Robotic Training System Reduces CVC Placement Complications

An innovative robotic training system diminishes the number of complications associated with central venous catheters (CVC) placement.

Under development at Penn State College of Medicine (PSU; Hershey, PA, USA) and Cedars-Sinai Medical Center (Los Angeles, CA, USA), the dynamic haptic robotic training (DHRT+) system integrates a mixed-reality smart tray, an advanced testing surface, high-fidelity virtual ultrasound imaging, and real-time, adaptive feedback assessment. The haptic system is based on a programmable robot that applies force to the hands of a surgical resident so as to replicate the sensation of inserting a needle into the patient's body.


To prepare surgical residents for the patient diversity they will see in the clinic, the DHRT+ will simulate varying realistic insertion scenarios. The device will provide direct feedback and assessment to users and immediate results on what they did right, what they did wrong, and what skills they need to work on and improve. The robotic training platform will also connect automatically to the centralized DHRT+ global learning system, which will automatically store and analyze performance information and update the DHRT+ simulation to continually improve learning performance.

“The DHRT+ system is focused on not just decreasing and even eliminating the mechanical complications and the training of that, but also looking at the entire procedure, so from the moment that they start consenting the patient to the moment that they insert the final devices,” said Scarlett Miller, PhD, of the PSU department of design and industrial engineering. “By focusing on the process from beginning to end, the team will decrease not only mechanical complications, but also infectious complications, both before and after the central line placement.”

“It's one thing to be really proficient on a simulator, to be fast and accurate, but it's a different thing to say that the learning in the sim center gets translated to the bedside and results in fewer complications, improved safety and less stress on everybody,” said Philip Ng, MD, director of the Procedure Center and Vascular Access Services at Cedars-Sinai Medical Center. “Every case that they do in the sim center should be viewed as learning a different tool they will put in their toolbox so that when they are faced with an actual clinical scenario out there, they can reach into their toolbox, apply what they've learned, and get the right tool for the right job.”

CVCs can be placed in veins in the neck (internal jugular vein), the chest (subclavian or axillary vein), the groin (femoral vein) or through veins in the arm (when they are known as a peripherally inserted central catheter (PICC) line. They can be used to administer medication or fluids that are unable to be taken by mouth or would harm a smaller peripheral vein, obtain blood measurements, such as central venous oxygen saturation, measure central venous pressure (CVP) or for dialysis.

Related Links:
Penn State College of Medicine
Cedars-Sinai Medical Center