Using Heart Rate Variability to Assess Resident Stress During Central Venous Catheter Simulation

Abstract

Simulation based central venous catheter (CVC) training has been shown to result in fewer needle passes and complications. Heart rate variability (HRV) has been shown to be effective in identifying stress and self-confidence in surgeons, but there is no data examining HRV during simulation based CVC training. The purpose of this study was to use heart rate variability to identify stress during CVC simulation training. This was a prospective cohort study with a convenience sample of resident physicians who enrolled in a CVC simulation-training course. Participants were attached to an HRV monitoring device that measures heart rate variability. A 12 step procedural standardized skills check list was used to measure psychomotor skill performance. Stress was analyzed in five-minute intervals using a software program that analyzes heart rate variability in terms of stress index (SI), standard deviation of normal-to-normal intervals (SDNN), and square root of the mean normal-to-normal interval (RMS-SD) during each CVC simulation. Sixteen participants were enrolled in the study. Stress as determined by SI, SDNN, and RMS-SD was not significantly different across participants prior to beginning the simulation. Stress as determined by SI, SDNN, and RMS-SD did not change significantly between any one of the 12 individual procedural steps. 3 of the 16 (18%) participants appeared to have increased stress during the final examination portion, with an average stress index of 51.9 (range 31.4-58.5) at baseline compared to an average of 280 (range 160-360) during the final exam. This study suggests that stress, as measured by HRV, during simulated CVC training did not change throughout any procedural step, and did not decrease over time. Further studies examining HRV during real life CVC placement is warranted.