Teaching Plan on the Use of Ultrasound
The placement of an intravenous (IV) catheter is among the main procedures performed and commonly used by healthcare professionals to improve patients’ care (Pandurangadu et al., 2016). Successful access to IV improves patient care by facilitating the administration of fluids, lifesaving medications, and antibiotics. Healthcare professionals may experience difficulties when obtaining an IV among a subset of patients with poor vascular access, for instance in situations involving persons with obesity, known vascular disease, edema, IV drug abuse, poorly palpable pulses, and limited access options. It is essential to teach nurse anesthetists about the use of ultrasound-guided IV and central line access to equip them with the required knowledge and skills. The use of central venous catheters enables healthcare professionals to give IV medications over a long period, for instance, antibiotics and chemotherapy. The catheter is also used to deliver large amounts of fluid and blood. Additionally, the central venous catheter enable nurses, and other healthcare professionals to frequently take blood samples, to directly measure blood pressure in a central or large vein, and connect a patient to a hemodialysis machine (Pandurangadu et al., 2016). Training of nurses on the use of ultrasound-guided IV helps in decreasing procedural attempts when establishing vascular access, thus preventing pain in patients, reducing risk for infection, and improving quality of care. In this paper, a teaching plan to teach nurse anesthetists how to use ultrasound to obtain central line and IV access is presented.
Task Analysis
Training of nurses is essential for the development of the required knowledge and skills to improve the quality of care (Pepito & Locsin, 2019). Through training, healthcare professionals are prepared to adopt new approaches to offering care to patients and improve clinical outcomes. Additionally, training is important in enabling nurses to learn about new development in practice. The continuous advancement of technology has affected operations in different sectors, including healthcare. Healthcare professionals need to be trained on technological advancements in nursing practice (Pepito & Locsin, 2019). Advancements in technology, including humanoid nurse robots, have changed the practice of nursing. Proper training of nurses is important in enabling nurses to use the latest technology in offering care to patients. Among available technology that can be used in nursing to perform specific clinical procedures is ultrasound. The technology is suitable for obtaining IV access in patients. Healthcare professionals experience difficulties in obtaining IV access. Among the reasons that cause difficulties obtaining IV access are health conditions such as obesity, history of intravenous drug use, and being underweight. Ultrasound technology can be used to deal with challenges associated with normal peripheral IV access (Millington et al., 2019).
It is necessary to train nurse anesthesia to provide them with the required skills to use an alternative approach to deal with the challenge of obtaining an IV in patients (Pandurangadu et al., 2016). When using the traditional blind technique, healthcare professionals can spend up to 30 minutes when performing the procedure in patients with difficult IV access. Additionally, the traditional blind technique of obtaining IV access requires more resources because the approach may require multiple needle sticks by providers. The use of the approach is also associated with delays in obtaining IV access leading to an extended treatment course. Delay in the treatment processes put a patient at risk of health complication when IV access is not available. Among the main approaches to dealing with the problem associated with traditional blind techniques is ultrasound-guided IV access (Pandurangadu et al., 2016). Thus, the implementation of a training program is necessary to train nurse anesthesia to effectively obtaining IV access.
How Ultrasound Technology Work
Healthcare professionals have adopted ultrasound-guided IV as the standard of care among patients with difficult IV access (Oliveira & Lawrence, 2016). The ultrasound approach facilitates IV access by taking dynamic or static images of a target blood vessel. Ultrasound machines provide long-axis and short-axis views to actively visualize needle insertion. The use of color-flow ultrasound can help to confirm venous and arterial flow. Additionally, ultrasound can differentiate between venous and arterial structures through a compression test. The test helps to differentiate between venous and arterial structures because the thinner-walled vein collapses when pressure is applied using the probe (Oliveira & Lawrence, 2016).
The brachial artery, nerve, and vein are close at proximity to each other (Alexandrou, 2019). Therefore, ultrasound enables healthcare professionals to visualize and access the exact vessel during IV catheter placement. Vein access can be optimized through the use of micropuncture needles and ultrasound guidance. The approach enables the operator to visualize vessels, avoid nearby nerves, and minimize access trauma efficiently. Ultrasound-guided IV insertion has been considered to be reliable and fast for use in upper arm venous access. The guide allows healthcare professionals to isolate the brachial, cephalic, and basilic veins.
Additionally, ultrasound allows access into a vessel with the right size to adequately accommodate catheters. Access site selection using ultrasound for vascular helps identify and map structures within the chest, leg, and neck that may be most appropriate for device insertion. The ultrasound imaging transmits sound waves that the healthcare professionals interpret on a viewing screen (Alexandrou, 2019).
How to Recognize Veins in the Arms and Internal Jugular Vein
Healthcare needs to differentiate between vein and artery before cannulation (Alexandrou, 2019). When the pressure is applied using the ultrasound probe, veins become easily compressible, whereas arteries are not collapsed (InterAnest, 2018). Additionally, the Doppler mode may assist in differentiating between the artery and vein. Nurses and other healthcare professionals should be adequately prepared to recognize the internal jugular vein. A transverse view of the vessels is used to examine the internal jugular vein (IJV) at the mid-neck. A healthcare professional should assess for size, compressibility, and shape. It is necessary to apply pressure to the veins to determine compressibility and confirm the patency and a thromb. A healthcare professional can slide down the transducer to the neck’s base to allow a view of the carotid artery and internal jugular. The next step involves placing the probe level on the clavicle’s superior edge using the sternal notch. The probe’s position should be to the side of the sternal notch and above the clavicle in the transverse plane. Slight pressure is necessary to attain optimal visualization of the vessel (Alexandrou, 2019).
How to Direct Needles to Access Veins
When performing ultrasound-guided IV access, the most common sites are the superficial veins of the forearm and hand, external jugular vein, antecubital fossa, or the deeper brachial, cephalic, basilic veins of the upper arm (Currie et al., 2019). The vessel is identified using the static approach, and the skin is marked when a proper needle entry point is identified. A sterile probe cover is positioned on the ultrasound probe. The ultrasound is used to visually guide the needle during the procedure. An ultrasound-guided IV access approach is associated with a higher success rate leading to a reduced number of attempts and increased patient satisfaction (Currie et al., 2019).
Knowledge Gap
Difficult IV access is among the problem affecting healthcare professionals when performing clinical procedures. The problem affects between 15% and 26% of emergency department (ED) patients (Feinsmith et al., 2018). Difficult IV access is caused by medical conditions such as sickle cell disease, diabetes, and IV drug abuse. Anatomic characteristics such as poorly visualized, small vein diameter, and palpated veins also contribute to difficult IV access. The problem also causes delays in laboratory evaluation and medication administration, especially when IV access is postponed as a result of difficult access. Nurse anesthetists have turned to ultrasound-guided IV access to deal with the problems caused by DIVA. The use of the approach helps in reducing the amount of time spent on IV placement and the negative effects of multiple IV attempts on patients. The application of an ultrasound-guided IV access approach in clinical setting is hindered by limited knowledge among nurses to obtain vascular access in patients with DIVA. Obtaining IV access requires healthcare professionals to have fundamental knowledge and skill. Knowledge, skills, and minimal previous experience are required to successfully use the ultrasound-guided technique. There is a lack of knowledge of how ultrasound works and how to use the skill to gain peripheral IV and central line IV access. The problem of lack of required knowledge and skill affect older nurse anesthetists who have never received clinical and didactic training on the use of ultrasound-guided IV access approach. Thus, the implementation of a training program is required to equip nurses with the required skills and knowledge to use ultrasound for IV access procedures. The training will help in preparing nurse anesthetists to use the procedure in laboratory analysis, fluid infusion, and medication administration (Davis et al., 2017).
Performance Objectives
The educational program’s implementation will involve nurse anesthetists who will be trained on the use of ultrasound-guided IV access approach. The training program’s effectiveness will be evaluated using a performance objective developed using Bloom’s taxonomy. The main aim of Bloom’s taxonomy is to guide the creation of objectives and assessments. Bloom’s taxonomy levels include remembering, understanding, analyzing, applying, evaluating, and creating (Armstrong, 2016). The training program’s first performance objective is that nurses will be able to distinguish between a vein and artery before cannulation. The second objective is: Healthcare professionals will be able to describe the vein selection process. The third learning objective is that nurse anesthetists will demonstrate a technique for cannulating a vessel using ultrasound. The first objective belongs to the fourth level of Bloom’s taxonomy. The second and third objects belong to Bloom’s taxonomy’s second and third levels, respectively (Armstrong, 2016).
Objective-Based Learning Modules
The training process’s main aim is to ensure that nurse anesthetists acquire the required knowledge and skills to gain peripheral IV and central line IV access. At the end of the training process, nurses should be able to effectively select the vein. Nurses should also be able to cannulate a vessel using ultrasound.
Methods and Tools
The training process will involve the use of the lecture method and video-assisted teaching. According to Sanaie et al. (2019), the traditional lecture teaching method has been the primary teaching approach in medical education. The method facilitates the transfer of knowledge to promote learning. The reason for using videos assisted teaching method is that the approach helps learners to remember the steps used in a clinical procedure (Kale et al., 2019). Thus, the use of the evidence-based approaches in the teaching process promotes maximum learning and retention among nurses.
The content to be used in teaching nurses about ultrasound-guided IV access will be prepared using appropriate sources such as books and other publications. Experts in medical fields, such as certified registered nurse anesthetists (CRNAs), will be involved in training other healthcare professionals. It is essential to involve experts to enable them to use their knowledge and experience to educate other nurses. Required tools will be prepared commencement of the training process. The main equipment that the instructors will use includes an ultrasound machine, sterile gel, probe cover, tourniquet, cannula bung, gloves, skin preparation, a syringe of normal saline, and cannula. Learners will require a notebook and a pen to record important points from the training process.
Learning Theories
The training program will be guided by Social Cognitive Theory (SCT) by Albert Bandura (Bandura, 1991; Mirzaei et al., 2019). The theory indicates that learning occurs in a social setting with a reciprocal and dynamic interaction of the person, behavior, and environment. The theory is suitable for the implementation of the training program on how to gain peripheral IV and central line IV access. The training process will involve interaction between nurses and the instructors in a hall within a healthcare facility to facilitate change of behaviors relating to acquired knowledge to effectively gain peripheral IV and central line IV access.
Plan for Education
The training process will involve learning sessions of six hours. The reason for creating sessions of six hours is that a sufficient amount of time is required to train nurses on the use of ultrasound-guided IV access. Every nurse anesthetist will be required to attend one training session. An adequate amount of time is required to allow the instructors to use lecture and video-assisted teaching approaches (Sanaie et al., 2019).
Timing of Learning Activities
The training will occur in a hall within a healthcare facility. The reason for holding training within the facility is to allow nurses to attend training sessions when they are off duty. Healthcare professionals will be advised to attend training after work to ensure that the facility’s normal operations are not interrupted. Together with videos, the lecture method will be used to deliver content to nurses during the training process. The use of videos in the training process will enable nurses to remember concepts taught during the training. The training activities that involve lecture and video-assisted teaching relate to SCT because the teaching approaches enable learning to occur through interaction (Mirzaei et al., 2019).
Conclusion
The placement of an IV catheter is a common procedure performed in a clinical setting to facilitate the administration of fluids, blood, and lifesaving medications. The IV catheter also enables nurses and healthcare professionals to take blood samples, connect a patient to a hemodialysis machine, and directly measure blood pressure in a central or large vein. Nurse anesthetists experience difficulties in gaining peripheral IV and central line IV access due to a lack of required knowledge and skills. Nurse anesthetists also experience the problem of difficult IV access caused by medical conditions such as sickle cell disease and diabetes. Ultrasound-guided IV has been considered a suitable solution to IV access difficulties during the IV catheter placement procedure. Healthcare professionals should have the required knowledge and skills to use an ultrasound-guided IV access approach. Thus, the implementation of a training program would enable nurses to acquire fundamental knowledge and skill to successfully use the ultrasound-guided technique. Training will enable nurse anesthetists to use the approach to facilitate laboratory analysis, fluid infusion, and medication administration in patients. The training process will involve the use of a video-assisted teaching approach and lecture method. The main equipment that the instructors will use during the training process are ultrasound machine, sterile gel, tourniquet, probe cover, cannula bung, gloves, a syringe of normal saline, skin preparation, and cannula. The training will be guided by SCT to facilitate interaction during the learning process.
