Simulation Technology for Central Venous Catheter Placement Training: Limitations and Opportunities

Central Venous Catheter (CVC) placement is a common surgical procedure, with an estimated 400,000 complications every year in the United States (Raad, 1998). There are mechanical complications related to arterial puncture and pneumothorax derived from the wrong placement of the catheter at the insertion step, as well as over 80,000 catheter-related bloodstream infections in Intensive care Units every year (World Health Organization, 2015). The Agency for Healthcare Research and Quality (AHRQ) recommends utilizing ultrasound (US) guidance for central line placement to minimize the complications. Nevertheless, taking into consideration all the recommendations and security measures given by the AHRQ, it is considered that the lack of proper training on central line placement is one of the reasons that contributes to complications. This study is the pioneering research towards the design of an “instructor-less” simulator that will self-monitor the performance of the trainee. This dissertation is organized as follows. Chapter 1 shows a review of Central Venous Catheter (CVC) placement procedure. Chapter 2 gives an introduction to the current methods of training of CVC placement based on part-task trainers, computer-based simulators, and a hybrid combination of both technologies. Chapter 3 covers human factors considered for the posture and instrument handling related to the placement of CVCs. Chapter 4 includes current techniques used on computer-based CVC placement training and technologies such as electromagnetic sensors and computer vision.