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

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. © 2013 Fenik et al.; licensee BioMed Central Ltd.