Feasibility of Low-Fidelity Simulation for POCUS Assisted Vascular Access in the Critical Care Transport Environment

Background

Distributed mobile care teams such as emergency medical services and critical care transport teams face constraints of time, funding, staffing and access to high-fidelity training environments. Introducing skills into resource limited settings using innovative low-fidelity methods expand opportunities for development.

Objective

We aim to test the feasibility of low-fidelity point of care ultrasound (POCUS) simulation training for assisted peripheral intravenous (PIV) placement to develop baseline competence and confidence in critical care transport team clinicians.

Methods

A low-fidelity simulation model was developed using off the shelf items including canned-meat (i.e. Spam), modeling balloons, and dyed water to provide a similar image as a POCUS-PIV high-fidelity mannequin and human training subject. A convenience sample of seven staff were recruited to undergo didactic and hands-on training using the low-fidelity model. Training was led by an emergency ultrasound fellow in our affiliated hospital system. A non-compulsory post-training survey using structured questions and Likert-scale was electronically distributed to the training participants, with one hundred percent of the surveys returned.

Results

Use of a low-fidelity simulation model required no formal meetings or utilization of an off-site simulation center, reducing administrative burden. Low cost of simulation model supplies allowed for multiple simulators to be available, enabling concurrent use among participants which decreased total time spent in the training session. Post-training survey data indicated the following results: overall participants found that low-fidelity training developed their initial clinical decision making for completing this intervention in clinical practice. Eighty-six percent report increased confidence in placing ultrasound guided PIV after the lab. Seventy-one percent of participants identified as entry-level handheld ultrasound users. Most providers report receiving proper knowledge and skillset with the use of this low-fidelity task trainer and that the training successfully allowed them to perform the simulated intervention. One learner does remark subjectively that they did not receive proper knowledge and skillset in this lab.

Conclusions

A low-fidelity simulation model using off-the-shelf items allowed for successful psychomotor training for ultrasound assisted peripheral IV insertion. The low-cost simulation model allowed for multiple models to be present during training, enabling multiple repetitions to be completed when compared to having one, high-fidelity simulator. Practicing this intervention in a safe learning environment, without outside spectators, was found to promote confidence and increase self-reported likelihood of completing the intervention in clinical practice. Use of low-fidelity simulation models appears to be feasible and effective for initial training of critical care transport clinicians who self-identify as entry level point of care ultrasound users. Further study of low-fidelity simulation should be considered for multiple disciplines within emergency medical services and critical care transport.