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 | ||||