即时床旁超声在确认脐静脉置管位置中的应用：模拟增强课程对新生儿重症监护病房医务人员能力的影响。

Point-of-Care Ultrasound to Confirm Umbilical Line Placement: Impact of a Simulation Enhanced Curriculum on Neonatal Intensive Care Unit Provider Competency.

机构信息

From the Departments of Pediatrics (M.J.K., S.B.H., R.M.V.) and Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD; Department of Pediatrics (S.J.M.), Penn State Health Children's Hospital, Hershey, PA; and Division of Neonatology (J.H.K.), Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH .

出版信息

Simul Healthc. 2021 Oct 1;16(5):303-310. doi: 10.1097/SIH.0000000000000501.

DOI:10.1097/SIH.0000000000000501

PMID:32910107

Abstract

INTRODUCTION

Neonatal intensive care unit (NICU) provider point-of-care ultrasound (POCUS) procedural competency for umbilical line placement confirmation has not been defined, and the necessary training to achieve competency has not been previously studied. This study's objective was to test the hypothesis that a simulation-enhanced curriculum will improve NICU providers' POCUS competency to confirm umbilical line placement.

METHODS

Neonatal intensive care unit providers without prior ultrasound experience were randomized to a curriculum with or without simulation-based training. Competency for catheter detection, tip localization, and scan interpretation on patients was determined using learning curve-cumulative summation, a specific statistical tool designed to indicate when a predefined level of performance is reached. Differences in success rates were analyzed by χ2 test.

RESULTS

Two thirds (22/33) of participants completed 10 scans. Three (simulation) and 1 (control) attained catheter detection competency (P = 0.28). The simulation group was more successful for catheter detection (81% vs. 69%, P = 0.04) and scan interpretation (61% vs. 48%, P = 0.04). Success did not differ by umbilical vessel location, provider role, or duration of NICU experience.

CONCLUSIONS

A simulation-enhanced POCUS curriculum improved catheter detection rate and scan interpretation, but there was no difference in procedural competency between groups on ultrasound scans performed on patients with umbilical catheters. We speculate that more than 10 scans may be needed for NICU providers to obtain POCUS competency.

摘要

简介

新生儿重症监护病房（NICU）医护人员在进行脐静脉置管确认时的即时超声（POCUS）操作能力尚未明确，且之前并未对实现该能力所需的培训进行研究。本研究旨在验证以下假设，即模拟增强课程将提高 NICU 医护人员行 POCUS 以确认脐静脉置管位置的能力。

方法

无超声经验的 NICU 医护人员被随机分为接受或不接受基于模拟的培训的课程。通过学习曲线累积和（一种旨在指示达到预定义绩效水平的特定统计工具）确定在患者身上进行导管检测、尖端定位和扫描解读的能力。通过卡方检验分析成功率的差异。

结果

三分之二（22/33）的参与者完成了 10 次扫描。3 名（模拟组）和 1 名（对照组）医护人员达到了导管检测能力（P=0.28）。模拟组在导管检测（81%比 69%，P=0.04）和扫描解读（61%比 48%，P=0.04）方面的成功率更高。成功率在脐血管位置、医护人员角色或 NICU 经验持续时间方面没有差异。