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.
Keywords
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References
- Critical care basic ultrasound learning goals for American anesthesiology critical care trainees: recommendations from an expert group.Anesth Analg. 2015; 120: 1041-1053https://doi.org/10.1213/ANE.0000000000000652
- Point-of-care ultrasonography.N Engl J Med. 2011; 364: 749-757https://doi.org/10.1056/NEJMra0909487
- Ultrasound imaging in anesthesia: an overview of vascular access and peripheral nerve blocks.Semin Anesth. 2007; 26: 197-209https://doi.org/10.1053/j.sane.2007.10.003
- Ultrasound-guided intravenous line placement course for certified registered nurse anesthetists: a necessary next step.AANA J. 2019; 87: 269-275
- Use of a simulation-based mastery learning curriculum to improve ultrasound-guided vascular access skills of pediatric anesthesiologists.Pediatr Anaesth. 2020; 30: 1204-1210https://doi.org/10.1111/pan.13953
- 2020 top 10 health technology hazards executive brief.ECRI, 2020 (Updated January 18. Accessed June 20, 2020)
- Reliable and valid assessment of ultrasound operator competence in obstetrics and gynecology: assessment of ultrasound competence.Ultrasound Obstet Gynecol. 2014; 43: 437-443https://doi.org/10.1002/uog.13198
- Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications.J Ultrasound. 2013; 16: 161-170https://doi.org/10.1007/s40477-013-0046-5
- AIUM practice parameter for the use of ultrasound to guide vascular access procedures.J Ultrasound Med. 2019; 38: E4-E18https://doi.org/10.1002/jum.14954
- Ultrasound guided vascular access: Efficacy and safety.Best Pract Res Clin Anaesthesiol. 2009; 23: 299-311https://doi.org/10.1016/j.bpa.2009.02.006
- The impact of the aging population on surgical diseases.Curr Geri Rep. 2021; 10: 21-31https://doi.org/10.1007/s13670-020-00352-4
- Recommendations on the use of ultrasound guidance for central and peripheral vascular access in adults: a position statement of the Society of Hospital Medicine.J Hosp Med. 2019; 14https://doi.org/10.12788/jhm.3287
Standards for accreditation of nurse anesthesia programs: practice doctorate. Updated May 27, 2022. Accessed October 30, 2022. https://www.coacrna.org/wp-content/uploads/2022/06/Standards-for-Accreditation-of-Nurse-Anesthesia-Programs-Practice-Doctorate-revised-May-2022.pdf
Point-of-care ultrasound in anesthesia care: Practice considerations. American Association of Nurse Anesthetists. Accessed June 20, 2020. https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/professional-practice-manual/pocus-in-anesthesia-care-practice-considerations.pdf?sfvrsn=a3259e3e_2
- Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.J American Soc Echocardiogr. 2011; 24: 1291-1318https://doi.org/10.1016/j.echo.2011.09.021
- Effect of ultrasound-guided placement of difficult-to-place peripheral venous catheters: a prospective study of a training program for nurse anesthetists.AANA J. 2016; 84: 86-92
- Ultrasound-guided catheterization of the radial artery.Chest. 2011; 139: 524-529https://doi.org/10.1378/chest.10-0919
- Ultrasound-guided cannulation of the femoral vein in electrophysiological procedures: a systematic review and meta-analysis.Europace. 2017; 19: 850-855https://doi.org/10.1093/europace/euw113
- A randomized controlled trial assessing the use of ultrasound for nurse-performed IV placement in difficult access ED patients.Am J Emerg Med. 2016; 34: 1950-1954https://doi.org/10.1016/j.ajem.2016.06.098
- Ultrasound guidance for radial artery catheterization: an updated meta-analysis of randomized controlled trials. Lazzeri C., ed.PLoS ONE. 2014; 9e111527https://doi.org/10.1371/journal.pone.0111527
- Efficacy of ultrasound-guided technique for radial artery catheterization in pediatric populations: a systematic review and meta-analysis of randomized controlled trials.Crit Care. 2020; 24: 197https://doi.org/10.1186/s13054-020-02920-8
- Establishing the required components for training in ultrasoundguided peripheral intravenous cannulation: a systematic review of available evidence.Med Ultrason. 2019; 21: 464https://doi.org/10.11152/mu-2120
- Implementation and evaluation of training for ultrasound-guided vascular access to small vessels using a low-cost cadaver model.Pediatr Crit Care Med. 2018; 19: e611https://doi.org/10.1097/PCC.0000000000001721
- An unseen danger: frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance.Crit Care Med. 2009; 37: 2345-2349https://doi.org/10.1097/CCM.0b013e3181a067d4
- SQUIRE 2.0 (Standards for quality improvement reporting excellence): revised publication guidelines from a detailed consensus process.BMJ Qual Saf. 2016; 25: 986-992https://doi.org/10.1136/bmjqs-2015-004411
- Practice guidelines for central venous access 2020.Anesthesiology. 2020; 132: 8-43https://doi.org/10.1097/ALN.0000000000002864
Article info
Publication history
Published online: January 18, 2023
Publication stage
In Press Corrected ProofFootnotes
Conflict of Interest: None to report.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2022 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
