560 Ultrasound guided vascular access should be routinely taught to all paediatricians

Abstract

<h3>Background</h3> Paediatric vascular access can be notoriously difficult due to small vessels and patient cooperation. Studies have shown ultrasound (US) guided technique to be a more successful method of vascular access in experienced hands, especially in children with difficult access. US guided vascular access is well established within adult medicine practice, especially emergency and intensive care, whereby point of care ultrasound (POCUS) is mandated. At present there is no standardised UK paediatric POCUS curriculum. Most UK paediatricians will not gain any US experience, unless undertaking acute sub-specialist placements. Within district general hospitals (DGH), children with difficult access are often escalated to adult anaesthetists who are usually less experienced in paediatrics. Some children are transferred to tertiary centres where there is more US expertise. To enable best patient care within their local setting, US guided paediatric vascular access should be routinely taught to paediatricians in DGH and tertiary settings <h3>Objectives</h3> To date there have been no studies exploring the experience and significance of US guided vascular access training amongst DGH-based UK paediatricians. We developed US training sessions for paediatricians in our busy DGH, and evaluated their confidence levels, feedback and progress with this skill. <h3>Methods</h3> Small-group sessions were led by our accredited and experienced paediatric advanced nurse practitioner (ANP) over a year. Two-hour sessions covered theoretical aspects and a practical session. Recommendations of practice bespoke to paediatrics were taught. Participants learned to map veins and practiced US cannulation on the gelatinous ‘phantom’ model. A mixed-method research methodology was used to evaluate the course impact. A questionnaire was provided, asking attendees to evaluate confidence levels before and after sessions, and open-space for comments. <h3>Results</h3> 30 paediatricians, from senior house officers to consultants, attended sessions. 75% had never conducted US vascular access and 96% did not feel confident prior to the session. Following sessions, 100% of participants felt significantly more confident, and would consider attempting this on real patients. Qualitative comments showed they valued the sessions: ‘good opportunity to practice vein mapping and cannulation on gel model’. 100% felt US guided vascular access should be taught routinely within training. Five participants used this new skill, following the sessions, to undertake successful US- guided cannulation in acute resuscitation contexts. <h3>Conclusions</h3> This study demonstrates the effectiveness and usefulness of delivering vascular access training to DGH paediatricians. It enabled improved self-reported confidence, which translated into improved patient care in real-life acute scenarios. However, further research in a larger cohort of participants is required to truly evaluate its impact. We recommend that all UK paediatricians should be routinely trained in US guided vascular access, to promote better quality care for all paediatric patients within their local settings. The importance and role of US guided paediatric vascular access is still lacking in recognition, and demands wider acceptance. Further work is needed with appropriate stakeholders to endorse and prioritise the integration of this essential skill into the UK paediatric curriculum.