University of Iowa Stead Family Children's Hospital, Iowa City, IA, Alliance for Vascular Access Teaching.
Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith, University, Queensland, Australia.
Br J Nurs. 2020 Jul 23;29(14):S40-S48. doi: 10.12968/bjon.2020.29.14.S40.
There is a wide variance in neonatal and pediatric vascular access workforce models, training, and competency assessments. Pain control during procedures is critical for children, yet it is not consistently used. Procedural support has shown improved patient outcomes, yet is not standardly used for every distressful procedure. Core standards are needed to ensure proper training and support for the pediatric and neonatal vascular access clinicians.
Despite evidence to support best practice in neonatal and pediatric venipuncture delivery and procedural support, there are inconsistencies in practice. To inform future research, education, and workforce innovation, the Association for Vascular Access Pediatric Special Interest Group (PediSIG) developed and undertook a survey to describe the current vascular access practice for clinicians caring for neonatal and pediatric patients.
Describe the current state of workforce models, training, and clinical practices surrounding pediatric and neonatal vascular access.
Cross-sectional, electronic survey using convenience sampling.
International clinicians who provide vascular access (peripheral intravenous catheter insertion, venipuncture for blood sampling) for neonatal and pediatric patients.
An electronic survey was developed by the PediSIG. The survey covered workforce models, clinician training and competency, pain relief, procedural support, and device securement. The electronic survey was then distributed to the PediSIG membership and shared among several neonatal/pediatric email lists. Data were analyzed descriptively, with an exploration of association between clinical outcomes, workforce, and training.
There were 242 responses from 5 countries showing a wide variance of practice. Workforce models showed many different team names and responsibilities along with a variance of personnel and staffing hours. Clinician training was described as 4 hours or less by 44% ( = 69) of respondents. Less than half of the responses (47%; = 99) reported having a formal procedure to escalate a patient to an expert care and not having a set number of max attempts before escalation. Only two-thirds ( = 115) of respondents said they had a standardized protocol for pain control and procedural support, with only 13% ( = 23) and 15% ( = 27), respectively, self-reporting that they always followed the protocol.
The respondents reported a wide variance in neonatal and pediatric vascular access procedures and the resources used to support this practice. Core standards need to be developed to help guide neonatal and pediatric clinicians and their institutions. The standards should encompass recommendations for workforce models, proper training, competency, insertion guidelines, pain control.
要点：新生儿和儿科血管通路工作人员的模式、培训和能力评估存在很大差异。在操作过程中控制疼痛对儿童至关重要，但并未得到一致应用。程序性支持已显示出改善患者结局的效果，但并非对每一次痛苦操作都标准使用。需要核心标准来确保对儿科和新生儿血管通路临床医生进行适当的培训和支持。
背景：尽管有证据支持新生儿和儿科静脉穿刺术操作和程序支持的最佳实践，但实践中存在不一致的情况。为了为未来的研究、教育和劳动力创新提供信息，血管通路协会儿科特别兴趣小组（PediSIG）制定并开展了一项调查，以描述照顾新生儿和儿科患者的临床医生的当前血管通路实践情况。
目的：描述围绕儿科和新生儿血管通路的劳动力模式、培训和临床实践的现状。
设计：使用便利抽样的横断面电子调查。
地点：为新生儿和儿科患者提供血管通路（外周静脉导管插入、静脉采血用于血样采集）的国际临床医生。
方法：PediSIG 开发了一项电子调查。该调查涵盖了劳动力模式、临床医生培训和能力、缓解疼痛、程序性支持以及设备固定。然后将电子调查分发给 PediSIG 成员，并在几个新生儿/儿科电子邮件列表中共享。数据采用描述性分析，探讨临床结果、劳动力和培训之间的关联。
结果：来自 5 个国家的 242 份回复显示出实践中的广泛差异。劳动力模式显示了许多不同的团队名称和职责，以及人员和人员配置时间的差异。44%（=69）的受访者表示，临床医生的培训时间为 4 小时或更短。不到一半的受访者（47%；=99）报告说，他们有一个正式的程序将患者升级到专家护理，并且在升级之前没有设定的最大尝试次数。只有三分之二（=115）的受访者表示他们有一个标准化的疼痛控制和程序支持协议，只有 13%（=23）和 15%（=27）的受访者分别表示他们始终遵循该协议。
结论：受访者报告了新生儿和儿科血管通路程序以及支持该实践的资源的广泛差异。需要制定核心标准来帮助指导新生儿和儿科临床医生及其机构。这些标准应包括对劳动力模式、适当培训、能力、插入指南、疼痛控制的建议。
