Table 2.
Procedural checklist used by the video raters to evaluate performance
|
Action |
Correct |
Minor technical error |
Major technical error |
Breaches in aseptic technique |
|---|---|---|---|---|
| Preparation of materials (26 Points): | ||||
| Sterile gloves |
|
|
|
|
| Sterile gown |
|
|
|
|
| Cap |
|
|
|
|
| Mask |
|
|
|
|
| Disinfecting agent |
|
|
|
|
| Sterile gauze |
|
|
|
|
| Sterile compresses |
|
|
|
|
| Local anesthetic |
|
|
|
|
| 3ml Syringe (for the anesthetic) |
|
|
|
|
| Needle (for the anesthetic) |
|
|
|
|
| Sterile drape |
|
|
|
|
| Sterile fenestrated drape |
|
|
|
|
| 10 ml Syringe |
|
|
|
|
| Distilled water (to simulate NaCl 0.9%) |
|
|
|
|
| TLC |
|
|
|
|
| Seldinger needle |
|
|
|
|
| Guide wire |
|
|
|
|
| Dilator |
|
|
|
|
| Scalpel |
|
|
|
|
| 3-way ports |
|
|
|
|
| Blood gas syringe |
|
|
|
|
| TLC holder/ clip |
|
|
|
|
| Suture thread |
|
|
|
|
| Needle driver |
|
|
|
|
| Adhesive bandage |
|
|
|
|
| Sharps container |
|
|
|
|
|
Patient preparation (6 Points): |
|
|
|
|
| Sterile use of ultrasound equipment, if applied to find the vein |
|
|
|
|
| Hand washing/ sanitizing |
|
|
|
|
| All of the following are worn: sterile gloves and gown, mask, cap |
|
|
|
|
| Disinfection of the injection site |
|
|
|
|
| Fenestrated drape is applied to injection site |
|
|
|
|
| Injection of the local anesthetic (must aspirate before injection!) |
|
|
|
|
|
Central line insertion (19 Points): |
|
|
|
|
| Both 10 mL syringes are filled with NaCl |
|
|
|
|
| All 3 lumina of the catheter are flushed with NaCl |
|
|
|
|
| All ports are blocked after the flush |
|
|
|
|
| Repeat disinfection of the injection site (assistant) |
|
|
|
|
| Insertion of Seldinger needle (30° angle) |
|
|
|
|
| Patient is asked if he can still feel the needle |
|
|
|
|
| The needle is inserted until the vein is punctured and blood can be drawn |
|
|
|
|
| A sample for blood gas analysis is drawn |
|
|
|
|
| Blood gas syringe is transferred to assistant |
|
|
|
|
| Insertion of the guide wire |
|
|
|
|
| Removal of the needle (the guide wire is secured in place) |
|
|
|
|
| Skin incision along the guide wire |
|
|
|
|
| Insertion of the dilator over the guide wire |
|
|
|
|
| Insertion of the catheter over the guide wire |
|
|
|
|
| The catheter is inserted through the skin only after the guide wire is secured |
|
|
|
|
| Removal of the guide wire (the catheter is secured in place) |
|
|
|
|
| Safe disposal of the guide wire (double knot/ sharps container) |
|
|
|
|
| Blood is drawn from all 3 lumina |
|
|
|
|
| All 3 lumina are flushed with NaCl |
|
|
|
|
|
Securing the catheter and clean-up (4 Points): |
|
|
|
|
| TCL clip is attached to the catheter |
|
|
|
|
| TLC clip is sutured in place |
|
|
|
|
| The site of insertion is covered with an adhesive bandage |
|
|
|
|
| All needles and the scalpel are safely disposed of (sharps container) and the work station is left clean |
|
|
|
|
|
Sum (max. 55 Points) |
|
|
|
|
|
Miscellaneous: |
|
|||
| Duration of the procedure |
|
|||
| Number of misunderstandings (Physician-Assistant) |
|
|||
| Number of questions from the assistants | ||||