TEMPLE UNIVERSITY HOSPITAL GRADUATE MEDICAL EDUCATION POLICIES AND PROCEDURES

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1 Page 1 of 6 TEMPLE UNIVERSITY HOSPITAL GRADUATE MEDICAL EDUCATION POLICIES AND PROCEDURES NUMBER: TUH-GMEC-104 TITLE: Central Venous Catheter Insertion Training Policy EFFECTIVE DATE: 07/01/2013 LAST REVIEWED: 10/20/14, 1/21/15, 4/21/15, 6/9/16, 11/8/16 REFERENCES: ATTACHMENT: TUH ADMIN Central Venous Catheter Insert & Care TUH ADMIN Universal Protocol - Time out TUH ADMIN Informed Consent (Attachment A) Central Line Training Placement Log PURPOSE Temple University Hospital Graduate Medical Education (GME) Committee sponsored programs are committed to providing high quality and safe patient care. The purpose of this policy is to train appropriate clinicians in the proper rationale and techniques for insertion of central venous catheters (CVC) by standardizing the education, training and supervision of resident physicians. POLICY It is the policy of Temple University Hospital that all designated resident physicians receive standardized education, training and supervision regarding central venous catheter (CVC) insertion. The CVC s covered by this policy include non-tunneled central venous catheters. The policy does not include the training or placement of tunneled catheters. It is recommended that with the exception of subclavian vein access requiring an anatomic approach, whenever appropriate, the CVC should be inserted using ultrasound guidance. This policy sets a minimum training standard for those participating clinical departments. Departments may have further requirements at the discretion of the Program Directors. SCOPE This policy outlines the education, training and supervision of all incoming PGY 1 residents involved in CVC insertion. In addition, this policy governs residents who enter residency programs at the PGY 2 level, transferring residents, visiting residents and fellows. This policy pertains to those clinical specialties who routinely participate in CVC insertions and are therefore

2 Page 2 of 6 expected to be certified through this process. This policy applies to any program that has residents/fellows participating in independent central line insertions. IMPLEMENTATION The implementation of this policy is the responsibility of the Graduate Medical Education (GME) Program Directors. PROCEDURES The following criteria must be fulfilled in order to be certified as being able to independently insert a CVC at Temple University Hospital. REQUIREMENTS All incoming PGY 1 Residents from programs that have residents participating in independent central line insertions as of June 2016: 1. All residents must complete the Duke Infection Control Outreach Network (DICON) CVC online training courses. There are two required courses, Care and Maintenance of Central Venous Catheters and Insertion of Central Venous Catheters. The resident must pass the post-tests with a score of greater than 80%. (This is a prerequisite to the Simulation Training session). 2. All residents must view the New England Journal of Medicine videos on Central Line Insertion. There are three videos, Ultrasound Guided Internal Jugular Vein Cannulation (April 2010), Central Venous Catheterization Subclavian Vein (December 2007), and Placement of a Femoral Venous Catheter (June 2008). (This is a prerequisite to the Simulation Training session). 3. Each GME Program will determine which insertion sites are appropriate for their resident/fellows to receive training on. 4. All residents must complete the Simulation Institute training prior to proceeding to the next step in the training program. The residents will be required to attest to their compliance with the prerequisites at the time of their scheduled Simulation Center training. If they have not completed their prerequisite training they cannot participate in the training.. 5. After successful completion of the Simulation Institute training, the algorithm of 3 successful assists & 3 successful performs for each site is required of the resident/fellow prior to certification for independent insertions. The algorithm of 3 Assists & 3 Performs is defined as: 3 successfully assisted central accesses with primary operator as a supervising physician, and 3 successfully performed central accesses as primary operator with secondary assist/observation by supervising physician.

3 Page 3 of 6 Once a resident meets the qualifications above, and documentation and sign-off have been completed for each site, (see attachment A Central Line Training Placement Log ) the trainee is capable of independent insertion, at that site. It is expected that the resident will maintain a log of these procedures. There is no set time for completion as this may be dictated by rotations, however, no resident is approved to perform independent central access without completion of all modules per site including attestation by the Resident Program Director or their designee. Residents Entering Graduate Medical Education Programs at the PGY 2 level, Transferring Residents, Visiting Residents and Fellows from programs that have residents participating in independent central line insertions as of June 2016: : 1. The resident / fellow provides written documentation from their prior residency program director (residents entering at the PGY 2 level, transferring residents or fellows) or current residency program director (visiting residents) of successful completion of comparable training. Comparable training includes a description of their training program regarding CVC insertion; attestation of their current competency as a primary operator; and the number of CVC insertions performed as primary operator, by site. This documentation must be provided to the Graduate Medical Education Office. a. All residents and fellows must complete the DICON CVC online training courses: Care and Maintenance of Central Venous Catheters and Insertion of Central Venous Catheters. Residents and Fellows must pass the post-tests with a score of greater than 80%. They must also review the New England Journal Videos. b. Must demonstrate competency in the insertion of at least 1 CVC insertion supervised by a qualified physician using the Central Line Training Log, Attachment A. 2. Residents or fellows who have not successfully completed comparable training / supervision regarding CVC insertion or if not competent on demonstration must complete the entire program for independent CVC insertion. TRACKING RESIDENT COMPETENCY All requirements for documenting the dates of successful completion of all educational materials including all prerequisites and the Simulation Institute training, all insertions as described in the Requirements Section #4 of this policy must be documented throughout the Residency. The Resident Physician is solely responsible for initiating, documenting, and the ongoing maintenance of his/her CVC procedural log.. CRITERIA FOR SUCCESSFUL CENTRAL LINE INSERTION Each attempted insertion requires assessment of the resident s performance. The supervising physician s assessment includes the items listed on the Central Line Training Placement Log, (see attachment A)

4 Page 4 of 6 Qualifications for Supervising Physician: 1. Any Attending physician fully experienced in CVC insertions may be appointed by the Chair or Division Chief as. This attending must have routine experience with central line insertions at Jugular and Femoral and/or Subclavian (if appropriate) sites. They should be facile with ultra sound guidance as this is a key component of resident training. The identified s must be familiar with having previewed the Duke and New England Journal Core modules. 2. Any Resident / Fellow (PGY-3 or above) should have a documented log of routine insertions covering their entire residency prior to being appointed as a supervisor. This resident or fellow must have routine experience with central line insertions at Jugular and Femoral and/or Subclavian (if appropriate) sites. They should be facile with ultra-sound guidance as this is a key component of resident training. The identified s must be familiar with having previewed the Duke and New England Journal Core modules. Qualifications for Simulation Instructor: 1. Any Attending physician credentialed in CVC insertion may be appointed by the Chair or Division Chief as an Instructor. 2. Any Resident/Fellow (PGY 5 or above) who has successfully completed all requirements for independent CVC insertion and is appointed by the Program Director. These instructors must have routine experience with central line insertions at the designated sites selected by the residency clinical program. They should be facile with ultra sound guidance as this is a key component of resident training. The identified Instructor must be familiar with having previewed the online Duke course and the New England Journal video. The Instructor should also be familiar with the Simulation Institute operational systems and curricula as appropriate. Recommended by: Iatrogenic Pneumothorax & Central Line Associated Blood Stream Infection (CLABSI) Subcommittee of the Patient Value Council Safety Team May 2015, April 2016, November 2016 Approved by: Graduate Medical Education Committee June 2015 December pending

5 Page 5 of 6 FRONT ATTACHMENT A CENTRAL LINE TRAINING PLACEMENT LOG ASSISTED CENTRAL LINE PLACEMENT (Assisting step must be completed at each site before trainee can begin as primary operator at that site) SUCCESSFULLY PERFORMED CENTRAL LINE PLACEMENT AS PRIMARY OPERATOR (See requirements on reverse) INDEPENDENT OPERATOR APPROVAL SUBCLAVIAN INTERNAL JUGULAR FEMORAL DATE DATE DATE DATE DATE DATE DATE DATE DATE s DATE DATE DATE DATE DATE DATE DATE DATE DATE s Program Director Signature Program Director Signature Program Director Signature Resident/Fellow Name and Title: Program:

6 Page 6 of 6 BACK Checklist for Primary Operator