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Buchanan C, Burt A, Moureau N, Murray D, Nizum N. Registered Nurses' Association of Ontario (RNAO) best practice guideline on the assessment and management of vascular access devices. J Vasc Access 2024; 25:1389-1402. [PMID: 37125815 DOI: 10.1177/11297298231169468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION Vascular access is the most common invasive procedure performed in health care. This fundamental procedure must be performed in a safe and effective manner. Vascular access devices (VADs) are often the source of infections and other complications, yet there is a lack of clear guidance on VADs for health providers across different settings. A Best Practice Guideline (BPG) was developed by the Registered Nurses' Association of Ontario (RNAO) to provide evidence-based recommendations on the assessment and management of VADs. METHODS RNAO BPGs are based on systematic reviews of the literature following the GRADE approach. Experts on the topic of vascular access were selected to form a panel. Systematic reviews were conducted on six research areas: education, vascular access specialists, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. A search for relevant research studies published in English limited to January 2013 was applied to eight databases. All studies were independently assessed for eligibility and risk of bias by two reviewers based on predetermined inclusion and exclusion criteria. The GRADE approach was used to determine certainty of the evidence. RESULTS Over 65,000 articles were screened related to the six priority research questions. Of these, 876 full-text publications were examined for relevance, with 174 articles designated to inform nine recommendations in the BPG on the subject areas of: comprehensive health teaching, practical education for health providers, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. In June 2021, the RNAO published the BPG on vascular access, which included the recommendations and other supporting resources. CONCLUSION The vascular access BPG provides high quality guidance and updated recommendations, and can serve as a primary resource for health providers assessing and managing VADs.
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Affiliation(s)
| | - Amy Burt
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Nancy Moureau
- PICC Excellence, Hartwell, GA, USA; Griffith University, Brisbane, QLD
| | | | - Nafsin Nizum
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
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Mills-Rudy M, Thorvilson M, Chelf C, Mavis S. The State of Mastery Learning in Pediatric Graduate Medical Education: A Scoping Review. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:637-648. [PMID: 39007126 PMCID: PMC11244625 DOI: 10.2147/amep.s463382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024]
Abstract
Objective The aim of this study was to characterize the state of mastery learning interventions, identify gaps in current approaches, and highlight opportunities to improve the rigor of ML in pediatric graduate medical education (GME) training programs. Methods In October 2022, we searched Ovid, PubMed, Scopus, and ERIC. Two reviewers independently screened 165 citations and reviewed the full manuscripts of 20 studies. We developed a modified data abstraction tool based on the Recommendations for Reporting Mastery Education Research in Medicine (ReMERM) guidelines and extracted variables related to mastery learning curricular implementation and design and learner assessment. Results Eleven studies of ML approaches within pediatric GME were included in the full review, with over half published after 2020. ML interventions were used to teach both simple and complex tasks, often in heterogeneous learner groups. While deliberate practice and feedback were consistently reported features of ML in pediatrics, opportunities for improvement include clearly defining mastery, conducting learning over multiple sessions, presenting sufficient validity evidence for assessment tools, adhering to rigorous standard setting processes, and reporting psychometric data appropriate for ML. Conclusion In pediatric GME, ML approaches are in their infancy. By addressing common shortcomings in the existing literature, future efforts can improve the rigor of ML in pediatric training programs and its impact on learners and patients.
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Affiliation(s)
- Michaela Mills-Rudy
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Megan Thorvilson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Cynthia Chelf
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Stephanie Mavis
- Department of Pediatric and Adolescent Medicine, Division of Neonatal Medicine, Mayo Clinic, Rochester, MN, USA
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Bullington PW, Reed JR, Owens DL, Rothers JL, Peek GJ, Herring C. Improving healthcare professionals' ultrasound-guided peripheral vascular access ability utilizing self-assembled ultrasound phantoms: A prospective, observational quality improvement project. J Vasc Access 2024:11297298241254633. [PMID: 38800992 DOI: 10.1177/11297298241254633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Ultrasound guidance can reduce the number of attempts to gain peripheral IV access while improving the success rate and satisfaction in patients with difficult IV access. Education and simulation are effective tools for improving the skills and knowledge related to ultrasound-guided peripheral IV access. Ultrasound phantom models allow for skill development without the risk of patient harm. METHODS Twenty-nine registered nurses and nurse practitioners were recruited for education and simulation regarding ultrasound-guided peripheral IV (USGPIV) placement. Participants completed a survey evaluating the efficacy of the phantom models in addition to pre- and post-intervention confidence, perceived competence, knowledge surveys, and a Directly Observed Procedural Skills Evaluation (DOPSE). The intervention included an educational PowerPoint and open practice session using the phantom models. RESULTS Statistically significant improvements were found in participants' confidence (p < 0.001; 95% CI: 5.287, 9.499; d = 1.31), perceived competence (p < 0.001; 95% CI: 1.231, 2.742; d = 1.20), knowledge (p < 0.001; 95% CI: 1.079, 2.163; d = 1.47), and skills (p < 0.001; 95% CI: 2.499; 5.501; d = 1.29). Participants improved in maintaining needle visualization (p < 0.001; 95% CI: 0.272, 0.9; d = 0.79) and decreasing their cannulation attempts (0.045; 95% CI: 0.013, 1.022; d = 0.48). Participants with no and novice experience saw statistically significant improvement across all categories (p < 0.02) compared to those with intermediate, advanced, or expert experience with ultrasound. 96.5% of participants could perform ultrasound-guided peripheral IV cannulation independently or with indirect supervision following the intervention. CONCLUSIONS At $36.52 per model, the self-assembled ultrasound phantom models provided a cost-effective and sustainable solution to teaching ultrasound-guided peripheral IV cannulations. Education and simulation for ultrasound-guided peripheral vascular access may benefit individuals with no or novice ultrasound experience.
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Affiliation(s)
- Phillip W Bullington
- University of Arizona Certified Registered Nurse Anesthetist Program, Tucson, AZ, USA
| | - James R Reed
- University of Arizona Certified Registered Nurse Anesthetist Program, Tucson, AZ, USA
| | - Derek L Owens
- Nurse Anesthesia Program, Mary Baldwin University, Staunton, VA, USA
| | | | - Gloanna J Peek
- Advanced Nursing Practice and Science Division, University of Arizona DNP Program, Tucson, AZ, USA
| | - Christopher Herring
- University of Arizona Certified Registered Nurse Anesthetist Program, Tucson, AZ, USA
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Barsuk JH, Cohen ER, Patel RV, Keswani RN, Aadam AA, Wayne DB, Cameron KA, Komanduri S. Effect of Polypectomy Simulation-Based Mastery Learning on Skill Retention Among Practicing Endoscopists. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:317-324. [PMID: 37934830 PMCID: PMC10922268 DOI: 10.1097/acm.0000000000005538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE Practicing endoscopists frequently perform and teach screening colonoscopies and polypectomies, but there is no standardized method to train and assess physicians who perform polypectomy procedures. The authors created a polypectomy simulation-based mastery learning (SBML) curriculum and hypothesized that completion of the curriculum would lead to immediate improvement in polypectomy skills and skill retention at 6 and 12 months after training. METHOD The authors performed a pretest-posttest cohort study with endoscopists who completed SBML and were randomized to follow-up at 6 or 12 months from May 2021 to August 2022. Participants underwent SBML training, including a pretest, a video lecture, deliberate practice, and a posttest. All learners were required to meet or exceed a minimum passing standard on a 17-item skills checklist before completing training and were randomized to follow-up at 6 or 12 months. The authors compared simulated polypectomy skills performance on the checklist from pretest to posttest and posttest to 6- or 12-month follow-up test. RESULTS Twenty-four of 30 eligible participants (80.0%) completed the SBML intervention, and 20 of 24 (83.3%) completed follow-up testing. The minimum passing standard was set at 93% of checklist items correct. The pretest passing rate was 4 of 24 participants (16.7%) compared with 24 of 24 participants (100%) at posttest ( P < .001). There were no significant differences in passing rates from posttest to combined 6- and 12-month posttest in which 18 of 20 participants (90.0%) passed. CONCLUSIONS Before training and despite years of clinical experience, practicing endoscopists demonstrated poor performance of polypectomy skills. SBML was an effective method for practicing endoscopists to acquire and maintain polypectomy skills during a 6- to 12-month period.
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Yanko FM, Rivera A, Cheon EC, Mitchell JD, Ballard HA. Patient and Technical Factors Associated with Difficult Arterial Access and Ultrasound Use in the Operating Room. CHILDREN (BASEL, SWITZERLAND) 2023; 11:21. [PMID: 38255335 PMCID: PMC10814054 DOI: 10.3390/children11010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Arterial catheterization enables continuous hemodynamic monitoring but has been shown to cause severe complications, especially when multiple attempts are required. The aim of this study was to explore what factors were associated with multiple attempts and ultrasound use in the operating room. We performed a retrospective analysis of patients who had arterial catheters inserted at a tertiary care children's hospital from January 2018 to March 2022, identifying clinical factors that were associated with both outcomes. A total of 3946 successful arterial catheter insertions were included. Multivariable analysis showed multiple attempts were associated with noncardiac surgery: pediatric (OR: 1.79, 95% CI: 1.30-2.51), neurologic (OR: 2.63, 95% CI: 1.89-3.57), orthopedic (OR: 3.23, 95% CI: 2.27-4.55), and non-radial artery placement (OR: 5.00, 95% CI: 3.33-7.14) (all p < 0.001). Multivariable analysis showed ultrasound use was associated with neonates (OR: 9.6, 95% CI: 4.1-22.5), infants (OR: 6.98, 95% CI: 4.67-10.42), toddlers (OR: 6.10, 95% CI: 3.8-9.8), and children (OR: 2.0, 95% CI: 1.7-2.5) compared to teenagers, with cardiac surgery being relative to other specialties-pediatric (OR: 0.48, 95% CI: 0.3-0.7), neurologic (OR: 0.27, 95% CI: 0.18-0.40), and orthopedic (OR: 0.38, 95% CI: 0.25-0.58) (all p < 0.001). In our exploratory analysis, increased odds of first-attempt arterial catheter insertion success were associated with cardiac surgery, palpation technique, and radial artery placement. Younger patient age category, ASA III and IV status, cardiac surgery, and anesthesiologist placement were associated with increased odds of ultrasound use.
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Affiliation(s)
- Frank M. Yanko
- Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (F.M.Y.); (E.C.C.)
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Adovich Rivera
- Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (F.M.Y.); (E.C.C.)
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Eric C. Cheon
- Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (F.M.Y.); (E.C.C.)
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | | | - Heather A. Ballard
- Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (F.M.Y.); (E.C.C.)
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
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Jamal AN, Ruse N, Wellings T, McLean LJ. Outcomes of a Comprehensive Ultrasound Guided Peripheral IV Insertion (USGPIV) Training Program in a Pediatric Emergency Department. J Emerg Nurs 2023; 49:870-880. [PMID: 37589623 DOI: 10.1016/j.jen.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Timely and reliable peripheral intravenous cannulation is an imperative skill in a pediatric emergency department. Utilization of point-of-care ultrasound guidance has proven to significantly improve first-attempt peripheral intravenous cannulation insertion rates in pediatric patients. We sought to develop, implement, and evaluate an ultrasound-guided peripheral intravenous training program for emergency nurses in a tertiary care pediatric center. METHODS Twelve emergency nurses underwent a training program that consisted of an interactive asynchronous learning module followed by 8 hours of training by a vascular access clinical instructor. Data was collected on each ultrasound-guided peripheral intravenous insertion via survey methodology. RESULTS Complete data for a total of 210 ultrasound-guided peripheral intravenous were recorded over the 9-month period. A total of 65.2% (137/210) of patients who received an ultrasound-guided peripheral intravenous had known difficult intravenous access on history. A total of 89.5% (188/210) of patients had a difficult intravenous access of ≥4. The mean difficult intravenous access score for the patients in which ultrasound-guided peripheral intravenous insertions were attempted was 4.78 (95% confidence interval, 4.55-5.01). A total of 193 of 210 (91.9%) of ultrasound-guided peripheral intravenous were attained successfully. On the first attempt, 86.5% (167/193) ultrasound-guided peripheral intravenous were attained, and 98.96% (191/193) were attained within the first 2 attempts. CONCLUSION We found that implementing a comprehensive ultrasound-guided peripheral intravenous training program for emergency nurses in a pediatric tertiary care center led to a high first-pass success rate in attaining peripheral intravenous cannulations. It also facilitates vascular access in patients with known difficult intravenous access. Consideration should be made to implementing point-of-care ultrasound intravenous training programs to improve pediatric vascular access in the emergency department, particularly in patients with known difficult intravenous access.
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Pitman JS, Buscemi M, Funk EM, Weaver S, Thompson JA, Falyar C. Incorporating Evidence-based Ultrasound-guided Vascular Access (USGVA) Standards Into the Nurse Anesthetist Armamentarium: A Quality Improvement Project. J Perianesth Nurs 2023:S1089-9472(22)00603-7. [PMID: 36658031 DOI: 10.1016/j.jopan.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE This quality improvement (QI) project developed and implemented a hybrid training program, that included online modules and hands-on training for experienced certified registered nurse anesthetists (CRNAs) to increase confidence, knowledge, and competency with ultrasound-guided vascular access (USGVA). DESIGN This QI project used a pre-post design. Seventeen volunteer CRNAs participated in USGVA training and education, and a 90-day follow-up assessment was performed. METHODS The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines were used as a framework to assess confidence, knowledge, and hands-on competency of 17 CRNAs who regularly place vascular access devices using USGVA in patients with difficult vascular access at a single facility. These assessments were measured at: (1) baseline, (2) immediately after attending a hybrid training educational program, and (3) 90 days after implementation into clinical practice. Additionally, the number of vascular access attempts required for successful placement of peripheral intravenous (PIV) catheters, arterial catheters, and central venous catheters (CVC) with ultrasound assistance over a 90-day period was reviewed. FINDINGS Certified registered nurse anesthetists' median confidence score increased significantly from pre- to post-education (P = .009). The confidence reported from post- to 90 days post-education improved, however it did not reach statistical significance (P = .812). The knowledge scores from pre- to post-education indicated significant improvement (P <. 001), as well as from pre- to 90 days post-education (P = .03). However, knowledge scores from post- to 90 days post-education revealed a statistically significant decline (P = .004). The overall median score for hands-on USGVA competency declined from post- to 90 days post-education (P = .109). The number of successful USGVA placements increased from 50% to 80% within a 90-day period. CONCLUSIONS The implementation of a USGVA hybrid training and education program improved overall provider confidence, knowledge, and competency. While confidence remained high in the 90-day follow-up, knowledge retention declined. Despite a decline in knowledge retention over time, results showed a significant improvement when compared to baseline scores. Although a decline in hands-on USGVA competency was seen at 90 days posteducation, it was not statistically significant. The percentage of overall successful USGVA placements in clinical practice increased following implementation.
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Affiliation(s)
| | | | | | - Shanna Weaver
- University of North Carolina - Chapel Hill, Department of Anesthesiology
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Ballard HA, Rivera A, Tsao M, Phillips M, Robles A, Hajduk J, Feinglass J, Barsuk JH. Use of an ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum to improve paediatric anaesthesia care. BJA OPEN 2022; 4:100101. [PMID: 37588791 PMCID: PMC10430828 DOI: 10.1016/j.bjao.2022.100101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/06/2022] [Indexed: 08/18/2023]
Abstract
Background We previously showed that an ultrasound-guided i.v. catheter insertion (USGIV) simulation-based mastery learning (SBML) curriculum improves the simulated USGIV skills of paediatric anaesthesiologists. It remains unclear if improvements in simulated USGIV skills translate to improved patient care. Methods A cohort study was conducted from August 2018 to August 2020 to evaluate paediatric anaesthesiologists' USGIV performance in the operating theatre before and after they participated in the USGIV SBML curriculum. Paediatric anaesthesiologists' use of ultrasound for successful i.v. insertion and first-attempt i.v. insertion success rate with ultrasound were compared before and after training. Results Twenty-nine paediatric anaesthesiologists completed training. Unadjusted analysis showed a significant increase in the percentage of i.v. catheters inserted with ultrasound for successful i.v. catheter insertion (9.5-14.5%; P<0.001) and first i.v. catheter insertion attempt success with ultrasound (5.5-8.9%; P<0.001) from before to after training. Multivariable regression analysis showed higher odds of ultrasound use for a successful i.v. catheter attempt (1.79; 95% confidence interval [CI]: 1.11-2.90; P=0.018) and first-attempt success with ultrasound (4.11; 95% CI: 2.02-8.37; P<0.001) after training. Conclusions After completing the USGIV SBML curriculum, paediatric anaesthesiologists increased their ultrasound use for successful i.v. catheter insertion and first-attempt success rate with ultrasound for patients in the operating theatre.
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Affiliation(s)
- Heather A. Ballard
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Adovich Rivera
- Institute of Public Health, Division of Health Services Outcomes Research, USA
| | - Michelle Tsao
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Mitch Phillips
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Alison Robles
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - John Hajduk
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Joe Feinglass
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey H. Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Ballard HA, Hajduk J, Cheon EC, King MR, Barsuk JH. Clinical and demographic factors associated with pediatric difficult intravenous access in the operating room. Paediatr Anaesth 2022; 32:792-800. [PMID: 35293066 PMCID: PMC9310763 DOI: 10.1111/pan.14438] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric intravenous catheter insertion can be difficult in the operating room due to the technical challenges of small diameter vessels and the need to rapidly gain intravenous access in anesthetized children. Few studies have examined factors associated with difficult vascular access in the operating room, especially accounting for the increased possibility to use ultrasound guidance. AIMS The primary aim of the study was to identify factors associated with pediatric difficult vascular access in the operating room. Our primary hypothesis was that Black race, Hispanic ethnicity, and ultrasound use would be associated with pediatric difficult vascular access. METHODS We performed a retrospective analysis of prospectively collected data from a cohort of pediatric patients who had intravenous catheters inserted in the operating room at an academic tertiary care children's hospital from March 2020 to February 2021. We measured associations among patients who were labeled as having difficult vascular access (>2 attempts at access) with demographic, clinical, and hospital factors. RESULTS 12 728 intravenous catheter insertions were analyzed. Multivariable analysis showed significantly higher odds of difficult vascular access with Black non-Hispanic race (1.43, 95% CI: 1.06-1.93, p = .018), younger age (0.93, 95% CI: 0.89-0.98, p = .005), overweight (1.41, 95% CI: 1.04-1.90, p = .025) and obese body mass index (1.56, 95% 95% CI: 1.12-2.17, p = .008), and American Society of Anesthesiologists physical status III (1.54, 95% CI:1.11-2.13, p = .01). The attending anesthesiologist compared to all other practitioners (certified registered nurse anesthetist: (0.41, 95% CI: 0.31-0.56, p < .001, registered nurse: 0.25, 95% CI: 0.13-0.48, p < .001, trainee: 0.21, 95% CI: 0.17-0.28, p-value <.001 with attending as reference variable) and ultrasound use (2.61, 95% CI: 1.85-3.69, p < .001) were associated with successful intravenous catheter placement. CONCLUSIONS Black non-Hispanic race/ethnicity, younger age, obese/overweight body mass index, American Society of Anesthesiologists physical status III, and ultrasound were all associated with pediatric difficult vascular access in the operating room.
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Affiliation(s)
- Heather A. Ballard
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - John Hajduk
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Eric C. Cheon
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Michael R. King
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Jeffrey H. Barsuk
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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Quraishi I, Mufarrih SH, Mahmood F, Matyal R, Mitchell JD. In Response. Anesth Analg 2022; 134:e6-e7. [PMID: 35030128 DOI: 10.1213/ane.0000000000005720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ibrahim Quraishi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts,
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Affiliation(s)
- Jillian A DiBiase
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, Illinois,
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Adrian RJ, Choi A, Lamba S, Ostrovsky I, Ramdin C, Traba C, Chen S, Sudyn A, Alerhand S. Teaching Module on Ultrasound-Guided Venous Access Using a Homemade Gel Model for Fourth-Year Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11222. [PMID: 35136837 PMCID: PMC8807663 DOI: 10.15766/mep_2374-8265.11222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/20/2021] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Evidence supports an ultrasound-guided approach in patients with difficult vascular access. Prior research on teaching ultrasound-guided intravenous access has included only small groups of first- and second-year medical students. METHODS We enrolled fourth-year medical students in our teaching module. The module featured a 6-minute prelearning narrated lecture and 5-minute orientation, followed by ultrasound-guided IV placement on homemade gel models. Facilitators were emergency medicine (EM) residents with a prespecified level of procedural ultrasound skills according to EM milestones. Students completed pre- and postmodule surveys. Facilitators completed the Directly Observed Procedural Skills Evaluation. Primary outcomes included global rating, proficiency on six procedural skills, and perceived learning. RESULTS Our module was completed by 150 fourth-year medical students (94% of the class); 84% cannulated the vein in one attempt. We used a global rating scale to describe the students' cannulation abilities; 59% were trusted to perform this procedure with direct supervision and coaching, 29% with indirect supervision, and 8% without supervision. There was no association between a student's order of attempting IV access within the group and global rating (p = .41). Students reported increased understanding of indications, antecubital anatomy, sonographic anatomy, and procedural comfort (12%, 29%, 38%, and 65% improvement pre- vs. postmodule, respectively; p < .001). DISCUSSION Our module enabled more than one-third of fourth-year medical students to achieve an indirect supervision or better level of proficiency in ultrasound-guided IV access, with significant improvements in perceived knowledge. This module may be useful for other educators facilitating the transition to residency.
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Affiliation(s)
- Robert James Adrian
- Fourth-Year Resident, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - April Choi
- Fourth-Year Resident, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - Sangeeta Lamba
- Professor, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - Ilya Ostrovsky
- Assistant Professor, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - Christine Ramdin
- Research Associate, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - Christin Traba
- Assistant Professor, Department of Pediatrics, Rutgers New Jersey Medical School
| | - Sophia Chen
- Assistant Professor, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - Alexander Sudyn
- Fourth-Year Medical Student, Rutgers New Jersey Medical School
| | - Stephen Alerhand
- Assistant Professor, Department of Emergency Medicine, Rutgers New Jersey Medical School
- Corresponding author:
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Jørgensen R, Laursen CB, Konge L, Pietersen PI. Education in the placement of ultrasound-guided peripheral venous catheters: a systematic review. Scand J Trauma Resusc Emerg Med 2021; 29:83. [PMID: 34176508 PMCID: PMC8237454 DOI: 10.1186/s13049-021-00897-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Placing a peripheral vein catheter can be challenging due to several factors, but using ultrasound as guidance increases the success rate. The purpose of this review is to investigate the knowledge already existing within the field of education in ultrasound-guided peripheral vein catheter placement and explore the efficacy and clinical impact of different types of education. METHODS In accordance with PRISMA-guidelines, a systematic search was performed using three databases (PubMed, EMBASE, CINAHL). Two reviewers screened titles and abstracts, subsequently full-text of the relevant articles. The risk of bias was assessed using the Cochrane Collaboration risk of bias assessment tool and the New Ottawa scale. RESULTS Of 3409 identified publications, 64 were included. The studies were different in target learners, study design, assessment tools, and outcome measures, which made direct comparison difficult. The studies addressed a possible effect of mastery learning and found e-learning and didactic classroom teaching to be equally effective. CONCLUSION Current studies suggest a potential benefit of ultrasound guided USG-PVC training on success rate, procedure time, cannulation attempts, and reducing the need for subsequent CVC or PICC in adult patients. An assessment tool with proven validity of evidence to ensure competence exists and education strategies like mastery learning, e-learning, and the usage of color Doppler show promising results, but an evidence-based USG-PVC-placement training program using these strategies combined is still warranted.
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Affiliation(s)
- Rasmus Jørgensen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark. .,Regional Center for Technical Simulation, Region of Southern Denmark, 5000, Odense, Denmark.
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.,Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Lars Konge
- Regional Center for Technical Simulation, Region of Southern Denmark, 5000, Odense, Denmark.,Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.,Regional Center for Technical Simulation, Region of Southern Denmark, 5000, Odense, Denmark
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