The Construction Of Learning Curves For Peripherally Inserted Central Venous Catheter

ObjectiveTo investigate the least practice number for nurses to learn the skill of insertionof peripherally inserted central venous catheter, investigate the regular pattern oflearning a new skill, so as to provide the reference basis for formulating the criterionof the qualifications to practice the insertion of PICC and the skill trainment.MethodFrom the August2011to February2013, chose the nurses, who have received thestandard trainment of PICC and passed the examination of the theory test andoperational examination on the simulation, as the study cases. The nurses started to dothe insertion of PICC under the surpervision of specific nurse of PICC. The researcherrecorded the time observation target such as the time of insertion, the attempt numberto puncture, the score and the location of the catheter tip. Applied the CUSUManalysis to establish the learning curve for the insertion of PICC. At last, cumulatedthe δ for every attempt, and defined the overall learning curve, the abscissa is theattempts, and the ordinate is the sum of ex-CUSUM. Applying the curve fittingprogram to get the curve equation and the curve function chart, then use the functionalequation to get the slope for every attempt of insertion. The slope is decreasing, whenthe slope changes into negative, the number corresponding to the changement is theminimum training experience necessary to succeed at this skill.ResultsTotally15nurses are accepted in the research, and do225insertions of PICC.Firstly, the learner will go through the rising stage, and from the5th attempt, turn intothe platform stage, when the X=7.05, the slope K=0,the maximum of the curve is85.82. From the8th attempts, the slope of the curve turns into negative, the curve turninto the stage of falling.To the time taken for the insertion and the rate of dislocation for the tip of thecatheter,there is statistical meaning between the difference of falling stage and rising and platform stage (P＜0.05),the successful rate for the one insertion is differencebetween the falling and rising stage(P＜0.05), he score of evaluating the process ofinsertion is different among the three stages(P＜0.001).The least practice number for nurses to learn the skill of insertion of PICC isrelated to the equal interval time before the peak of the curve(r=0.825， P＜0.001),related to the equal number of PICC insertions in the academic environment(r=-0.587，P＜0.05)。ConclusionThe minimum number of training experience necessary to succeed in graspingthis skill is8.The more insertions every month in the academic environment, the less equalinterval days of practices, the smaller number of training experience to succeed at thisskill is necessary.