Barriers and Facilitators to Central Venous Catheter Insertion: A Qualitative Study.

OBJECTIVES: The aims of the study were to identify perceived barriers and facilitators to central venous catheter (CVC) insertion among healthcare providers and to understand the extent to which an existing Simulation-Based Mastery Learning (SBML) program may address barriers and leverage facilitators. METHODS: Providers participating in a CVC insertion SBML train-the-trainer program, in addition to intensive care unit nurse managers, were purposively sampled from Veterans Administration Medical Centers located in geographically diverse areas. We conducted semistructured interviews to assess perceptions of barriers and facilitators to CVC insertion. Deidentified transcripts were analyzed using a grounded theory approach and the constant comparative method. We subsequently mapped identified barriers and facilitators to our SBML curriculum to determine whether or not the curriculum addresses these factors. RESULTS: We interviewed 28 providers at six Veterans Administration Medical Centers, identifying the following five overarching factors of perceived barriers to CVC insertion: (1) equipment, (2) personnel/staff, (3) setting or organizational context, (4) patient or provider, and (5) time-related barriers. Three overarching factors of facilitators emerged: (1) equipment, (2) personnel, and (3) setting or organizational context facilitators. The SBML curriculum seems to address most identified barriers, while leveraging many facilitators; building on the commonly identified facilitator of nursing staff contribution by expanding the curriculum to explicitly include nurse involvement could improve team efficiency and organizational culture of safety. CONCLUSIONS: Many identified facilitators (e.g., ability to use ultrasound, personnel confidence/competence) were also identified as barriers. Evidence-based SBML programs have the potential to amplify these facilitators while addressing the barriers by providing an opportunity to practice and master CVC insertion skills.

Healthcare Providers' Awareness and Perceptions of Competency Requirements in Central Venous Catheter Insertion.

This article was migrated. The article was marked as recommended. Background Studies show that medical residents do not feel comfortable and lack the skills and confidence to perform common bedside procedures. Regulatory bodies often require a set number of procedures to determine resident competence, yet medical providers' knowledge of competency guidelines are less well known. This study aimed to qualitatively assess existing practices relevant to documentation of competency in central venous catheter (CVC) insertion and explore healthcare providers' awareness and perceptions of those practices at their institutions. Methods The authors performed a qualitative study at Veterans Affairs Medical Centers (VAMCs) from February to December 2014 as part of a larger project related to the dissemination of a simulation-based CVC insertion curriculum. Two authors conducted interviews with hospital staff (including attending physicians, nurses, and residents) at selected VAMCs. Recordings of interviews were transcribed, coded, and analyzed using a grounded theory approach and constant comparative techniques. Results Twenty-six participants were interviewed at six VAMCs. Participants reported varying perspectives regarding their institutions' policies about CVC insertion. Four major themes emerged: (1) knowledge of institutional policy; (2) competency by numbers; (3) documentation of competency; and (4) perceptions of competency measures. Participants reported concern about the reliability of these policies and measures of competence. Conclusions This study demonstrates that healthcare providers' knowledge and perceptions about institutional requirements for procedural competency vary widely. Our findings suggest the need for establishment of consistent competency policies based on evidence-based practices, and highlight the need for increased communication regarding individual institutional policies. Integration of rigorous simulation-based education, implemented consistently across institutions, can provide a reliable mechanism to train and assess procedural competence and ensure patient safety.