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Hillebrand G, Gartmeier M, Weiss N, Engelmann L, Stenzl A, Johnson F, Hofauer B. [Virtual DEGUM-certified course in the head and neck region-a useful complement to conventional course formats?]. HNO 2024; 72:154-160. [PMID: 38353674 PMCID: PMC10879222 DOI: 10.1007/s00106-023-01413-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Training in clinical ultrasound has become highly relevant for working as an otorhinolaryngologist. While there is a high demand for standardized and certified training courses, until recently, there was no possibility to attend web-based and exclusively virtual head and neck ultrasound courses certified by the Deutsche Gesellschaft für Ultraschall in der Medizin (DEGUM; German Society for Ultrasound in Medicine). OBJECTIVE The aim of this study was to provide a qualitative and semi-quantitative analysis of the first purely virtual DEGUM-certified head and neck ultrasound courses. MATERIALS AND METHODS In 2021, three purely web-based DEGUM-certified head and neck ultrasound courses were carried out and then qualitatively analyzed using questionnaires including an examination. RESULTS The purely virtual implementation of head and neck ultrasound courses proved to be a viable alternative to the conventional course format, with a high level of acceptance among the participants. The lack of practice among the participants remains a relevant criticism. CONCLUSION A more dominant role of web-based and remote ultrasound training is likely and should be considered as an alternative depending on existing conditions. Nevertheless, acquisition of practical sonographic skills remains a major hurdle if courses are purely digital.
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Affiliation(s)
- Gabriel Hillebrand
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - Martin Gartmeier
- TUM Medical Education Center, Lehrstuhl für Medizindidaktik, medizinische Lehrentwicklung und Bildungsforschung, Fakultät für Medizin, Klinikum rechts der Isar, Nigerstraße 3, 81675, München, Deutschland
| | - Nora Weiss
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Luca Engelmann
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Anna Stenzl
- Klinik für Hals, Nasen und Ohrenheilkunde, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Felix Johnson
- Klinik für Hals, Nasen und Ohrenheilkunde, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Benedikt Hofauer
- Klinik für Hals, Nasen und Ohrenheilkunde, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
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Stone R, Walker RM, Marsh N, Ullman AJ. Educational programs for implementing ultrasound guided peripheral intravenous catheter insertion in emergency departments: A systematic integrative literature review. Australas Emerg Care 2023; 26:352-359. [PMID: 37423812 DOI: 10.1016/j.auec.2023.06.001] [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: 04/14/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Ultrasound-guided peripheral intravenous catheter insertion has been identified as an effective method to improve the success rate of cannulation, thereby improving patient experience. However, learning this new skill is complex, and involves training clinicians from a variety of backgrounds. The aim of this study was to appraise and compare literature on educational methods in the emergency setting used to support ultrasound guided peripheral intravenous catheter insertion by different clinicians, and how effective these current methods are. REVIEW METHODS A systematic integrative review was undertaken using Whittemore and Knafl's five stage approach. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. RESULTS Forty-five studies met the inclusion criteria, with five themes identified. These were: the variety of educational methods and approaches; the effectiveness of the different educational methods; barriers and facilitators of education; clinician competency assessments and pathways; clinician confidence assessment and pathways. CONCLUSIONS This review demonstrates that a variety of educational methods are being used in successfully training emergency department clinicians in using ultrasound guidance for peripheral intravenous catheter insertion. Furthermore, this training has resulted in safer and more effective vascular access. However, it is evident that there is a lack of consistency of formalised education programs available. A standardised formal education program and increased availability of ultrasound machines in the emergency department will ensure consistent practices are maintained, retained, therefore leading to safer practice as well as more satisfied patients.
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Affiliation(s)
- Renee Stone
- Menzies Health Institute of Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Queensland, Australia.
| | - Rachel M Walker
- Menzies Health Institute of Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nicole Marsh
- Menzies Health Institute of Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- Menzies Health Institute of Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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Taylor TA, Kemp K, Mi M, Lerchenfeldt S. Self-directed learning assessment practices in undergraduate health professions education: a systematic review. MEDICAL EDUCATION ONLINE 2023; 28:2189553. [PMID: 36919556 PMCID: PMC10026772 DOI: 10.1080/10872981.2023.2189553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE The goal of this systematic review was to examine self-directed learning (SDL) assessment practices in undergraduate health professions education. METHODS Seven electronic databases were searched (PubMed, Embase, PsycINFO, ERIC, CINAHL, Scopus, and Web of Science) to retrieve English-language articles published between 2015 and July of 2022, investigating assessment of SDL learning outcomes. Extracted data included the sample size, field of study, study design, SDL activity type, SDL assessment method, number of SDL assessments used, study quality, number of SDL components present utilising the framework the authors developed, and SDL activity outcomes. We also assessed relationships between SDL assessment method and number of SDL components, study quality, field of study, and study outcomes. RESULTS Of the 141 studies included, the majority of study participants were medical (51.8%) or nursing (34.8%) students. The most common SDL assessment method used was internally-developed perception surveys (49.6%). When evaluating outcomes for SDL activities, most studies reported a positive or mixed/neutral outcome (58.2% and 34.8%, respectively). There was a statistically significant relationship between both number and type of assessments used, and study quality, with knowledge assessments (median-IQR 11.5) being associated with higher study quality (p < 0.001). Less than half (48.9%) of the studies used more than one assessment method to evaluate the effectiveness of SDL activities. Having more than one assessment (mean 9.49) was associated with higher quality study (p < 0.001). CONCLUSIONS The results of our systematic review suggest that SDL assessment practices within undergraduate health professions education vary greatly, as different aspects of SDL were leveraged and implemented by diverse groups of learners to meet different learning needs and professional accreditation requirements. Evidence-based best practices for the assessment of SDL across undergraduate healthcare professions education should include the use of multiple assessments, with direct and indirect measures, to more accurately assess student performance.
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Affiliation(s)
- Tracey A.H. Taylor
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Kyeorda Kemp
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Misa Mi
- Medical Library, Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Sarah Lerchenfeldt
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Steinwandel U, Coventry LL, Kheirkhah H. Evaluation of a Point-of-care ultrasound (POCUS) workshop for peripheral intravenous cannulation. BMC MEDICAL EDUCATION 2023; 23:451. [PMID: 37337172 DOI: 10.1186/s12909-023-04428-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is increasingly used as a non-invasive vascular access assessment method by clinicians from multiple disciplines worldwide, prior and during vascular access cannulations. While POCUS is a relatively new method to establish a vascular access in patients with complex vascular conditions, it is also essential to train and educate individuals who are novices in the techniques of cannulation so that they become proficient in performing this task subsequently on patients safely and successfully. A simulated environment may be a helpful tool to help healthcare providers establish skills in using POCUS safely and may also help them to successfully establish vascular access in patients. With this project, we sought to determine if participants of a simulated POCUS workshop for vascular access can use this technique successfully in their individual clinical environment after their attendance of a half-day workshop. METHODS A mixed-methods longitudinal study design was chosen to evaluate a point-of-care ultrasound workshop for peripheral intravenous cannula insertion. The workshops used simulation models for cannulation in combination with multiple ultrasound devices from various manufacturers to expose participants to a broader variety of POCUS devices as they may also vary in different clinical areas. Participants self-assessed their cannulation skills using questionnaires on a 10-point rating scale prior to and directly after the workshop. RESULTS A total of 85 Individuals participated in eleven half-day workshops through 2021 and 2022. Workshop participants claimed that attending the workshop had significantly enhanced their clinical skill of using ultrasound for the purpose of cannulating a venous vessel. The level of confidence in using this technique had increased in all participants directly after conclusion of the workshop. CONCLUSIONS Globally, clinicians are increasingly using POCUS to establish vascular access in patients, and it is necessary that they receive sufficient and adequately structured and formal training to successfully apply this technique in their clinical practice. Offering a workshop which uses simulation models in combination with various POCUS devices to demonstrate this technique in a hands-on approach has proven to be useful to establish this newly learned skill in clinicians.
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Affiliation(s)
- Ulrich Steinwandel
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027, WA, Australia.
| | - Linda L Coventry
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027, WA, Australia
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, Australia
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Homa Kheirkhah
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027, WA, Australia
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Jarraya A, Kammoun M, Chtourou A, Ammar S, Kolsi K. Complications and its risk factors of percutaneous subclavian vein catheters in pediatric patients: enhancing the outcomes of a university hospital in a low-income and middle-income country. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000523. [PMID: 38328394 PMCID: PMC10848620 DOI: 10.1136/wjps-2022-000523] [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: 11/01/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Assessing central venous catheter-related complications with regular feedback and investigating risk factors are mandatory to enhance outcomes. The aim of this study is to assess our experience in the management of pediatric subclavian vein catheters (SVCs) and to investigate the main risk factors for complications. Methods In this prospective observational study, we included children aged 3 months to 14 years who underwent infraclavicular subclavian vein catheterization consecutively using the anatomic landmark technique. Patients were divided into two groups: group 1 included complicated catheters and group 2 included non-complicated catheters. The management protocol was standardized for all patients. After comparing the two groups, univariate and multivariate logistic regression were used to investigate the risk factors for complications. Results In this study, we included 134 pediatric patients. The rate of complications was 32.8%. The main complications were central line-associated bloodstream infection (63.6%), bleeding and/or hematoma (22.7%), mechanical complications (13.6%), and vein thrombosis (13.6%). After adjustment for confounding factors, predictors of catheter-related complications were difficult insertion procedure (adjusted odds ratio (aOR)=9.4; 95% confidential interval (CI): 2.32 to 38.4), thrombocytopenia (aOR=4.43; 95% CI: 1.16 to 16.86), comorbidities (aOR=2.93; 95% CI: 0.58 to 14.7), and neutropenia (aOR=5.45; 95% CI: 2.29 to 13.0). Conclusions High rates of complications were associated with difficult catheter placement and patients with comorbidities and severe thrombocytopenia. To reduce catheter-related morbidity, we suggest an ultrasound-guided approach, a multidisciplinary teaching program to improve nursing skills, and the use of less invasive devices for patients with cancer.
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Affiliation(s)
- Anouar Jarraya
- The Anesthesiology department, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Manel Kammoun
- The Anesthesiology department, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Ameni Chtourou
- The Anesthesiology department, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Saloua Ammar
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
- University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Kamel Kolsi
- The Anesthesiology department, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
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Peters N, Thomas J, Woods C, Rickard C, Marsh N. Remotely supervised ultrasound-guided peripheral intravenous cannulation training: A prospective cohort study examining success rates and patient experience. Australas J Ultrasound Med 2022; 25:176-185. [PMID: 36405792 PMCID: PMC9644440 DOI: 10.1002/ajum.12318] [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: 11/10/2022] Open
Abstract
Introduction Ultrasound-guided peripheral intravenous cannulation (USGPIVC) benefits patients with difficult intravenous access (DIVA) through visualising otherwise non-visible and non-palpable veins. Supervised live-case training is an important component of learning this skill, but supervisor availability can present a barrier limiting or delaying staff completing their training. Aims The aim of this study was to determine the first-attempt success rate of newly trained USGPIVC inserters using remote supervision and timely written feedback based on app-based screen recordings taken during insertion. Secondary aims were overall procedural success, and inserter and patient experiences. Methods This study is an observational cohort study carried out between October and December 2021. Fourteen newly trained junior medical officers (JMOs) were eligible to utilise USGPIVC on a minimum of five consenting patients while simultaneously recording the ultrasound screen during insertion to capture their technique. Feedback was generated following expert review of these recordings against a standardised feedback tool. Results Average first-attempt success was 71% (n = 72) in the 102 patients recruited. The average time for JMOs to receive feedback was 30 h, and 13 JMOs (93%) felt well supported and completed the remote training pathway. The majority of patients were female (n = 59; 58%), were aged 41-80 years (n = 75; 74%) and had ≥2 risk factors for DIVA (n = 57; 56%). Conclusions First-attempt success rates were similar when comparing remote supervision used in this study to direct supervision used by other studies.This finding supports incorporating remote supervision into training guidelines for USGPIVC as an alternative method of supervision, particularly when supervisor availability is limited.
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Affiliation(s)
- Nathan Peters
- Department of Anaesthesia and Perioperative MedicineRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- University of QueenslandBrisbaneQueenslandAustralia
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
| | - Joel Thomas
- Department of Anaesthesia and Perioperative MedicineRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- University of QueenslandBrisbaneQueenslandAustralia
| | - Christine Woods
- Department of Anaesthesia and Perioperative MedicineRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- University of QueenslandBrisbaneQueenslandAustralia
| | - Claire Rickard
- University of QueenslandBrisbaneQueenslandAustralia
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- Alliance for Vascular Access Teaching and Research GroupGriffith UniversityBrisbaneQueenslandAustralia
- Metro North Hospitals and Health ServiceBrisbaneQueenslandAustralia
| | - Nicole Marsh
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- Alliance for Vascular Access Teaching and Research GroupGriffith UniversityBrisbaneQueenslandAustralia
- Metro North Hospitals and Health ServiceBrisbaneQueenslandAustralia
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Duarte ML, dos Santos LR, Iared W, Peccin MS. Comparison of ultrasonography learning between distance teaching and traditional methodology. An educational systematic review. SAO PAULO MED J 2022; 140:806-817. [PMID: 36043680 PMCID: PMC9671565 DOI: 10.1590/1516-3180.2021.1047.r.19052022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/19/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Use of the web for radiological education is an obvious application. Many computer-based teaching materials have been developed over recent years, and e-learning is becoming increasingly popular in medical schools. OBJECTIVE To assess whether the effectiveness of distance-learning and/or e-learning, m-learning and web-based methods are equivalent to traditional methods. DESIGN AND SETTING Systematic review of comparative studies of teaching techniques guided by Best Evidence Medical Education. METHODS A search was carried out in the MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS online databases in April 2020, for original publications in all languages. The following MeSH terms were used: Ultrasonography; Teleradiology; Telemedicine; Education, Medical; Teaching; and Simulation Training; along with the terms e-learning, m-learning and web-based. All eligible studies were assessed using the Kirkpatrick model and Buckley's quality indicators. RESULTS The search in the databases and a manual search resulted in 4549 articles, of which 16 had sufficient methodological quality for their inclusion. From analysis of these data, it was observed that teaching of ultrasonography using telemedicine methods is similar to the traditional method, except for venous access procedures, for which the studies did not show agreement. CONCLUSION We found that learning via telemedicine methodologies presents great acceptance among students, besides demonstrating quality similar to the traditional method. Thus, at least at the moment, this has the capacity to serve as an important adjunct in the teaching of ultrasonography. REGISTRATION NUMBER DOI: 10.17605/OSF.IO/CGUPA at the OPENSCIENCE Framework.
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Affiliation(s)
- Márcio Luís Duarte
- MD, MSc, PhD. Musculoskeletal Radiologist, WEBIMAGEM Telerradiologia, São Paulo (SP), Brazil; and Professor, Ultrasonography, Centro Universitário Lusíada (UNILUS), Santos (SP), Brazil
| | - Lucas Ribeiro dos Santos
- MD, MSc. Endocrinologist and Professor, Physiology and Internal Medicine, Centro Universitário Lusíada (UNILUS), Santos (SP), Brazil; and Doctoral Student, Evidence-Based Health Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Wagner Iared
- MD, PhD. Supervisor Professor, Evidence-Based Health Postgraduate Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Maria Stella Peccin
- PT, PhD. Associate Professor, Department of Human Movement Sciences and Advisor, Evidence-Based Health Postgraduate Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
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Kenny EJG, Makwana HN, Thankachan M, Clunie L, Dueñas AN. The Use of Ultrasound in Undergraduate Medical Anatomy Education: a Systematic Review with Narrative Synthesis. MEDICAL SCIENCE EDUCATOR 2022; 32:1195-1208. [PMID: 36276779 PMCID: PMC9583998 DOI: 10.1007/s40670-022-01593-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 06/16/2023]
Abstract
This systematic review aimed to synthesize the literature on how ultrasound is currently used in anatomy education within medical schools. A systematic search of Ovid MEDLINE, Scopus, and Educational Resources Information Centre was conducted. Thirty-four relevant unique articles were included from the 1,272 identified from the databases and analyzed via narrative synthesis. Thematic analysis generated two domain summaries: "Successful Aspects of Ultrasound Teaching" and "Barriers to Implementation," each with additional subthemes, aimed to help educators inform best teaching practices from the current evidence base in this field.
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Affiliation(s)
- Edward J. G. Kenny
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Kingston Upon Hull, UK
| | - Haran N. Makwana
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Kingston Upon Hull, UK
| | - Maria Thankachan
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Kingston Upon Hull, UK
| | - Lauren Clunie
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Kingston Upon Hull, UK
| | - Angelique N. Dueñas
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
- Department of Medical Education, Northwestern University, Feinberg School of Medicine, Chicago, IL USA
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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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Ultrasonography in undergraduate medical education: a comprehensive review and the education program implemented at Jichi Medical University. J Med Ultrason (2001) 2022; 49:217-230. [PMID: 35034230 PMCID: PMC8761092 DOI: 10.1007/s10396-021-01178-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/01/2021] [Indexed: 11/03/2022]
Abstract
The concept of point-of-care ultrasound has been widely accepted owing to the development of portable ultrasound systems and growing body of evidence concerning its extensive utility. Thus, it is reasonable to suggest that training to use this modality be included in undergraduate medical education. Training in ultrasonography helps medical students learn basic subjects such as anatomy and physiology, improve their physical examination skills, and acquire diagnostic and procedural skills. Technological advances such as simulators, affordable handheld devices, and tele-ultrasound systems can facilitate undergraduate ultrasound education. Several reports have indicated that some medical schools have integrated ultrasound training into their undergraduate medical curricula. Jichi Medical University in Japan has been providing medical students with ultrasound education to fulfill part of its mission to provide medical care to rural areas. Vertical integration of ultrasound education into a curriculum seems reasonable to ensure skill retention and improvement. However, several issues have hampered the integration of ultrasound into medical education, including a lack of trained faculty, the need to recruit human models, requisition of ultrasound machines for training, and limited curricular space; proposed solutions include peer teaching, students as trained simulated patients, the development of more affordable handheld devices, and a flipped classroom approach with access to an e-learning platform, respectively. A curriculum should be developed through multidisciplinary and bottom-up student-initiated approaches. Formulating national and international consensuses concerning the milestones and curricula can promote the incorporation of ultrasound training into undergraduate medical education at the national level.
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Marsh N, Larsen EN, Takashima M, Kleidon T, Keogh S, Ullman AJ, Mihala G, Chopra V, Rickard CM. Peripheral intravenous catheter failure: A secondary analysis of risks from 11,830 catheters. Int J Nurs Stud 2021; 124:104095. [PMID: 34689013 DOI: 10.1016/j.ijnurstu.2021.104095] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/22/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Peripheral intravenous catheters are an essential medical device which are prone to complications and failure. OBJECTIVES Identify patient, provider and device risk factors associated with all-cause peripheral intravenous catheter failure as well as individual complications: phlebitis, infiltration/occlusion, and dislodgement to improve patient outcomes. DESIGN Secondary analysis of twelve prospective studies performed between 2008 and 2020. SETTINGS Australian metropolitan and regional hospitals including one paediatric hospital. PARTICIPANTS Participants were from medical, surgical, haematology, and oncology units. METHODS Multilevel mixed-effects parametric survival regression was used to identify factors associated with all-cause peripheral intravenous catheter failure, phlebitis, occlusion/infiltration, and dislodgement. We studied patient (e.g., age, gender), device (e.g., gauge), and provider (e.g., inserting clinician) variables. Stepwise regression involved clinically and p<0.20 significant variables entered into the multivariable model. Results were expressed as hazard ratios (HRs) and 95% confidence intervals (CI); p<0.01 was considered statistically significant. RESULTS Of 11,830 peripheral intravenous catheters (8,200 participants) failure occurred in 36% (n = 4,263). Occlusion/infiltration incidence was 23% (n = 2,767), phlebitis 12% (n = 1,421), and dislodgement 7% (n = 779) of catheters. Patient factors significantly associated with failure and complications were: female gender (phlebitis; (HR 1.98, 95% CI 1.72-2.27), (infiltration/occlusion; HR 1.45, 95% CI 1.33-1.58), (failure; HR 1.36, 95% CI 1.26-1.46); and each year increase in age (phlebitis; 0.99 HR, 95% CI 0.98-0.99), (failure; 0.99 HR, 95% CI 0.99-0.99). The strongest provider risk factor was intravenous antibiotics (infiltration/occlusion; HR 1.40, 95% CI 1.27-1.53), (phlebitis; HR 1.36, 95% CI 1.18-1.56), (failure; HR 1.26, 95% CI 1.17-1.36). Catheters inserted by vascular access teams were less likely to dislodge (HR 0.53, 95% CI 0.42-0.67). Device risk factors most associated with all-cause failure were wrist/hand (HR 1.34, 95% CI 1.23-1.46), antecubital fossa peripheral intravenous catheters (HR 1.29, 95% CI 1.16-1.44) and 22/24 gauge (HR 1.27, 95% CI 1.12-1.45) catheters. CONCLUSION Factors identified, including the protective aspect of vascular access team insertion, and high catheter failure associated with intravenous antibiotic administration, will allow targeted updates of peripheral intravenous catheter guidelines and models of care.
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Affiliation(s)
- Nicole Marsh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Emily N Larsen
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Mari Takashima
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; School of Medicine, Griffith University, Queensland, Australia; Centre for Applied Health Economics, Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia; Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
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Andersen NL, Jensen RO, Posth S, Laursen CB, Jørgensen R, Graumann O. Teaching ultrasound-guided peripheral venous catheter placement through immersive virtual reality: An explorative pilot study. Medicine (Baltimore) 2021; 100:e26394. [PMID: 34232171 PMCID: PMC8270624 DOI: 10.1097/md.0000000000026394] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/27/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Immersive virtual reality (IVR)-based training is gaining ground as an educational tool in healthcare. When combined with well-established educational methods, IVR can potentially increase competency and autonomy in ultrasound (US)-guided peripheral venous cannulation.The aim of this study was to examine the impact of adding IVR training to a course in US-guided peripheral venous cannulation. METHODS Medical students (n = 19) from the University of Southern Denmark with no former standardized US education were recruited to voluntarily participate in a pilot study, designed as a randomized controlled trial. The primary outcome was the proportion of successful peripheral venous cannulations on a phantom. Secondary outcomes included the proportion of surface punctures on the phantom and procedure time. Participants received e-learning on the basic US before randomization to either IVR (n = 10) or no further training (n = 9). The additional IVR training comprised 10 virtual scenarios for US-guided peripheral venous catheter (PVC) placement. Students were subsequently evaluated in peripheral venous cannulation by a blinded assessor. RESULTS The proportion of successful peripheral venous cannulations was significantly higher in the IVR group (P ≤ .001). The proportions of successful cannulations were significantly higher in the IVR group compared to the control group for the 1st and 2nd PVC (P = .011, P = .023), but not for the 3rd PVC (P = .087). Similar results were found for the proportion of surface punctures (1st: P ≤ .001, 2nd: P = .001, and 3rd: P = .114). No significant differences in procedure times were found between the groups. CONCLUSION This pilot study showed that adding an IVR-based training simulation to an existing e-learning curriculum significantly increased the learning efficacy of US-guided PVC placement for medical students.
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Affiliation(s)
- Nanna L. Andersen
- Department of Radiology, Odense University Hospital
- Research and Innovation Unit of Radiology, University of Southern Denmark
| | - Rune O. Jensen
- Research and Innovation Unit of Radiology, University of Southern Denmark
| | | | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Denmark
| | - Rasmus Jørgensen
- Department of Respiratory Medicine, Odense University Hospital
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital
- Research and Innovation Unit of Radiology, University of Southern Denmark
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Higgins N, Iu P, Carr P, Ware R, Van Zundert A. Techniques to select site of insertion for a peripheral intravenous catheter with vessel locating devices using light, sounds or tactile actions (or palpations). J Clin Nurs 2021; 30:1091-1098. [PMID: 33440051 DOI: 10.1111/jocn.15654] [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: 05/01/2020] [Revised: 12/06/2020] [Accepted: 12/31/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Approximately 80% of patients admitted to acute hospitals have at least one peripheral intravenous catheter inserted during their admission, for the administration of fluids and medicines, and/or diagnostic tests, so the failure rate is concerning. New technology may decrease these rates even when used by inexperienced inserters. The choice of insertion site for an intravenous catheter is a known predictor of catheter failure. Therefore, the objective for this study was to evaluate the utility of vessel locating devices for novice clinicians to select catheter insertion sites in the forearm. METHODS An inter-subject incomplete counterbalanced research design was employed with healthy volunteers. Novice clinicians used either a vessel locating device using light or sound waves or they used palpation to identify relatively superficial veins in the forearm. This was compared to site selection performed by an expert clinician using palpation method only. Measurements of differences were analysed from photos of chosen sites. Bland-Altman agreement analysis was used to plot novice expert agreement. The STROBE checklist was followed in reporting this study (Techniques to select site of insertion for a peripheral intravenous catheter with vessel locating devices (Appendix S1)). RESULTS A total of 32 novice clinicians used three vessel locating devices and a palpation technique. Novice clinicians did not choose more veins for optimum catheter placement when assisted with vessel locating devices compared to palpation techniques. All methods had a similar mean difference between novice and expert measurements and a similar percentage difference in distance from the expert choice. Bland-Altman agreement analysis did not identify any advantage for the novice with vessel locating devices over palpation. CONCLUSION Vessel locating devices do not enhance the ability of novice clinicians any greater than palpation when selecting suitable forearm veins. If vessel locating device approaches are to be adopted in clinical practice to support better insertion outcomes then current PIVC teaching techniques should include structured vessel locating devices theory and practice. RELEVANCE TO CLINICAL PRACTICE Successful insertion of a peripheral intravenous catheter (PIVC) on the first attempt is a challenging procedure for nurses. Careful consideration of the selected site of insertion could modify this risk factor for catheter failure. The choice of PIVC insertion site by a novice clinician compared to an expert does not necessarily improve with the use of vein locating technology. While there is a range of technological devices available to assist with locating vessels, there needs to be more emphasis from educators on how to select an appropriate insertion site for intravenous therapy.
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Affiliation(s)
- Niall Higgins
- Queensland University of Technology, Kelvin Grove, Qld, Australia.,Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| | - Peter Iu
- Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| | - Peter Carr
- National University of Ireland, Galway, Ireland.,Griffith University, Nathan, Qld, Australia
| | | | - André Van Zundert
- Queensland University of Technology, Kelvin Grove, Qld, Australia.,Royal Brisbane and Women's Hospital, Herston, Qld, Australia.,The University of Queensland, Herston, Qld, Australia
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Vandenhouten CL, Owens AK, Hunter MR, Raynak A. Peripheral Intravenous Education in North American Nursing Schools: A Call to Action. J Nurs Educ 2020; 59:493-500. [DOI: 10.3928/01484834-20200817-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
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15
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van Loon FHJ, Willekens FJP, Buise MP, Korsten HHM, Bouwman ARA, Dierick-van Daele ATM. Clinical use of electrical stimulation with the Veinplicity®device and its effect on the first attempt success rate of peripheral intravenous cannulation: A non-randomized clinical trial. J Vasc Access 2019; 20:621-629. [DOI: 10.1177/1129729819838093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background:Peripheral intravenous cannulation is one of the most frequently performed medical procedures. Venodilation, which can be achieved with different techniques, is an important factor for first attempt success. The objective of this study was to compare the first attempt success rates upon peripheral intravenous cannulation after applying a tourniquet, with venous dilation by electrical stimulation using the Veinplicity®device, or a combination of both techniques, in participants at moderate risk of a difficult peripheral intravenous access.Methods:This non-randomized clinical trial was carried out in adult patients divided into three parallel study groups, consisting of cannulation with a tourniquet (control group), cannulation after electrical stimulation without using a tourniquet (intervention group 1), and cannulation after applying electrical stimulation followed by the application of a tourniquet on the selected upper extremity (intervention group 2). The primary outcome was the first attempt success rate of peripheral intravenous catheter placement.Results:In all, 141 participants were included in this study, with an overall success rate of 86%. Success rates of 78%, 88%, and 92% were observed in the control group, intervention group 1, and intervention group 2, respectively ( p = 0.25, χ2 = 2.771, df = 2). A higher first attempt success rate was detected in participants in intervention group 2, when compared to the control group ( p = 0.04, χ2 = 4.63, df = 1).Conclusion:Increase in first attempt success was clinically relevant when electrical stimulation with the Veinplicity®device was combined with the application of a tourniquet in participants at moderate risk of a difficult peripheral intravenous access.
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Affiliation(s)
- Fredericus HJ van Loon
- Department of Technical and Anesthesia Nursing Sciences, Fontys University of Applied Sciences, Eindhoven, The Netherlands
- Department of Anesthesiology, Pain Medicine and Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
| | - Freek JP Willekens
- Department of Anesthesiology, Pain Medicine and Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
| | - Marc P Buise
- Department of Anesthesiology, Pain Medicine and Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
| | - Hendrikus HM Korsten
- Department of Anesthesiology, Pain Medicine and Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
- Department of Signal Processing Systems and Electrical Engineering, TU/e Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Arthur RA Bouwman
- Department of Anesthesiology, Pain Medicine and Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
- Department of Signal Processing Systems and Electrical Engineering, TU/e Eindhoven University of Technology, Eindhoven, The Netherlands
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Hempel D, Schröper T, Pfister R, Michels G. [Ultrasound training in emergency and intensive care medicine : Integration already in medical school?]. Med Klin Intensivmed Notfmed 2019; 114:519-524. [PMID: 30830291 DOI: 10.1007/s00063-019-0550-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/02/2019] [Indexed: 12/21/2022]
Abstract
Ultrasound is an important diagnostic tool especially in emergency and intensive care medicine. It is always available at the bedside and shortens time to diagnosis. Many specialties have integrated ultrasound into diagnostic algorithms as part of the extended physical exam. Numerous differential diagnoses can be easily excluded using point-of-care ultrasound and therefore adequate treatment is initiated faster. Emergency or focused ultrasound is therefore of outstanding relevance to any emergency or critical care physician. Integration into medical school curricula is becoming more common tough no nationwide standards are in place yet.
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Affiliation(s)
- D Hempel
- Zentrale Notaufnahme und Aufnahmestation, Universitätsklinik Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - T Schröper
- Klinik III für Innere Medizin, Herzzentrum, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - G Michels
- Klinik III für Innere Medizin, Herzzentrum, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
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The Modified A-DIVA Scale as a Predictive Tool for Prospective Identification of Adult Patients at Risk of a Difficult Intravenous Access: A Multicenter Validation Study. J Clin Med 2019; 8:jcm8020144. [PMID: 30691137 PMCID: PMC6406455 DOI: 10.3390/jcm8020144] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/14/2022] Open
Abstract
Peripheral intravenous cannulation is the most common invasive hospital procedure but is associated with a high failure rate. This study aimed to improve the A-DIVA scale (Adult Difficult Intra Venous Access Scale) by external validation, to predict the likelihood of difficult intravenous access in adults. This multicenter study was carried out throughout five hospitals in the Netherlands. Adult participants were included, regardless of their indication for intravenous access, demographics, and medical history. The main outcome variable was defined as failed peripheral intravenous cannulation on the first attempt. A total of 3587 participants was included in this study. The first attempt success rate was 81%. Finally, five variables were included in the prediction model: a history of difficult intravenous cannulation, a difficult intravenous access as expected by the practitioner, the inability to detect a dilated vein by palpating and/or visualizing the extremity, and a diameter of the selected vein less than 3 millimeters. Based on a participant’s individual score on the A-DIVA scale, they were classified into either a low, moderate, or high-risk group. A higher score on the A-DIVA scale indicates a higher risk of difficult intravenous access. The five-variable additive A-DIVA scale is a reliable and generalizable predictive scale to identify patients at risk of difficult intravenous access.
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Safavi AH, Shi Q, Ding M, Kotait M, Profetto J, Mohialdin V, Shali A. Structured, Small-group Hands-on Teaching Sessions Improve Pre-clerk Knowledge and Confidence in Point-of-care Ultrasound Use and Interpretation. Cureus 2018; 10:e3484. [PMID: 30613446 PMCID: PMC6314823 DOI: 10.7759/cureus.3484] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Many undergraduate medical education (UME) programs have begun adopting point-of-care ultrasound (PoCUS) curricula, reflecting the increasing ubiquity of this technique across medical specialties. The structures of international PoCUS curricula have been extensively studied. However, the efficacy of these curricula to increase knowledge and confidence in PoCUS is less well-studied. We investigated whether a structured, small-group PoCUS teaching session consisting of pre-defined learning objectives, an introductory presentation, and a mandatory hands-on scanning component would increase pre-clerk knowledge of and confidence in PoCUS theory, use, and interpretation. Methods A pre-post study was designed to assess changes in pre-clerk knowledge and confidence in PoCUS theory, use, and interpretation. Pre-clerks were recruited from the Hamilton campus of the Michael G. DeGroote School of Medicine at McMaster University. Pre-clerks were organized into four groups, with an average group size of seven learners. Two preceptors each taught two groups. Sessions included an introductory PowerPoint presentation and one-on-one preceptor-guided practice in identifying abdominal and genitourinary structures using PoCUS. Student responses on pre- and post-intervention surveys were analyzed to identify changes in knowledge and confidence. Student satisfaction with the teaching session was assessed from self-reported levels of agreement with satisfaction statements. The strengths and areas of improvement for the teaching sessions were identified from open-ended survey responses. Results Data from 27 students indicated a significant improvement in knowledge test scores (p < .05), with no significant differences between groups (F(3,23) = 0.64, p = n.s.) or between students with different preceptors (p = n.s.). Students’ confidence in PoCUS use and interpretation improved significantly (p < .05 for both), with no significant differences between groups (F(3,23) = 0.70, p = n.s. and F(3,23) = 0.32, p = n.s., respectively) or between students with different preceptors (p = n.s. for both). Improvements in knowledge of and confidence in PoCUS use were significantly correlated (r = .44, p < .05). All of the students agreed that they liked the instruction, content, and structure of the teaching session. The most frequently cited strengths of the teaching sessions were the mandatory individual practice time per student, individualized instruction from and interactions with preceptors, and the small group structure of the sessions. Conclusion This study provides novel evidence that a structured, small-group teaching session featuring a didactic presentation, defined learning objectives, and mandatory hands-on learning can effectively teach introductory PoCUS knowledge and skills to pre-clerks and increase student confidence. Future studies will investigate the retention and application of PoCUS knowledge and skill throughout clerkship and early residency training to determine if this teaching model can facilitate longitudinal PoCUS learning and competency as well as improved diagnostic capabilities as students advance through undergraduate medical training.
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Affiliation(s)
- Amir H Safavi
- Medical Education and Simulation, McMaster University, Hamilton, CAN
| | - Qian Shi
- Medical Education and Simulation, McMaster University, Hamilton, CAN
| | - Maylynn Ding
- Medical Education and Simulation, McMaster University, Hamilton, CAN
| | - Maryam Kotait
- Medical Education and Simulation, McMaster University, Hamilton, CAN
| | | | - Vian Mohialdin
- Pathology and Molecular Medicine, McMaster University, Hamilton, CAN
| | - Ari Shali
- Pathology and Molecular Medicine, McMaster University, Hamilton, CAN
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Hunter MR, Vandenhouten C, Raynak A, Owens AK, Thompson J. Addressing the Silence: a Need for Peripheral Intravenous Education in North America. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.java.2018.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background: Greater than 90% of hospitalized patients receive some form of peripheral intravenous therapy for the delivery of fluids, medication, or parenteral nutrition. Nurses are the largest group of clinicians responsible for the placement and management of peripheral intravenous therapies. The literature suggests that many graduate nurses lack the confidence, knowledge, and ability to not only place peripheral intravenous catheters, but also adequately maintain peripheral intravenous sites. This fact, combined with the increasing acuity of hospitalized patients with multiple comorbidities, makes peripheral intravenous placement and management even more challenging. This drove a team of researchers to explore the current state of peripheral intravenous education in health care institutions and examine potential gaps in ongoing professional development and competency assessment.
Methods: A convenience sample of United States and Canadian health care institution representatives were recruited to participate in a 12-item web-based questionnaire regarding peripheral intravenous education and staff competency. Participants were recruited via the Association for Vascular Access listserv, newsletter, and annual meeting. Members were also asked to forward the recruitment e-mail to other health care institutions to ensure a representative sample.
Results: A total of 611 health care institution representatives participated in the study. The large majority (80%) worked in a health care institution with more than 150 beds. Over half (67%) indicated that they provide peripheral intravenous education to their staff using varying modalities to deliver the education. The majority (54%) of health care institutions reported spending between 1 and 5 hours on peripheral intravenous education while, alarmingly, 38% reported spending less than 1 hour on peripheral intravenous education for their staff. Despite these numbers, over half of the participants (58%) believe peripheral intravenous education is a shared responsibility between pre-licensure nursing schools and health care institutions.
Discussion: The study highlights the varying level of peripheral intravenous education and competency evaluation of staff working in health care institutions. The results suggest the need for an evidence-based, standardized peripheral intravenous curriculum that could be used in both health care institutions and nursing education programs.
Conclusion: Currently, there are inconsistencies in the peripheral intravenous education and competency programs used in health care institutions. The authors will use the results of this study to design and examine the effects of a standardized, evidence-based peripheral intravenous curriculum to assist health care professionals responsible for peripheral intravenous education and competency assessment. Given the risk for complications from peripheral intravenous therapy, it is hoped that improved peripheral intravenous education will reduce potential complications and improve patient outcomes.
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Affiliation(s)
| | | | - Andrea Raynak
- Chronic Disease Prevention & Management, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Andrea K. Owens
- Leighton School of Nursing, Marian University, Indianapolis, IN
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van Loon F, Buise M, Claassen J, Dierick-van Daele A, Bouwman A. Comparison of ultrasound guidance with palpation and direct visualisation for peripheral vein cannulation in adult patients: a systematic review and meta-analysis. Br J Anaesth 2018; 121:358-366. [DOI: 10.1016/j.bja.2018.04.047] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/06/2018] [Accepted: 05/21/2018] [Indexed: 12/11/2022] Open
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