AANA journal
-
Comparative Study
Using a Structured Assessment Tool to Evaluate Nontechnical Skills of Nurse Anesthetists.
Nontechnical skills are critical for good anesthetic practice but are seldom addressed explicitly in clinical training. The purposes of this study were (1) to evaluate the reliability and validity of the observation-based assessment tool Nurse Anaesthetists' Non-Technical Skills system (N-ANTS) and (2) to evaluate the effect of training nurse anesthetist supervisors in the use of N-ANTS. This system comprises a global rating score, 4 categories, and 15 elements to rate nurse anesthetists' nontechnical skills. ⋯ It remained stable for the global rating score in N-ANTS and its category ratings, but improved at the elements level. When the raters' ratings were compared with ratings by an expert reference group, there was no statistically significant effect on training. We conclude that Danish nurse anesthetist supervisors without further rater training besides their work experience can use N-ANTS to assess nontechnical skills of nurse anesthetists.
-
Ultrasound-guided selective C5 nerve root blocks have been described in several case reports as a safe and effective means to anesthetize the distal clavicle while maintaining innervation of the upper extremity and preserving diaphragmatic function. In this study, cadavers were injected with 5 mL of 0.5% methylene blue dye under ultrasound guidance to investigate possible proximal and distal spread of injectate along the brachial plexus, if any. Following the injections, the specimens were dissected and examined to determine the distribution of dye and the structures affected. ⋯ It appears unlikely that local anesthetic spread is limited to the nerve root following an ultrasound-guided selective C5 nerve root injection. Under certain conditions, intrathecal spread also appears possible, which has major patient safety implications. Additional safety measures, such as injection pressure monitoring, should be incorporated into this block, or approaches that are more distal should be considered for the acute pain management of distal clavicle fractures.
-
Patients with difficult intravenous access (DIVA) often experience discomfort because of failed attempts to place peripheral venous catheters (PVCs); however, ultrasound guidance may improve this problem with catheter placement. The aim of this study was to evaluate the use of ultrasound when operated by nurse anesthetists for these patients. This prospective observational study with a pre/post design focused on inpatients with DIVA referred for PVC placement, a service provided by nurse anesthetists in most Scandinavian hospitals. ⋯ Procedure time was reduced from 20 to 10 minutes, discomfort was unchanged, and the median number of skin punctures decreased from 3 to 2. The incidence of central venous catheter placement dropped from 34% to 7%. Implementation of a training program and a mobile service in which nurse anesthetists performed ultrasound-guided PVC placement improved the success rate and quality of care in patients with DIVA.
-
Certified Registered Nurse Anesthetists (CRNAs) provide high-quality patient care to ensure patient safety. Strict vigilance and prompt response is required of the CRNA to make critical decisions. Distractions during anesthesia delivery may threaten patient safety. ⋯ Inappropriate PED use while administering anesthesia remains grossly underreported and understudied related to its impact on patient safety. The purpose of this article is to illustrate the critical need for further research in order to analyze safety risk, appropriately guide CRNA education, and properly develop and enforce media policies within organizations. Currently, PED use by the CRNA exists in ethically blurred boundaries, with potentially major patient safety and legal consequences.
-
Review Meta Analysis
Nonpharmacologic Neuraxial Interventions for Prophylaxis of Postdural Puncture Headache in the Obstetric Patient.
Postdural puncture headache due to accidental dural puncture during epidural catheter placement is a source of morbidity for new mothers. It can interfere with maternal-newborn bonding and increase the length of hospitalization. This evidence-based article examined the question: For obstetric patients experiencing an accidental dural puncture during epidural placement, which nonpharmacologic prophylactic neuraxial interventions safely and effectively decrease the incidence of postdural puncture headache? A search of online databases revealed 4 systematic reviews with meta-analysis and a randomized controlled trial meeting the inclusion criteria. ⋯ The evidence suggested there may be value in performing a prophylactic blood patch or placing an intrathecal catheter. The risk of the intervention must be carefully weighed with the benefits. Further rigorous studies are needed to help determine the best methods to decrease the incidence of postdural puncture headache in obstetric patients experiencing an accidental dural puncture during epidural placement.