Boosting Confidence in Emergent Umbilical Venous Catheter Placement: A Just-In-Time Training Video

Emergency Medicine physicians must be ready to manage critically ill neonates but may lack comfort with umbilical vein catheter (UVC) placement. UVCs offer safe and effective intravenous access, yet optimal methods to ensure competency in this infrequent procedure are unclear. To evaluate whether a just-in-time (JIT) video improves physicians’ knowledge, confidence, and skill in UVC placement.

We performed a prospective study using a JIT video in a simulated encounter at a tertiary pediatric hospital. Eligible participants were physicians completing their semiannual competency session. Experience, knowledge, and confidence were assessed via a survey adapted from prior studies. Participants’ hands were recorded placing a UVC in a low-fidelity manikin. Two independent raters reviewed anonymized videos and graded performance using a nine-item checklist adapted from the Neonatal Resuscitation Program (NRP®). A 2-minute JIT video demonstrating emergent UVC placement was created based on baseline data. One year later, participants received the video before repeating the survey and skill. Pre- and post-intervention data were compared using the Wilcoxon matched-pairs signed-rank test.

Of 35 eligible faculty, 15 completed the study. Only 2 (13%) had placed more than 10 UVCs; most (73%) last placed one more than 5 years ago. Participants showed significant improvement after viewing the JIT video. Median checklist scores increased from 6/9 at baseline to 9/9 post-intervention (p<0.001). All checklist items improved, with the largest gains in selecting the correct catheter (+67%) and flushing the catheter (+53%). Confidence rose from a median of 2 to 4 on a 5-point Likert scale (p=0.015). Knowledge scores increased from a median of 2 to 4.5 out of 5 (p=0.002).

A focused JIT training video significantly improved physicians’ knowledge, confidence, and performance in simulated UVC placement at our academic center.