Midline Catheters: A Novel Curriculum for Emergency Medicine Residents
Correspondence should be addressed to Braden W McIntosh, MD at bmcin1@lsuhsc.edu
DOI: https://doi.org/10.5070/M5.52243
ABSTRACT:
Audience and Type of Curriculum: This curriculum is designed for all levels of emergency medicine (EM) Residents. The curriculum covers the appropriate anatomy, indications, contraindications, and specific steps for placement of midline catheters.
Length of Curriculum: Three one-hour sessions over a period of three months or a single three-hour session.
Introduction: Midline catheters have become more mainstream in the emergency department as a replacement for central lines. They are readily insertable into a peripheral vein and useful for access, blood draws, and medication administration, which are well known benefits of peripheral lines. They also offer long-term reliable access and are becoming more accepted for caustic medication administration, which are clear indications for central line placement. They are significantly more comfortable than a central line and may be associated with lower rates of catheter related bloodstream infections (CRBSI) when compared to peripherally inserted central catheter (PICC) lines.1 These combined advantages have led to increasing interest in midline use in the emergency department. Unfortunately, EM residents are often not educated on the indications for midline catheters and are not trained in placing them either. We propose a midline curriculum for EM resident success in this area.
Educational Goals: The purpose of this curriculum is to teach emergency medicine residents how to place and utilize midline catheters.
Educational Methods: The educational strategies used in this curriculum include written and skills assessments as well as in-person lectures, and asynchronous learning. Specifically, there is a pre- intervention and post-intervention knowledge assessment as well as a pre- and post-skills assessment and skills check list. The knowledge assessments are conducted using written multiple-choice exams, and the skills curriculum evaluation is performed with task trainers and instructor feedback.
Research Methods: Educational content was evaluated by learners via online survey. Efficacy of the educational content was assessed using scores and feedback from the written pre- and post-intervention examinations and procedural skills assessments.
Results: Thirty-nine residents completed the study curriculum. Overall, we found the written exam score improved from pre- to post-intervention by roughly 5% (75% to 80% on average). The time to midline placement from tourniquet to vessel catheterization was significantly improved from pre-intervention at 7 minutes, 32 seconds to post-intervention at 5 minutes, 0 seconds. The post-curriculum survey taken by participants demonstrated an increased self-reported likelihood of placing a midline on a patient and improved self-reported core knowledge. However, self-reported clinical skills did not improve significantly.
Discussion: The intent of our midline curriculum was to improve EM resident knowledge regarding line usage, placement, and confidence in using them in practice. The EM residents’ knowledge, ability to place, and self-reported intent to use midlines more often was improved based on our pre/post written, skills assessments and our feedback sessions. This project was well received and will hopefully result in more midline placement in the emergency department which should benefit learners, nurses, and patients.
Topics: Midline placement, curriculum, emergency medicine, procedural skills assessment.
