Design of a Novel Insertion Training System for Central Venous Catheterization.

Abstract

Central venous catheterization (CVC) is a common medical procedure with a complication rate of over 15%. Current CVC manikin-based simulators lack anatomical variation and objective feedback of user interaction skills, which greatly hinders effective skill acquisition. To address these limitations, a novel CVC insertion training system was developed and integrated with the Advanced Dynamic Haptic Robotic Trainer (DHRT+). This insertion training system contains a sensorized syringe, custom tissue phantom, and a tool detection subsystem, allowing residents to practice nearly the entire CVC procedure with realistic haptics and automated feedback on subcutaneous tool positioning. Five experiments were conducted to assess the haptic fidelity of the sensorized syringe and custom tissue and to evaluate the accuracy of subcutaneous tool detection. Results showed that the sensorized syringe, which detects aspiration and simulates arterial and venous flash, accurately reproduced clinical aspiration forces. The custom tissue phantom provided realistic force feedback during ultrasound (US) compression and needle insertion, comparable to that of commercial tissue phantoms at a substantially lower cost. The color sensors used to distinguish between inserted guidewires and catheters accurately verified tool depth and enabled tool insertion across multiple positions on the tissue surface. Overall, novel CVC insertion training system components were presented that enabled CVC simulation and provided accurate measurement on aspiration, guidewire depth, and catheter depth.