Developing a Tool to Assess Placement of Central Venous Catheters in Pediatrics Patients

J Grad Med Educ. 2016 Jul;8(3):346-52. doi: 10.4300/JGME-D-15-00365.1.


Background: Pediatric critical care medicine requires the acquisition of procedural skills, but to date no criteria exist for assessing trainee competence in central venous catheter (CVC) insertion.

Objective: The goal of this study was to create and demonstrate validity evidence for a direct observation tool for assessing CVC insertion.

Methods: Ten experts used the modified Delphi technique to create a 15-item direct observation tool to assess 5 scripted and filmed simulated scenarios of CVC placement. The scenarios were hosted on a dedicated website from March to May 2013, and respondents recruited by e-mail completed the observation tool in real time while watching the scenarios. The goal was to obtain 50 respondents and a total of 250 scenario ratings.

Results: A total of 49 pediatrics intensive care faculty physicians (6.3% of 780 potential subjects) responded and generated 188 scenario observations. Of these, 150 (79.8%) were recorded from participants who scored 4 or more on the 5 scenarios. The tool correctly identified the expected reference standard in 96.8% of assessments with an interrater agreement kappa (standard error) = 0.94 (0.07) and receiver operating characteristic = 0.97 (95% CI 0.94-0.99).

Conclusions: This direct observation assessment tool for central venous catheterization demonstrates excellent performance in identifying the reference standard with a high degree of interrater reliability. These assessments support a validity construct for a pediatric critical care medicine faculty member to assess a provider placing a CVC in a pediatrics patient.

MeSH terms

  • Adolescent
  • Catheterization, Central Venous / standards*
  • Child
  • Child, Preschool
  • Clinical Competence / standards*
  • Critical Care
  • Delphi Technique
  • Educational Measurement / methods
  • Humans
  • Infant
  • Pediatrics / education
  • Reproducibility of Results
  • Video Recording