Subject(s)
Arthroscopy , Knee Joint/surgery , Ambulatory Surgical Procedures , Anesthesia , Anesthetics, LocalABSTRACT
Safe vascular access is integral to anaesthetic and critical care practice, but procedures are a frequent source of patient adverse events. Ensuring safe and effective approaches to vascular catheter insertion should be a priority for all practitioners. New technology such as ultrasound and other imaging has increased the number of tools available. This guidance was created using review of current practice and literature, as well as expert opinion. The result is a consensus document which provides practical advice on the safe insertion and removal of vascular access devices.
Subject(s)
Vascular Access Devices/standards , Adult , Blood Coagulation Disorders/therapy , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/methods , Catheterization, Central Venous/standards , Catheterization, Peripheral/adverse effects , Catheterization, Peripheral/methods , Catheterization, Peripheral/standards , Child , Hospitals/standards , Humans , Ireland , Patient Safety , Ultrasonography, Interventional , United Kingdom , Vascular Access Devices/adverse effectsABSTRACT
This prospective study on a medium-fidelity simulator (SimMan, Laerdal Medical Corporation, Wappingers Falls, NY, USA) examined the management of unanticipated difficult airway by 21 anaesthetists and the effect of training in this context. There were two scenarios investigated: 'cannot intubate, can ventilate' (CI) and 'cannot intubate, cannot ventilate' (CICV). Following initial evaluation, volunteers underwent training in the 'Difficult Airway Society' (DAS) algorithms and associated technical skills. At 6-8 weeks and 6-8 months, performance was compared with the initial evaluation. There was a more structured approach following training (p < 0.05), which was sustained at 6-8 months, but only for the CICV scenario (p < 0.01). In CI, use of standard and intubating laryngeal mask airway increased following training (p = 0.021). This was sustained over time (p = 0.01). In both scenarios there was a reduced incidence of equipment misuse (p < 0.0005), which was sustained over time (p < 0.0001). We conclude that simulation-based training significantly improves performance for at least 6-8 weeks. Training should be repeated at intervals of 6 months or less.
Subject(s)
Anesthesiology/education , Clinical Competence , Education, Medical, Continuing/methods , Intubation, Intratracheal/standards , Manikins , Algorithms , Anesthesia, General , England , Humans , Laryngeal Masks , Medical Staff, Hospital/education , Outcome and Process Assessment, Health Care/methods , Prospective StudiesABSTRACT
Using an airway mannequin and artificial lung model, we compared surgical cricothyroidotomy with a 6.0-mm cuffed Portex tracheostomy tube with wire-guided cricothyroidotomy using a 5.0-mm cuffed Melker or 6.0-mm uncuffed Melker tube. The trial was carried out by 27 anaesthetists using a randomised, crossover design. Surgical cricothyroidotomy proved significantly faster (mean (SD) time to first breath 44.3 (12.5) s for Portex surgical, 87.2 (21.6) s for cuffed Melker, 87.8 (19.2) s for uncuffed Melker, p < 0.001). With a standardised ventilator model, the cuffed tubes provided more effective ventilation (mean (SD) tidal volume 446 (41) ml Portex, 436 (52) ml cuffed Melker, 19 (5) ml uncuffed Melker, p < 0.001). Fourteen of the participants preferred the wire-guided system. We conclude that, in this model, a cuffed device is preferable when cricothyroidotomy is needed. In addition, the surgical method is quicker than a wire-guided approach.
