• Julio A Miranda, William E Trick, Arthur T Evans, Marjorie Charles-Damte, Brendan M Reilly, and Peter Clarke.
• Department of Medicine, Cook County (Stroger) Hospital, Chicago, Illinois, USA. Julio.A.Miranda@Hitchcock.org
• J Hosp Med. 2007 May 1;2(3):135-42.

BackgroundCentral venous catheters placed in femoral veins increase the risk of complications. At our institution, residents place most catheters in the femoral vein.ObjectiveDetermine whether a hands-on educational session reduced femoral venous catheterization and improved residents' confidence and adherence to recommendations for infection control.DesignFirm-based clinical trial between November 2004 and March 2005.SettingGeneral medical wards of Cook County (Stroger) Hospital (Chicago, IL), a public teaching hospital.ParticipantsInternal medicine residents (n = 150).InterventionBefore their 4-week rotation, intervention-firm residents received a lecture and practiced placing catheters in mannequins; control-firm residents received the usual training.MeasurementsVenous insertion site, adherence to recommendations for infection control, knowledge and confidence about catheter insertion, and catheter-associated complicationsResultsResidents inserted 54 catheters, or 0.24 insertions per resident per 4-week rotation. There was a nonsignificant decrease in femoral insertions for nondialysis catheters in the intervention group compared to the control group (44% vs. 58%), difference: -14% (95% CI, -52% to 24%). The intervention significantly increased residents' knowledge of complications related to femoral vein catheterization and temporarily increased their confidence about placing internal jugular or subclavian venous catheters. Intervention-group residents were more likely to use masks during catheterization (risk ratio, 2.2; 95% CI, 1.3-2.7), but other practices were similar.ConclusionsOur intervention improved residents' knowledge of complications and use of masks during catheter insertion; however, it did not significantly change venous insertion sites. Catheter insertions on our general medicine wards are infrequent, and the skills acquired during the skills-building session may have deteriorated given the few clinical opportunities for reinforcement.(c) 2007 Society of Hospital Medicine.

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