Prepacked central line kits reduce time needed and mistakes during central line insertion
A study published by a research team1 at the University of Tübingen, Germany, indicates that prepacked central line kits may significantly reduce the number of procedural mistakes and complications during central line catheter insertion. The kits increased the quality of the procedure and at the same time reduced the time required to perform the procedure. Particularly healthcare novices will benefit from these kits since central line placement is a complex procedure causing a high cognitive load as it involves many parts and steps. According to the so-called “split attention principle”, cognitive load can be reduced by fusing many different sources of information into a single source2. The ProSet by B. Braun takes this principle into account by providing a prepacked kit containing all necessary components for the clinical procedure.
In a randomized, controlled, prospective and single-blind study thirty recent medical school graduates and medical students in their final year were randomly assigned to two groups of fifteen each. At the time of the study none of the participants had performed more than fifteen central lines insertions. While one group placed the central line catheter using a prepacked ProSet which contained all necessary components*, the control group used a standard kit which contained only the components for the catheterization of the catheter itself. The latter group thus had to actively select the additional components that are required to place the central line from usual cart. For safety reasons the lines were inserted in dummies. The study participants were assisted by equally inexperienced nursing students.
All procedures were recorded on video and the videos were evaluated by two experienced physicians. The evaluation was based on a 55-point checklist3 plus five additional quality indicators:
- Duration of the procedure
- Major technical mistakes with potentially negative impact on the patient
- Minor technical mistakes with no potentially negative impact on the patient
- Number of correctly performed procedures according to the checklist
- Breaks in the aseptic technique (each contact of sterile and non-sterile material)
The prepacked kit group made 35 % fewer major technical mistakes than the control group and adhered better to the process steps which were mapped on the checklist. And last but not least it took the participants of the ProSet group on average five minutes less than the control group (26:26 +/-3:50 min vs. 31:27 +/-5:57 min) to perform the procedure. Statistically not relevant but noticeable was the trend toward fewer breaches of aseptic technique during the procedure in the ProSet group (1.2 +/-0.8 vs. 3 +/-3.6, p =0.06).
Fewer complications by reducing the cognitive load
Central line catheter insertion is a frequent procedure that involves many different materials, components and process steps and thus produces a high cognitive load, particularly for novice physicians. Consequently, the error rate is high among inexperienced junior medical professionals. Prepacked kits can reduce the error rate because the novices do not have to focus on the active selection of the required components. This explains why in four out of five quality indicators the prepacked kits group achieved statistically significant better results than the control group.
Major technical mistakes
Minor technical mistakes
Correctly performed steps
Added value of ProSet in clinical routine
The point of departure for the Tübingen research team was the fact that:
- Clinical novices have been shown to have a higher complication rate than experienced healthcare professionals when placing central line catheters and thus need all the support they can be given to minimize risks.
- The use of prepacked kits can be applied to other complex medical procedures.
- Prepacked kits facilitate the selection of materials and allow for homogenous interventional process.
The authors of the study conclude that the advantages of the prepacked kits outweigh possible additional costs and other potential drawbacks such as material surplus since frequently not all kit components are used.
Central venous catheter study
Download CVC study extract
CVC study extract central venous catheter study extract
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General ProSet information
- Yelena Fenik, Nora Celebi, Robert Wagner, Christoph Nikendei, Frederike Lund, Stephan Zipfel, Reimer Riessen and Peter Weyrich: Prepacked central line kits reduce procedural mistakes during central line insertion: a randomized controlled prospective trial; BMC
- cf. van Merrienboer JJ, Sweller J: Cognitive load theory in health professional education: design principles and strategies. Med Educ 2010, 44(1)85-93Medical Education 2013, 13:60
- cf. Regehr G, MacRae H, Reznick RK, Szalay D: Comparing the psychometric properties of checklists and global rating scales for assessing performance on an OSCE-format examination. Acad Med 1998, 73(9):993-997
* The following items were not included in the kit: sterile gloves, mask, lidocaine, saline and syringes. A label listed the items that were not included.