Name: 作者聚焦：通过模拟培训评估临床医生对超声引导下血管插管的采用情况
Uploaded: 2024-08-09T13:20:00
Description: The use of point-of-care ultrasound (POCUS) has shown to be a beneficial non-invasive vascular access assessment method by clinicians, which can provide ...

作者要感谢西澳大利亚州尼德兰兹市查尔斯盖尔德纳爵士医院的超声学家 James Rippey 博士，他为如何在实验中创建所使用的仿真模型提供了指导和说明。该项目没有得到任何机构财政支持。

这项研究得到了埃迪斯科文大学人类研究伦理委员会的批准，参考编号 REMS 2021-02489-STEINWANDEL。从研讨会参与者那里获得了知情同意，并提供了参与者信息表的副本。只有在 2021 年至 2022 年的交付期间参加过其中一个超声研讨会的研讨会参与者才被邀请参加并纳入本研究。2023 年和 2024 年的所有后续研讨会参与者均被排除在本研究之外。
1. 创建和准备仿真模型<sup class="xref"...

使用仿真模型培训 POCUS 血管插管的新手

<ol>
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O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+point+of+care+ultrasound+(pocus)+by+intensive+care+paramedics+to+achieve+peripheral+intravenous+access+in+patients+predicted+to+be+difficult:+An+out-of-hospital+pilot+study.">Use of point of care ultrasound (pocus) by intensive care paramedics to achieve peripheral intravenous access in patients predicted to be difficult: An out-of-hospital pilot study.</a> Australas Emerg Care. 26 (2), 164-168 (2023).</li><li>Dornhofer, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+a+point-of-care+ultrasound+curriculum+taught+by+medical+students+for+physicians,+nurses,+and+midwives+in+rural+Indonesia.">Evaluation of a point-of-care ultrasound curriculum taught by medical students for physicians, nurses, and midwives in rural Indonesia.</a> J Clin Ultrasound. 48 (3), 145-151 (2020).</li><li>JoVE Science Education Database. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Physical Examination IV. , (2024).</li><li>Archer-Jones, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluating+an+ultrasound-guided+peripheral+intravenous+cannulation+training+program+for+emergency+clinicians:+An+Australian+perspective.">Evaluating an ultrasound-guided peripheral intravenous cannulation training program for emergency clinicians: An Australian perspective.</a> Australas Emerg Care. 23 (3), 151-156 (2020).</li><li>Steinwandel, U., Coventry, L. L., Kheirkhah, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+a+point-of-care+ultrasound+(pocus)+workshop+for+peripheral+intravenous+cannulation.">Evaluation of a point-of-care ultrasound (pocus) workshop for peripheral intravenous cannulation.</a> BMC Med Educ. 23 (1), 451 (2023).</li><li>Feinsmith, S., Huebinger, R., Pitts, M., Baran, E., Haas, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcomes+of+a+simplified+ultrasound-guided+intravenous+training+course+for+emergency+nurses.">Outcomes of a simplified ultrasound-guided intravenous training course for emergency nurses.</a> J Emerg Nurs. 44 (2), 169-175.e2 (2018).</li><li>Feinsmith, S. 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C., Blanco, P., Carr, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+affordable+and+easily+constructed+model+for+training+in+ultrasound-guided+vascular+access.">An affordable and easily constructed model for training in ultrasound-guided vascular access.</a> J Vasc Access. 16 (5), 422-427 (2015).</li><li>Birrane, J., Misran, H., Creaney, M., Shorten, G., Nix, C. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+scoping+review+of+ultrasound+teaching+in+undergraduate+medical+education.">A scoping review of ultrasound teaching in undergraduate medical education.</a> Med Sci Educ. 28 (1), 45-56 (2018).</li><li>Van Loon, F. H. J., Scholten, H. J., Van Erp, I., Bouwman, A. R. A., Daele, A. T. M. D. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Establishing+the+required+components+for+training+in+ultrasoundguided+peripheral+intravenous+cannulation:+A+systematic+review+of+available+evidence.">Establishing the required components for training in ultrasoundguided peripheral intravenous cannulation: A systematic review of available evidence.</a> Med Ultrason. 21 (4), 464-473 (2019).</li><li>Spencer, T. R., Bardin-Spencer, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pre-+and+post-review+of+a+standardized+ultrasound-guided+central+venous+catheterization+curriculum+evaluating+procedural+skills+acquisition+and+clinician+confidence.">Pre- and post-review of a standardized ultrasound-guided central venous catheterization curriculum evaluating procedural skills acquisition and clinician confidence.</a> J Vasc Access. 21 (4), 440-448 (2020).</li><li>Adhikari, S., Schmier, C., Marx, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Focused+simulation+training:+Emergency+department+nurses'+confidence+and+comfort+level+in+performing+ultrasound-guided+vascular+access.">Focused simulation training: Emergency department nurses' confidence and comfort level in performing ultrasound-guided vascular access.</a> J Vasc Access. 16 (6), 515-520 (2015).</li><li>Stone, R., Walker, R. M., Marsh, N., Ullman, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Educational+programs+for+implementing+ultrasound+guided+peripheral+intravenous+catheter+insertion+in+emergency+departments:+A+systematic+integrative+literature+review.">Educational programs for implementing ultrasound guided peripheral intravenous catheter insertion in emergency departments: A systematic integrative literature review.</a> Australas Emerg Care. 26 (4), 352-359 (2023).</li><li>Thomas, S., Moore, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+vanishing+target+sign:+Confirmation+of+intraluminal+needle+position+for+ultrasound+guided+vascular+access.">The vanishing target sign: Confirmation of intraluminal needle position for ultrasound guided vascular access.</a> Acad Emerg Med. 20 (10), e17-e18 (2013).</li><li>Schott, C. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Retention+of+point-of-care+ultrasound+skills+among+practicing+physicians:+Findings+of+the+VA+national+Pocus+training+program.">Retention of point-of-care ultrasound skills among practicing physicians: Findings of the VA national Pocus training program.</a> Am J Med. 134 (3), 391-399.e8 (2021).</li><li>Smith, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Should+nurses+be+trained+to+use+ultrasound+for+intravenous+access+to+patients+with+difficult+veins.">Should nurses be trained to use ultrasound for intravenous access to patients with difficult veins.</a> Emerg Nurse. 26 (2), 18-24 (2018).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=AIUM+practice+parameter+for+the+use+of+ultrasound+to+guide+vascular+access+procedures.">AIUM practice parameter for the use of ultrasound to guide vascular access procedures.</a> J Ultrasound Med. 38 (3), E4-E18 (2019).</li><li>Keogh, S., Mathew, S., Alexandrou, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Peripheral intravenous catheters: A review of guidelines and research. , (2019).</li><li>Lian, A., Rippey, J. C. R., Carr, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Teaching+medical+students+ultrasound-guided+vascular+access+-+which+learning+method+is+best.">Teaching medical students ultrasound-guided vascular access - which learning method is best.</a> J Vasc Access. 18 (3), 255-258 (2017).</li><li>Armenteros-Yeguas, V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+of+difficult+venous+access+and+associated+risk+factors+in+highly+complex+hospitalised+patients.">Prevalence of difficult venous access and associated risk factors in highly complex hospitalised patients.</a> J Clin Nurs. 26 (23-24), 4267-4275 (2017).</li><li>Van Loon, F. H. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=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.">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.</a> J Clin Med. 8 (2), 144 (2019).</li><li>Yalcinli, S., Akarca, F. K., Can, O., Sener, A., Akbinar, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Factors+affecting+the+first-attempt+success+rate+of+intravenous+cannulation+in+older+people.">Factors affecting the first-attempt success rate of intravenous cannulation in older people.</a> J Clin Nurs. 28 (11-12), 2206-2213 (2019).</li><li>Nickel, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Infusion therapy standards of practice. , (2024).</li><li>Coritsidis, G. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Point-of-care+ultrasound+for+assessing+arteriovenous+fistula+maturity+in+outpatient+hemodialysis.">Point-of-care ultrasound for assessing arteriovenous fistula maturity in outpatient hemodialysis.</a> J Vasc Access. 21 (6), 923-930 (2020).</li><li>Ballard, H. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+a+simulation-based+mastery+learning+curriculum+to+improve+ultrasound-guided+vascular+access+skills+of+pediatric+anesthesiologists.">Use of a simulation-based mastery learning curriculum to improve ultrasound-guided vascular access skills of pediatric anesthesiologists.</a> Paedia Anaesthesia. 30 (11), 1204-1210 (2020).</li><li>Russell, C., Mullaney, K., Campbell, T., Sabado, J., Haut, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcomes+of+a+pediatric+ultrasound-guided+short+peripheral+catheter+training+program+and+hands-on+poultry+simulation+course.">Outcomes of a pediatric ultrasound-guided short peripheral catheter training program and hands-on poultry simulation course.</a> J Infusion Nurs. 44 (4), 204-215 (2021).</li><li>Feinsmith, S. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Performance+of+peripheral+catheters+inserted+with+ultrasound+guidance+versus+landmark+technique+after+a+simulation-based+mastery+learning+intervention.">Performance of peripheral catheters inserted with ultrasound guidance versus landmark technique after a simulation-based mastery learning intervention.</a> J Vasc Access. 24 (4), 630-638 (2021).</li><li>Amick, A. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+mastery+learning+improves+ultrasound-guided+peripheral+intravenous+catheter+insertion+skills+of+practicing+nurses.">Simulation-based mastery learning improves ultrasound-guided peripheral intravenous catheter insertion skills of practicing nurses.</a> Simulation in Healthcare. 17 (1), 7-14 (2022).</li><li>Bahl, A., Mielke, N., Diloreto, E., Gibson, S. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Operation+stick:+A+vascular+access+specialty+program+for+the+generalist+emergency+medicine+clinician.">Operation stick: A vascular access specialty program for the generalist emergency medicine clinician.</a> J Vasc Access. , (2024).</li><li>Oh, E. J., Lee, J. -. H., Kwon, E. J., Min, J. 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困难静脉疾病的血管通路插管需要经验、手部灵活性以及在套管穿过人体组织进入血管内间隙时持续观察针尖位置的进展18。虽然超声在静脉通路困难的患者2 中的使用变得更加普遍，但初级临床医生和新手也有必要熟悉超声在血管通路空间中的使用，并接受足够的培训 17,19,20.在使用 POCUS 和...

大多数被紧急医院收治的患者至少接受一根外周静脉导管 （PIVC），目的是抽血、输液和/或给药以及诊断目的1。首次尝试插入失败是很常见的，据报道，高达 50% 的住院患者存在静脉通路困难 （DIVA）2。为了缓解这种情况，使用超声引导下 PIVC 插入 （USGPIVC） 已被证明可以提高插入成功率，并且已建议多个医疗保健专业进行培训和实践教育 3,4,5。如今，床边的床旁超声 （POCUS） 更频繁地用于建立血管通路。POCUS 也被描述为增强体格检查教学和学习的有用工具6。虽然有几项研究描述了 USGPIVC 的培训可能会提高临床医生的技能 7,8,9,10，但尚未详细描述该培训的哪些具体要素是在将 POCUS 应用于 USGPIVC 时实现预期结果的基本组成部分。为了实现这一目标，开发了 POCUS 和 USGPIVC 联合培训课程，涵盖了培训的基本方面，这些方面被认为是 USGPIVC 研讨会的基本方面和学习目标，包括理论背景和实践方面。
在血管通路插管之前和期间培训新手使用 POCUS 需要一个理想的模拟环境，以实现有效的学习成功，从而复制与人体解剖环境中类似的解剖条件11。因此，由鸡胸肉和充满液体的建模球囊创建的仿真模型被发现是理想的，可用于生成这样的仿真模型12。这种方法教会学习者观察技能，首先在安全的模拟环境中评估个体患者水平的血管状况，这有助于选择所需套管长度、评估血管深度和宽度以及个体患者的血管方向的整体决策过程。这允许对任何未来患者的个体解剖状况进行严格评估，临床医生可能希望随后决定计划的插管是否可能成功。为了获得这些信息，当 POCUS 获得的图像被正确解释时，通常会提供可靠和关键的信息元素，除了临床医生的经验和手动灵活性外，这些信息还可能导致插管成功。
在第二步中，学习者在这个模拟环境中被教导发展使用超声探头的手部灵巧性，同时在视觉下将套管插入模拟血管的手部技能，观察 POCUS 屏幕和插入部位。这种不断可视化模拟血管并在插入过程中仔细观察针尖的观察技能是该模拟活动总体学习目标中最重要的方面，直到针尖最终放置在感兴趣的解剖区域，在这种情况下位于模拟血管的中心。这个过程对于避免意外和不必要的血管损伤、组织、出血或外渗至关重要，因为该技术旨在随后由参与者在临床环境中用于患者。
一些作者之前曾建议使用低成本的模拟模型和小型教学小组13 将超声实施并整合到医学院课程中。其他人建议制定结构化的培训计划，然后在模拟环境中进行实践课程14。还描述说，使用超声有助于手术成功，并可能降低患者的风险15。其他人观察到，使用 POCUS 和 USGPIVC 培训急诊科 （ED） 的临床医生在短期内增加了这种方法的使用。尽管如此，血管通路的正式教育计划也可能缺乏一致性 7,16,17。相比之下，其他人描述说，正规的血管通路培训可以提高对 PIVC 插入最佳实践的依从性11。
这种教育方法的目的是为学习者模拟类似的视觉和灵巧体验，以便他们能够在临床环境和将来的患者中复制和应用这项技能。选择了一种观察性纵向混合方法研究方法，并使用电子调查来评估使用超声 （POCUS） 与外周静脉插管相关的研讨会参与者的信心水平。这些调查首先用于模拟模型，随后用于入院患者的研讨会参与者的临床专业。
研讨会分为三个部分。首先，向参与者介绍了在交互式学习环境中在血管通路插管空间使用超声的一些基本原理和理论。在第二种方法中，研讨会主持人使用模拟器演示了血管通路评估方法，并创建了模拟的人工血管，演示了通过横向和纵向视图以及使用 POCUS 进行观察来观察血管深度、大小和方向。随后通过研讨会主持人使用 POCUS 和模拟器进行了演示插管，然后邀请参与者在他们的个人模拟器上自己练习这项任务。在研讨会结束时，参与者在模拟器中使用横向和纵向视图识别和测量血管大小、深度和方向的技能进行了单独评估，然后对模拟血管进行超声引导插管。参加研讨会后，参与者被邀请在电子调查中评估他们对使用 USPIVC 的信心技能。在参加研讨会后 8 周，参与者再次被邀请在电子调查中回答他们是否在个人临床环境中应用了这项采用的技能。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>BD Insyte Autogard BC Pro shielded IV catheter with blood control technology (PIVC)</td>
			<td>BD</td>
			<td>318054</td>
			<td></td>
		</tr>
		<tr>
			<td>Catheter tipped syringe 30 or 50 ml</td>
			<td>BD Plastipak&#160;</td>
			<td>301229, 300865</td>
			<td></td>
		</tr>
		<tr>
			<td>Celeste Nitrile Powder Free Examination gloves sizes S/M/L (non-sterile)</td>
			<td>Celeste</td>
			<td>CLS121</td>
			<td></td>
		</tr>
		<tr>
			<td>Goliath Cling wrap</td>
			<td>Goliath</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>modelling balloons 260 Q</td>
			<td>Qualatex&#160;</td>
			<td>99321</td>
			<td></td>
		</tr>
		<tr>
			<td>Point-of care ultrasound device, eg. Philips Lumify or Vscan Air</td>
			<td>Philips or GE Healthcare</td>
			<td></td>
			<td>https://www.usa.philips.com/healthcare/product/HC989605450382/lumify-c5-2-curved-array-transducer</td>
		</tr>
		<tr>
			<td>probe cover for Philips lumify</td>
			<td>Philips&#160;&#160;</td>
			<td></td>
			<td>https://www.usa.philips.com/healthcare/product/HC989605450382/lumify-c5-2-curved-array-transducer</td>
		</tr>
		<tr>
			<td>raw chicken breast</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Sunsonic Ultrasound Transmission Gel 250 ml</td>
			<td>Sunsonic</td>
			<td>LG250</td>
			<td></td>
		</tr>
		<tr>
			<td>Tasty Herbal Infusion Rosehip Tea</td>
			<td>Tasty</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Victorinox Fibrox Chef&#39;s Knife 20 cm</td>
			<td>Victorinox</td>
			<td>40520</td>
			<td></td>
		</tr>
	</tbody>
</table>

using simulation models to train clinicians in the use of point-of-care ultrasound 

临床医生使用床旁超声 （POCUS） 已被证明是一种有益的无创血管通路评估方法，它可以提供视觉和可测量信息的关键要素，这些信息被证明在血管通路插管的情况下是有用的，并结合临床医生的实践技能进行插管。然而，在这种情况下使用 POCUS 是为了实际训练和使使用该技术的新手能够熟练地随后以谨慎和成功的方式对患者执行这项任务。这些血管状况的模拟可能有助于帮助医疗保健专业人员学习、理解、应用和建立安全血管插管的实用技能，以达到预期的结果。该项目旨在通过参加为期半天的研讨会，建立将 POCUS 与仿真模型结合使用并执行特定任务的技能，使临床医生能够在临床实践中使用该方法为患者进行血管通路插管。采用混合方法纵向研究设计来评估床旁超声研讨会对外周静脉插管插入的效果，包括参与者在模拟模型上执行的特定任务。共有 81 人参加了 2021 年和 2022 年的 11 场半天研讨会。提供一个将仿真模型与各种 POCUS 设备结合使用的研讨会有助于在临床医生中建立这种新学到的技能，例如在插管前使用 POCUS 测量静脉的深度、卡尺和方向，为操作者提供基本的解剖学事实，这增加了插管首次成功的可能性。

Most patients being admitted to acute hospitals receive at least one peripheral intravenous catheter (PIVC), with the purpose of withdrawing blood, administration of fluids and/or medication, and for diagnostic purposes1. It is common that first-attempt insertions fail, and it has been reported that up to 50% of hospitalized patients have difficult intravenous access (DIVA)2. To alleviate this, the use of ultrasound-guided PIVC insertion (USGPIVC) has been demonstrated to improve insertion success rates, and training and practical education have been recommended for multiple healthcare professions3,4,5. Point-of-care ultrasound (POCUS) at the bedside is nowadays more frequently used to gain vascular access. POCUS has also been described as a useful tool for augmenting the teaching and learning of physical examination6. While several studies have described that training in USGPIVC is likely to enhance the skills of clinicians7,8,9,10, it has not yet been described in detail which specific elements of this training are the essential components to achieve the desired outcomes when applying POCUS for USGPIVC. To achieve this, a combined POCUS and USGPIVC training curriculum was developed covering the essential aspects of the training, which were considered as being the elemental aspects and learning objectives for USGPIVC workshops, including the theoretical background and practical hands-on aspects.
Training novices in the use of POCUS prior to and during vascular access cannulation requires an ideal simulation environment to enable effective learning success which replicates similar anatomical conditions as in a human anatomical environment11. Therefore, simulation models created from chicken breast and fluid-filled modeling balloons were found to be ideal and can be used to generate such a simulation model12. This approach teaches the learner the observational skill of assessing vascular conditions at an individual patient level first in a safe, simulated environment, which helps in the overall decision-making process of choosing the required cannula length, assessment of the vascular depth and width, and vessel direction for an individual patient. This allows for a critical assessment of any future patient&#39;s individual anatomical conditions, where a clinician may want to subsequently decide if the planned cannulation is likely to be successful or not. To obtain this information, POCUS-obtained images, when they are interpreted correctly, usually provide reliable and critical elements of information, which, in addition to the clinicians&#39; experience and manual dexterity, are likely to lead to cannulation success.
In the second step, the learner is taught, in this simulative environment, the development of manual dexterity for using the ultrasound probe simultaneously with the manual skill of inserting a cannula, under vision, observing the POCUS screen and the insertion site, into the simulated blood vessel. This observational skill of constantly visualizing the simulated vessel and meticulously observing the needle tip during the insertion process is the most important aspect of the overall learning goal of this simulation activity until the needle tip is ultimately placed in the anatomical area of interest, in this case in the center of a simulated vessel. This process is crucial to avoid unintended and unnecessary vessel injury, tissue, bleeding, or extravasation, as this technique is intended to be subsequently used in a patient in clinical settings by the participant.
Some authors have previously recommended implementing and integrating ultrasound into the medical school curriculum, using low-cost simulation models and small teaching groups13. Others have recommended developing structured training programs followed by a hands-on session in a simulated environment14. It has also been described that the use of ultrasound helps with procedural success and may reduce risks for patients15. Others have observed that using POCUS and USGPIVC to train clinicians in the emergency department (ED) has increased the use of this approach in the short term. Still, there may also exist a lack of consistency in formalized education programs for vascular access7,16,17. In contrast, others have described that formalized vascular access training leads to improved adherence to best practices&#160;for PIVC insertion11.
The aim of this educational approach was to simulate a comparable visual and dexterity experience for learners so that they could replicate and apply this skill in a clinical setting and on patients in the future. An observational longitudinal mixed methods study approach was chosen, and electronic surveys were used to assess the confidence level of workshop participants using ultrasound (POCUS) in connection with peripheral venous cannulation. The surveys were first used in simulation models and subsequently used in the clinical specialty of workshop participants in admitted patients.
The workshop was divided into three parts. First, participants were introduced to some basic principles and theories of using ultrasound in the space of vascular access cannulation in an interactive learning environment. In a second approach, the workshop facilitator demonstrated the vascular access assessment approach using a simulator with a simulated artificial vessel created, demonstrating the observation of vessel depth, size, and direction through transverse and longitudinal view and observation using POCUS. This was followed by a demonstrated cannulation using POCUS and the simulator through the workshop facilitator, as participants were then invited to practice this task themselves on their individual simulators. At the workshop conclusion, participants were individually assessed on their skill of identifying and measuring vessel size, depth, and direction using transverse and longitudinal views in the simulator, followed by ultrasound-guided cannulation of the simulated vessel. After the workshop attendance, participants were invited to rate their confidence skills in using USPIVC in an electronic survey. At 8 weeks after the workshop attendance, participants were again invited to respond in an electronic survey if they had applied this adopted skill in their individual clinical setting.

作者聚焦：通过模拟培训评估临床医生对超声引导下血管插管的采用情况

使用仿真模型培训临床医生使用床旁超声 

This experiment tried to answer the question of clinicians unfamiliar with the use of ultrasound for vascular cannulation who may be able to learn and practice the skill of ultrasound-guided cannulation in a simulation model and are subsequently able to apply this skill in the clinical setting. Portable ultrasound devices are increasingly available in clinical areas because they are more affordable today than in the past, but clinicians need to be trained on how to use them successfully. Novices can learn the technique of ultrasound-guided cannulation fast when they have the opportunity to train on simulation models and make multiple attempts before they apply the same technique in their clinical setting.The use of ultrasound during the cannulation has the advantage of providing information about the depth, size, and direction of muscular structure before the actual cannulation occurs. Further, it provides a clear vision of the needle tip being observable during the cannulation process. We are planning on performing a survey amongst senior clinicians to determine their views and perspectives on the use of this technique and what kind of barriers in the clinical space may exist.

2021 年至 2022 年期间，共有 81 人参加了 11 次为期半天的研讨会。大多数参与者是住院医务人员 （n=43， 53%），其次是员工发展/临床护士和临床护士顾问 （n=19， 25.3%），平均具有 8 年的临床经验。一半的参与者 （n=40， 49%） 只有 2 年或更短的临床经验。还有一些其他研讨会参与者，例如核医学技术专家、牙科镇静师和诊断放射科医生。近四分之一的参与者受雇于卫星血液透析 （HD） 诊所。几乎?...

本方案描述了一种理想的解决方案，可以培训新手使用床旁超声设备，以掌握在患者使用床旁超声进行预期的静脉血管插管之前和期间目视评估不同个体解剖血管状况的实用临床技能。

The use of point-of-care ultrasound (POCUS) has shown to be a beneficial non-invasive vascular access assessment method by clinicians, which can provide ...

using-simulation-models-to-train-clinicians-use-point-care

Research

JoVE Journal

Medicine

Using Simulation Models to Train Clinicians in the Use of Point-of-Care Ultrasound 

The use of point-of-care ultrasound (POCUS) has shown to be a beneficial non-invasive vascular access assessment method by clinicians, which can provide critical elements of visual and measurable information that proves to be useful in the context of vascular access cannulation, in combination with the practical skill of the clinician performing the cannulation. However, the use of POCUS in this context is to practically train and enable individuals who are novices in using this technique to become proficient in performing this task subsequently on patients in a careful and successful way. The simulation of these vascular conditions may be useful to help healthcare professionals learn, understand, apply, and establish such practical skills for vascular cannulation safely to achieve the desired outcomes. This project intended, through the attendance of a half-day workshop, to establish skills to use POCUS in connection with simulation models and perform specific tasks to enable clinicians to use this method in their clinical practice for vascular access cannulation in patients. A mixed-methods longitudinal study design was used to evaluate the effect of a point-of-care ultrasound workshop for peripheral intravenous cannula insertion, including specific tasks for the participants to be performed on simulation models. A total of 81 individuals participated in 11 half-day workshops through 2021 and 2022. Offering a workshop that uses simulation models in combination with various POCUS devices is useful in establishing this newly learned skill in clinicians, such as measurements of depth, caliper, and direction of a vein with POCUS prior to cannulation providing essential anatomical facts to the operator, which increases the likelihood of first-time success in cannulation.

The present protocol describes an ideal solution to train novices in the use of point-of-care ultrasound devices for the practical clinical skill of visually assessing distinct individual anatomical vascular conditions prior to and during an intended venous vascular cannulation using point-of-care ultrasound in a patient.

科研

医学

Creation and Preparation of a Chicken Breast Simulation Model for Blood Vessel Experiments

To begin, cut a regular raw chicken breast horizontally with a sharp kitchen knife to allow for the insertion of three or more fluid-filled artificial blood vessels. Fill a 50-milliliter catheter-tipped syringe with cold rose hip tea. Push the fluid in the balloon and remove any air bubbles at the same time by repeatedly pushing the syringe in and out of the modeling balloon.At the end, ensure the balloon is free of air bubbles and slightly pressurized. Tighten the modeling balloon with a knot to avoid any fluid leaks. Place the fluid-filled modeling balloon on the lower half of the chicken breast.Fold the other half of the chicken breast over the balloon. Wrap this chicken breast simulation model with a transparent film. And place it on a tray.

创建和准备用于血管实验的鸡胸肉模拟模型

Simulated Vascular Access Cannulation and Vessel Measurement Using Point-of-Care Ultrasound (POCUS)

To begin, place a point-of-care ultrasound, or POCUS, device with a linear probe and a probe cover onto the prepared simulation model. Apply ultrasound gel to the area of interest in the simulation model. In a transverse view, visualize a simulated vessel in the simulation model.Place the ultrasound probe on top of the simulation model and center the view of the vessel in the middle of the screen of the ultrasound device, where vessels appear as a black circular structure. Move the ultrasound probe across the simulation model to place the vessel in the center of the screen of the POCUS device so that the whole vascular structure is visible. Adjust the image size and contrast settings to obtain optimal vision of the vessel and surrounding tissue.Press the freeze function button to freeze the image. Next, place digital markers to indicate the depth of the center of the vessel and to measure the diameter of the vessel. Rotate the ultrasound probe by 90 degrees to obtain a longitudinal view of the blood vessel.Observe the direction of the vessel being aligned with the probe. Place the linear probe in a transverse view of the vessel. Remove the protective needle cover of the peripheral intravenous catheter cannula to commence the cannulation procedure.Place the transverse vision of the vessel centrally on the screen of the POCUS device. Slowly and carefully cannulate in the middle of the linear probe the simulation model at an angle of around 40 degrees, aiming for the top of the vessel. Advance the needle tip into the tissue of the simulation model, aiming for the vessel.While advancing through the tissue, visually identify the needle tip on the screen of the POCUS device. Further advance the needle through the tissue towards the vessel, following the needle tip with the ultrasound probe simultaneously. Visualize the needle tip entering the intervascular space, then level the needle to a shallower angle and advance it to rest in the center of the vessel.To validate the position of the needle tip, change the angle of the ultrasound probe or move it in small increments back and forth until the needle tip visually disappears and reappears on the screen. Observe the opposite end of the peripheral intravenous catheter for some evidence of red-colored fluid to confirm correct placement. Finally, remove the stylet from the peripheral intravenous catheter.