Designing and Establishing an Ultrasound Guided Vascular Access Workshop for Non-Radiologist: A Practical Manual from A to Z

Authors

Dimitri A. Parra MD
Simal Goman
Anne Skelding
Rajat Chand MD

Theme

7II Simulation and Simulated Patients

INSTITUTION

Centre for Image Guided Care and Diagnostic Imaging.
The Hospital for Sick Children and
University of Toronto. Toronto. Ontario. Canada.

Background

Ultrasound guided vascular access is an increasing need in highly complex hospitals to reduce complications from central venous line placement, which range between 5%-26%.  Complications such as infection, penumothorax, arterial puncture, deep vein thrombosis, and bleeding are inversely related to the level of the practicioner's experience. Simulation Based Learning (SBL) has shown measurable efficacy in the ability to make medical trainees more skilled and self-confident in central line placement, specifically in the sequence of events involved and the safety procedures required. Different specialties are currently interested in learning these skills and acquiring this self-confidence, which prompted us to develop a simulation based workshop.

Summary of Work

A half day workshop was developed.  A pilot group with six participants from different specialties was selected. An online teaching module and pre-course reading material were delivered to the participants as a pre-requisite.  The online module provided an interactive review of the basics of vascular access including ultrasound orientation, aseptic technique, a step-by-step checklist of the procedure, and possible complications. The workshop started with didactic lectures (topics covered: ultrasound basics, technique of vascular access and types of central venous catheters). This was followed by an introduction on the use of the ultrasound machine, after which participants began simulation based learning in task trainers (ultrasound compatible vascular access models).  Three stations were setup to allow 30 minutes of practice in groups of two.  The stations were designated as "Needle Guidance," "Neck Jugular Access," and "Baby Jugular and Femoral Access"(Figure 1).  Time was given for deliberate practice and final debriefing.  Course evaluation was performed by all participants.

Figure 1. Course participants practicing ultrasound guided vascular access in task trainers.

Summary of Results

The workshop was very successful with an enthusiastic participation of the learners.  They were actively engaged in the different activities and positive feedback was obtained.  Deliberate practice is crucial to skill acquisition and maintenance.  Advanced workshops and dedicated electives are under development to maintain the skills taught.  Adjustments of the workshop were performed based on the learners' feedback.

Conclusion

Interventional Radiologists traditionally perform and teach ultrasound guided interventions.  It can be difficult for these specialists to teach non-imaging related specialties.  We were able to create a successful half day workshop targeted to this group of health care professionals. We believe that having an inter-professional approach and utilizing different teaching modalities was a key for success.

Take-home Messages

Our recommendations for developing an ultrasound guided vascular workshop are:

A. Create a pre-course online teaching module.

B. Deliver pre-course reading material.

C. Include multidisciplinary instructors and learners.

D. Combine didactic lectures with Simulation Based learning.

E. Give adequate time for deliberate practice, debriefing and course evaluation.

F. Have equipment available for all participants.

Z. Pay careful attention to the learners' feedback and be aggressive in making changes to the workshop accordingly.

 

Acknowledgement

To the Learning Institute of the Hospital for Sick Children and Image Guided Therapy. 

References
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Background
Summary of Work
Summary of Results
Conclusion
Take-home Messages
Acknowledgement
References
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