Opportunities for Improved Device Design Based on Central Line Placement Practices: Contextual Inquiry Study.

Area of Science:

• Medical Device Design
• Human Factors Engineering
• Clinical Procedure Optimization

Background:

• Central venous catheters (CVCs) are vital in critical care but insertion carries risks.
• Current CVC placement methods face preventable harm and inefficiency.

Purpose of the Study:

• To identify CVC placement improvements through device design.
• Utilizing Human-Centered Design and Qualitative Research methods.

Main Methods:

• Qualitative contextual inquiry involving CVC placement observation.
• Face-to-face interviews with physicians across ED, ICU, and OR settings.
• 19 observations and 24 interviews conducted, with video/photo recording where possible.

Main Results:

• CVC insertion has 34 steps, with most time spent on sterile preparation.
• Observed challenges include missing kit items, unclear sterility, lidocaine issues, patient claustrophobia, and obscured ultrasound views.
• Guidewire kinking, procedural untidiness, and waste management were also identified issues.

Conclusions:

• Intuitive kit design can reduce novice errors, cognitive load, and practice variability.
• Reframing CVC systems as socio-technical solutions improves safety, efficacy, and usability.
• Addressing modifiable design flaws enhances patient safety and provider efficiency.