Cerebrospinal Fluid Drainage Catheter Clinical Trial
Official title:
Evaluation of a Simulation Based Workshop to Enhance Learning of Insertion and Management of CSF Drainage Catheters in an Anesthesia Residency Program
The study aim is to determine whether simulation based learning would improve senior anesthesiology residents' patient care performance during the insertion and management of cerebrospinal fluid drainage catheters when compared to interactive problem based learning (PBL) using the Anesthetist's Nontechnical Skills Global rating scale
This prospective randomized trial allocates anesthesia residents into two educational groups
and compares resident's performance on the the composite score (Anesthetist's Nontechnical
Skills Global Rating Scale) assigned by supervising anesthesiologists after the insertion and
management of cerebrospinal fluid drainage catheter during resident's vascular rotation.
The senior residents (CA-3 and CA-2) rotating through the vascular rotation at the Cleveland
Clinic main campus starting December 2014 are randomly allocated to simulation based learning
versus problem based learning using computer generated randomization. Randomization occurs
prior to the start of the vascular rotation. The randomization is designed to allocate all
residents (usually one or 2 residents) rotating through the vascular rotation each month (4
week rotation) to either simulation or problem based learning. The learning activity (whether
simulation based or problem based) is scheduled to occur in the first week of the vascular
rotation and the content of the educational activities (simulation based and problem based)
is designed to cover the same educational material. Two of the authors of the study moderate
all educational activities interchangeably (simulation and problem based). Simulation based
learning required advanced scheduling of activities with our simulation center to ensure
space and equipment availability and is a key factor in the decision to perform the
randomization in 4 month intervals rather than month to month.
The primary outcome is the composite score (Anesthetist's Nontechnical Skills Global Rating
Scale) received by participating residents during their first CSF drainage catheter insertion
and management as evaluated by their supervising cardiothoracic anesthesiologists. Evaluating
staff anesthesiologists is blinded to the residents' allocation group and were not involved
in the study.
Baseline and outcomes data are prospectively collected on participating residents and
respective patients undergoing thoracic aortic vascular procedures requiring CSF drainage
catheters at the Cleveland Clinic main campus during the study period. Complications of CSF
drainage catheters is also collected by looking into the EPIC of all the patients who had CSF
drainage catheters handled by the residents in the study. Patients are followed up till they
leave the hospital to evaluate if they developed any complications like paraplegia,
infection, retained fragments. This will be a secondary descriptive outcome.
The simulation scenario consists of a patient requiring perioperative CSF drainage prior to
undergoing thoracic aortic aneurysm surgery. The simulation involves step-by-step
instructions on insertion of the CSF drainage catheter including aseptic technique, position
of patient (lateral vs. sitting), site of insertion. The simulation training is done on a
mannequin to simulate actual conditions. We plan to use a simulation model, which is
basically a torso with the ability to palpate the back and spinous processes and use the
epidural needle with loss of resistance technique with haptic feedback. The trainees would be
able to actually perform the procedure on the manikin.
Various commercial CSF drainage kits are available. We will use the Medtronic lumbar drainage
kit, which is available in the OR. Sterile technique, including chlorhexidine prep, full
gown, sterile drape, sterile gloves, mask, hat. Insertion is typically at L3-L4 or L4-L5.The
Tuohy needle will be inserted with the bevel facing cephalad in incremental fashion with loss
of resistance technique until the epidural space is reached and then inserted further till a
distinct pop is felt and the subarachnoid space entered. This will be confirmed by free flow
of CSF from the Tuohy needle. The CSF catheter will then be inserted through the Tuohy
needle, taking care to avoid marked seepage of CSF by minimizing the duration between trocar
withdrawal and catheter introduction. The technique of using wire reinforced catheters as
opposed to ordinary catheters will be demonstrated ( available on Integra CSF drainage
catheters). The catheter will be threaded approximately 5 to 7 cm past the needle into the
intrathecal space, the needle will be gently removed and the catheter secured with a clear
occlusive dressing. Confirmation of free CSF drainage is obtained prior to dressing. The
simulation would continue needing assembly and attachment of the catheter to the monitor
through a transducer and learning how to drain the CSF at a particular preset value.
The residents allocated to the non simulation group (problem based learning) receives
standard educational teaching in the form of a problem based learning discussion during the
first week of rotation.
;