Insertion of Central Venous Catheter Policy

  1. Introduction
    The purpose of this policy is to standardize the training requirement for competency in central venous catheter (CVC) insertion at the University of Nevada, Reno School of Medicine (UNR Med). The ability to safely and competently insert a CVC is a distinct skill and not dependent on a resident's training program specialty and shall be applicable to all residents and fellows.
  2. Procedure
    1. All graduate medical education trainees (residents and fellows) will be subjected to the same credentialing requirements in order to be certified to independently place a CVC.
      1. Completion of a simulation session using task trainers under the supervision of attending physicians focused on standard Seldinger technique and the use of real-time ultrasound guidance
      2. Completion of a didactic session (in conjunction with a simulation session) that provides specific education on the following:
        1. The informed consent process (including description of risks, benefits, and alternatives of the procedure)
        2. Utilization of a CVC insertion checklist
        3. iii. Utilization of "full barrier" sterile precautions
        4. Standard insertion technique as demonstrated in a teaching video (Available on the Savitt medical library webpage -> Clinical Tools / Databases -> Procedures Consult)
      3. Successful completion of technique-specific CVC insertion under direct supervision is required in the following quantity:
        1. Landmark guided CVC insertion (n=5)
        2. Real-time ultrasound guided CVC insertion (n=5): Determination of the presence of "real-time" guidance rather than simple landmark verification will be determined and attested to by the supervisor
      4. Direct Supervision of technique-specific CVC insertion will be limited to the following credentialed staff:
        1. Attending physician
        2. Fellow
        3. iii. Resident at the PGY-2 level or greater
      5. Electronic record keeping of successful completion of each CVC insertion will be completed using an UNR Med designated modality (e.g. and will include verification from the supervising staff
      6. Upon successful completion of each CVC insertion, a copy of the CVC insertion checklist, with patient sticker and signed by the observing RN, will be provided to that resident's respective residency coordinator.
      7. At least one of the final two technique-specific CVC insertions required for credentialing (i.e. insertion #4 or #5 for each technique) must be directly supervised by an attending physician or credentialed subspecialty fellow.
      8. Endorsement by the supervising attending or fellow of the operator's ability to safely, successfully, and independently insert the CVC (technique-specific) is required for a resident to be credentialed as "independent."
    2. Dissemination of information regarding residents able to independently perform CVC insertion will include the following:
      1. New Innovations
        1. Generic log-on information will be provided to UMC nursing staff
        2. Logs will be updated by residency coordinators at least monthly
      2. Badge Identifier
        1. Upon reaching "independent" status residents will be provided with a color coded badge sticker indicating ability to insert CVC's with either US guidance or by landmark.
        2. Distribution of color coded badge stickers will be controlled by residency coordinators
    3. Non- Emergency Medicine, Internal Medicine, or Surgical residents
      1. Credentialing for CVC insertion will be available to all residents regardless of specialty department (i.e. Family Medicine, OB, Pediatrics, etc.)
      2. Requirements outlined herein will apply to those residents
      3. Simulation and didactic training can be achieved through attendance at sessions provided by the Emergency Medicine, Internal Medicine, or Surgical departments
    4. Existing Residents with previous credentialing / certification
      1. Residents who have been previously determined to be able to independently perform CVC insertion (i.e. credentialed prior to the introduction of these guidelines) will be "grandfathered" into the new credentialing system at the discretion of that resident's program director.
      2. A written statement of confidence from the department will be provided to residency coordinators in order for these residents to obtain their color- coded badge stickers.
    5. Quality Assurance: Interdepartmental evaluations of the didactic and simulation educational sessions will be performed on an annual basis until consistency in instruction is determined by consensus between departments.