JMIR Publications

ABSTRACT

Background:

Central venous catheters (CVC) are indispensable to contemporary critical care, perioperative management, and emergency resuscitation, yet their insertion remains fraught with preventable harm and inefficiency.

Objective:

The aim of this paper is to identify all areas of CVC placement which can be improved through device design using Human Centered Design/Qualitative Research methods.

Methods:

This qualitative study is a contextual inquiry of CVC placement, which includes observation alongside a brief face-to-face interview with physicians. It is aimed at providing a depth of understanding using evidence to demonstrate causality. This study was conducted at three different hospitals, within the Emergency Department (ED), the Intensive Care Unit (ICU), and Operative Rooms (OR). Where possible and with additional consent, sessions were recorded in video or still photography, or at times both. The study included a total of 19 observations and 24 interviews

Results:

In this study, the approach to CVC insertion was consistent across hospitals and care environments with moderate variability spanning a few sections such as suture and the use, or lack thereof, of dressing in specific care environments, (e.g., suture and dressing use/lack of use in specific care environments). The described and observed difficulties leave room for improvement in device design. Results of this study, indicate that there are 34 discrete steps to placing a CVC line with most time spent during sterile preparation. As a result of device/kit design, there were observed challenges. These include missing essential materials from kits, the inability to distinguish non-sterile and sterile items, challenges with lidocaine ampules, patient claustrophobia due to draping, and a lack of user preference in kit contents. Additional challenges included obscured views of the ultrasound, kinking guidewires, overall procedure untidiness with considerable waste management issues.

Conclusions:

An intuitive kit that aligns with predictable human behavior and eliminates unnecessary multistep detours can reduce novice failure rates, cognitive load, and practice inconsistency just as it could serve to curb non‑recyclable waste from “backup” kits opened for a single missing item. By reframing CVC systems as socio‑technical solutions rather than static assortments of parts, the same design moves that minimize improvisation and coordination errors for providers also compress dwell time and manipulation events for patients, thereby advancing the core triad of safety, procedural efficacy, and everyday usability. By looking closely at how clinicians actually place central lines, this study exposes modifiable design faults that perpetuate risk despite decades of procedural standardization. Contextual inquiry provides the evidentiary bridge between clinical imperatives to reduce complications and the practical realities of device use. Embedding such inquiry at the outset of design and iteratively throughout product life cycles offers a path toward safer, more efficient, and more humane central venous access for both patient and provider. Clinical Trial: This research was not a clinical trial, therefore not a registered study. Consistent with best practices in research, informed consent with the ability for any participants to opt out was provided for this research. All participants, healthcare providers and patients were consented for this study. The protocol was IRB reviewed and determined that the focus was on device design and design improvements and therefore not considered human subjects research.