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Central Venous Access by Trainees: A Systematic Review and Meta-Analysis of the Use of Simulation to Improve Success Rate on Patients

Madenci, Arin L. AB; Solis, Carolina V. MD; de Moya, Marc A. MD

doi: 10.1097/SIH.0b013e3182a3df26
Empirical Investigations

Introduction Simulation training for invasive procedures may improve patient safety by enabling efficient training. This study is a meta-analysis with rigorous inclusion and exclusion criteria designed to assess the real patient procedural success of simulation training for central venous access.

Methods Published randomized controlled trials and prospective 2-group cohort studies that used simulation for the training of procedures involving central venous access were identified. The quality of each study was assessed. The primary outcome was the proportion of trainees who demonstrated the ability to successfully complete the procedure. Secondary outcomes included the mean number of attempts to procedural success and periprocedural adverse events. Proportions were compared between groups using risk ratios (RRs), whereas continuous variables were compared using weighted mean differences. Random-effects analysis was used to determine pooled effect sizes.

Results We identified 550 studies, of which 5 (3 randomized controlled trials, 2 prospective 2-group cohort studies) studies of central venous catheter (CVC) insertion were included in the meta-analysis, composed of 407 medical trainees. The simulation group had a significantly larger proportion of trainees who successfully placed CVCs (RR, 1.09; 95% confidence interval [CI], 1.03–1.16, P < 0.01). In addition, the simulation group had significantly fewer mean attempts to CVC insertion (weighted mean difference, −1.42; 95% CI, −2.34 to −0.49, P < 0.01). There was no significant difference in the rate of adverse events between the groups (RR, 0.50; 95% CI, 0.19–1.29; P = 0.15).

Conclusions Training programs should consider adopting simulation training for CVC insertion to improve the real patient procedural success of trainees.

Supplemental digital content is available in the text.

From the University of Michigan Medical School (A.L.M.), Ann Arbor, MI; Harvard School of Public Health (A.L.M., C.V.S.); and Division of Trauma, Emergency Surgery and Surgical Critical Care (M.A.D.M.), Department of Surgery, Massachusetts General Hospital, Boston, MA; Department of Surgery (C.V.S.), Duke University Medical Center, Durham, NC.

Reprints: Marc A. de Moya, MD, FACS, Massachusetts General Hospital, Harvard Medical School, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, 165 Cambridge St, Suite 810, Boston, MA 02114 (

The authors declare no conflict of interest.

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© 2014 Society for Simulation in Healthcare