Simulator training to learn the implantation of large lumen femoral arterial sheaths using Seldinger's technique

Background: Interventional procedures with large lumen sheaths are on the rise and are frequently associated with vascular complications. The present study was conducted to investigate the extent to which training with the CardioSkills SmartPuncture Simulator (CSS) (CardioSkills, Frankfurt am Main, Germany) could lead to a potential reduction in vascular complications. Material and methods: A total of 29 physicians who had never placed sheaths larger than 7F in diameter in the common femoral artery were randomized to groups A (n= 13, simulation group) and B (n= 16, control group). All participants were trained on large lumen vascular access via video podcast. Group A was allowed to practice with a 5F sheath before the punctures on the CSS. Then, each physician had to perform 4 punctures with a 16F sheath on the CSS. Puncture performance by procedural times and complication rates were documented in a score. Results: Group A performed significantly better in the total score (p = 0.011). Group B required more puncture attempts to establish vascular access (p= 0.04). There was a relevant difference between the duration of the first and fourth puncture in group B (p< 0.01), but not in group A. (p= 0,07). No significant differences were found between the two groups in terms of failed puncture, nerve damage, or wire handling, but a strong correlation was found between perforation and malpositioning of the sheath (r= -0.99 and P< 0.01) The risk of perforation was 30.8% in group A and 56.3% in group B. The absolute risk reduction was 25.5%. The number needed to train was four. Conclusion: The present study showed that the use of CSS can lead to potentially less complications and faster placement of large lumen sheaths. Therefore, consideration should be given to establishing simulator-based puncture training as an integral part of curricular course content for endovascular courses.