May 2021 - SEM Trainers

You can’t think of oncology care without thinking of Peripherally-Inserted Central venous Catheters (PICC). Patients who require long-term venous access, like those suffering from cancer, benefit from PICC lines. It is used to administer or deliver medication, liquid nutrition, and other treatment directly to the large central veins near the heart. If you frequently need to be jabbed for medicine or bloodwork, you may be advised a PICC line to avoid repeated irritation to your veins, and the pain from repeated jabbing.

A PICC line is a long, thin tube inserted through a vein in the arm (or, rarely, in the leg) and passed through so your doctor can access the large central veins near your heart. This is a temporary procedure, and is a great option if your treatment is going to last for at least a few days or weeks.

PICC Line Insertion: Techniques

Let’s talk about how we carry out PICC. The conventional technique is the landmark method where we feel the most prominent vein [usually] in the antecubital fossa, and cannulate it with a wide bore needle/sheath, and then insert the catheter through the sheath. Alternatively, we can use ultrasound and a micro-introducer needle where we identify [usually] the basilic vein above the elbow via ultrasound, and then insert a 21 gauge needle into the vein under direct ultrasound image. Then, we pass a guide wire through to the catheter through the needle and the sheath. This is a newer technique with a nearly 100% success rate and minimal injury rate.

Why Do We Need to Train Nurses for This?

In the past, only certified radiologists and specially-trained assistants would be allowed to perform PICC insertion. So why shift this responsibility to nurses? Well, here’s why. If we train our nurses in performing PICC insertions, it will create efficiency and take a load off an already overwhelmed hospital setting. Further, we will discuss the benefits of training nurses in PICC insertion.

Benefits of Training Nurses in PICC Insertion

As discussed previously, training nurses in PICC insertion has a number of benefits to it:

It helps nurses upskill.
With proper training, nurses can learn to competently insert a catheter, effectively avoiding running the risk of patient complications.
If nurses will be able to perform PICC insertions, it will take a considerable load off an already overwhelmed clinical setting.
It could reduce the overall costs of running the setting. When performed by a radiology specialist, a PICC insertion is more expensive.
If nurses would perform PICC insertions, patients won’t have to wait a long time for their turn. This would prevent procedure delays for the patients.
We could avoid post-insertion complications and infections alike. (PICC lines need to be monitored for complications like infections, bleeding, blood clots, nerve injury, irregular heartbeat, damage to veins, and a blocked/broken PICC line). Radiology specialists could do it, but then they likely won’t stick around after the procedure. Nurses will always be available to check up on the patient, and can keep monitoring the situation periodically. The nurses can preasses, follow-up, and troubleshoot.
It also helps avoid complications caused by delay in treatment.
Allowing nurses to handle PICC insertion ensures a better use of valuable healthcare resources.
It helps increase patient satisfaction.
It helps decrease the length of stay for the patient as delays are minimized.
It can reduce the number of failed cannulations.

Limitations

So are nurses qualified to do PICC insertions all the time? There are a few circumstances when a nurse must not insert a PICC line, and refer the patient to a medical practitioner instead:

When the patient does not give consent to the nurse.
When the patient is a minor.
When the patient has a pacemaker.
When the patient has an anatomical distortion from surgery, injury, trauma, or disease.
When the patient has bilateral arm lymphoedema.
When the patient has an implantable defibrillator.
When the patient has an arterio-venous fistula.
When the patient is on haemodialysis or peritoneal dialysis.
When the patient is scheduled for an arterio-venous fistula.
When the patient won’t allow care for the PICC line.
When the patient has an allergy to Lidocaine Hydrochloride 1%.
When the patient has a platelet count of 50 or less.
When the patient has a coagulation disorder.
When the patient has had thrombolytic therapy within 2 days.
When the patient has an inappropriate vein size under ultrasound.
When a PICC line insertion by the nurse has failed.

Nurses can be trained with a one-week course. If they have the necessary training and experience, their competence has been successfully assessed by a qualified professional, and they are confident in their ability to perform the insertions, training our nurses to perform PICC insertions would be a favourable decision.

Simulators for PICC Insertion Training

Like we said, manikins and simulators specially made for PICC insertion can help immensely with training. We provide some high-quality simulators for this purpose.

Peter PICC Line Simulator

This is a PICC line simulator and a great teaching model that is portable and lightweight. It is an upper torso with neck, chin, right arm, ribs, muscle tissue, arm skin, body skin, arm vein set, body vein set, fluid bag, a carrying case, and an additional pouch. It is anatomically correct and features the superior vena cava, subclavian, jugular, median basilic, basilic, and cephalic veins. It has a movable chin that might occlude insertion in real life just as well, and has palpable ribs that allow measuring proper catheter length from the insertion site to the second/third intercostal space. It also allows standard IV catheter placement.

Standard Arm for Chester Chest, Light Skin – VATA

This simulator helps train with infusion, withdrawal, care, securement, and dressing of multiple vascular access lines. The right chest area has a tunneled central catheter with a Dacron cuff, the external jugular vein is raised and opens to connect to a triple lumen catheter, and the upper chest area opens to connect to a subclavian catheter. It also has a real port for accessing IVAD placements. It allows infusing fluid and withdrawing blood.

We’ve been doing this for 25 years, so we know what we’re doing, and only deliver the best quality simulators. To make a purchase, you can call us at 02632 257259, +91-88495 63724, or +91-98791 03905, or write to us at sem@semtrainers.com.

Fidelity comes from the Latin word fidēlis, meaning faithful or loyal. Generally speaking, fidelity is the degree of exactness with which something is copied or reproduced.

What is Fidelity in Simulation Training?

We have always emphasized on the role and benefits of using simulation for training aspiring doctors and nurses. Simulators are devices that imitate the real-life medical environment, but in a safe way, so learners can practice with real-time feedback but without the risks involved.

In simulation, fidelity is a term that denotes the degree to which the simulator replicates reality. Simply speaking, it is how well the simulator is able to imitate a real-life medical environment, or how close it gets to a real scenario. So, a simulator that depicts a real scenario really well would be termed “high-fidelity”, and one that does not so much, “low-fidelity”. A low-fidelity simulation is less realistic than a high-fidelity one.

Levels of Fidelity in Simulation

In 1990, Miller sketched out a pyramid depicting how a person’s actions are built upon his knowledge, competence, and performance. An increased level of fidelity in simulation may correspond to a transformation from knowledge to competence, performance, and ultimately, action.

We observe the following levels of fidelity in simulation:

Low-Fidelity Simulation: This level of simulation helps build knowledge. This may not be very realistic, but it takes away the stress of the situation and lets the learner focus on learning the skill. Take static models and 2D displays for example.
Mid-Fidelity Simulation: This one is a bit more realistic and helps build competence in the learner. Take, for example, full-body manikins that imitate real heart and breathing sounds. Learners can use these to train on procedures like IV insertions, injections, and NG tube insertions.
High-Fidelity Simulation: These are the most realistic simulations- the closest to real life. Take, for example, full-body computerized manikins that can talk and run pre-programmed scenarios.

Types of Fidelity in Simulation

Fidelity can be physical, psychological, and conceptual. Physical fidelity can be perceived by the senses. If your manikin’s skin feels like real skin, and body parts react and bleed like they would on a real patient, it increases the degree of physical fidelity. Task-trainers, or lifelike manikin simulators representing a part of the body can help train on specific skills and focus on functional fidelity. And when they allow haptic feedback, that increases the degree of physical fidelity. Moulage, or applying makeup to mock injury, can engage learners’ sensory perceptions.

If you introduce some realistic background noises to the simulated setting, you will increase the physical fidelity, consequently also increasing the psychological fidelity as it elicits an emotional response from the learner and raises stress levels. If all aspects of your simulated scenario accurately represent how they would be in a real scenario, such that it makes sense to the learner, you have high conceptual fidelity.

Beyond the three major classifications, fidelity may also be classified as functional fidelity, which is the dynamic interaction between the learner and the task at hand, and sociological fidelity, which is how the interactions between the participants affect the level of realism.

So What Degree of Fidelity Do We Really Need?

Ideally, we want all simulators to be high-fidelity, but limited procurement budgets make that hard to achieve. So, often, we must settle for a trade-off between the degree of fidelity and the cost of procurement, or “mid-fidelity”. In high-stress environments, the costs may be monetary as well as loss of human life. We will discuss various scenarios ahead in the discourse.

Scenarios to Imagine

Imagine this. A well-established gaming company comes up with an exciting idea for a new game, and the developers must build it soon. A high-fidelity videogame would be meticulous with the graphics, the gameplay, and the story. A game that would manage to ignore even one of these aspects could fail to create an immersive, realistic gaming experience. This would result in a failure of the game to launch successfully, and possibly cost the company millions of dollars, along with ruining its reputation. Here, the cost would be monetary.

In the application of aircraft or driving simulation, higher fidelity would be required. Poor training and poor decisions made under high-stress, emergency situations in real-life could result in fatal outcomes. In emergency situations on an actual plane, you would expect your pilots to make the right decisions at the right time regardless of the immense stress of an urgent, unfamiliar situation. This cannot be made possible without training in high-fidelity simulation.

If we take the military for example, soldiers may be trained for combat in a high-fidelity simulation. Such training must prepare the soldier for making resource-aware decisions and train them in dealing with a variety of unexpected situations. Training for this in low-fidelity simulations may not prepare a soldier for combat, but create the illusion of competence.

Ultimately, the degree of fidelity exercised in simulation can impact the levels of confidence and anxiety. If learners practice in low-fidelity environments, they might incorrectly assume confidence. Being met with unexpected developments in-field can render a state of disillusionment and disbelief in the training, revealing that they were, in fact, unprepared, and further leading to possibly catastrophic consequences.

However, it is also true that learners and educators are biased towards HFS (High-Fidelity Simulation), and that higher levels of fidelity may increase the cognitive load on the learner to the point of overwhelming him, effectively decreasing learning. Maybe beginners would be better off starting with low-fidelity simulation and then move up as they gain experience. Low-fidelity simulation may also be preferred when training on skills that call for repeated practice.

For More Detailed Information Contact Us on sem@semtrainers.com or +91-88495 63724 .

Monthly Archives: May 2021

Why Do We Need to Train Nurses in PICC Insertion?