监督实践的学习曲线在超声引导下动态针尖追踪法桡动脉穿刺置管中的应用

Application of learning curve of supervision practice in radial artery catheterization by ultrasound-guided dynamic needle tip positioning technique

目的分析并描绘北京协和医院麻醉科住院医师行超声引导动态针尖追踪法(DNTP)桡动脉穿刺置管的学习曲线,探讨掌握该法所需的监督实践学习强度。方法回顾2018年1月至2018年6月2名北京协和医院麻醉科住院医师使用超声引导DNTP桡动脉穿刺置管的监督实践学习记录,使用累积和分析法(CUSUM)描绘学习曲线,探讨掌握该法所需的监督实践的学习强度,并比较达到此学习强度前后成功穿刺置管所需穿刺次数和时间,以及首次和总体桡动脉穿刺置管成功率的差异。结果分别以成功穿刺置管所需穿刺次数和时间,以及首次和总体成功率为评价标准,2名受训者掌握DNTP所需学习强度为29/36、29/29、29/36、14/11例。达到该学习强度后,成功穿刺置管所需操作次数显著下降(P<0.05),所需时间、首次和总体成功率有所改善。结论综合考虑成功穿刺置管所需操作次数和时间,以及首次和总体成功率,掌握超声引导DNTP桡动脉穿刺置管的监督实践的学习强度为36例。

Objective To analyze and describe the learning curve of radial artery catheterization under ultrasound-guided dynamic needle tip positioning(DNTP)by anesthesia residents in Peking Union Medical College Hospital and to explore the learning intensity of supervision practice required to master this technique.Methods From January 2018 to June 2018,the learning records of two anesthesia residents in the Peking Union Medical College Hospital who perform radial artery catheterization under ultrasound-guided DNTP technique were used to describe the learning curve of cumulative sum analysis(CUSUM).The learning intensities were explored to improve the attempts and time needed for successful catheterization,first-attempt and overall success rates.The evaluation indexes before and after reaching the learning intensity were compared.Results Taking the attempts and time needed for successful catheterization,and the first and overall success rate as the evaluation indexes,the learning intensity required for the two trainees to master DNTP was 29/36,29/29,29/36 and 14/11 cases.After reaching this learning intensity,the number of operations required for successful puncture and catheterization decreased significantly(P<0.05),and the time required,the first time and the overall success rate improved.Conclusions Considering theattempts and time needed for successful catheterization,first-attempt and overall success rates the learning intensity of the supervision practice needs to reach 36 cases.