images encountered during central line placement, as well as the different types of central lines and what the various pieces in a central line kit are meant to do. There were also comments about the positive impact of effective, closed-loop, frequent communication throughout an invasive procedure. The simulations were regarded as realistic, and participants appreciated the opportunity to experience the results of their interventions in managing the complications.
Overall, this paradigm of simulation-based, inter-professional health care team training is well received and effective in meeting the educational needs of practicing RNs and physicians. Future endeavors will include expanding the scenarios used in simulation-based training and demonstrating improvement in clinical care and patient outcomes.
Congratulations to the planners and faculty of this innovative educational activity!