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Cantwell, Stacy; Tadlock, Matthew; Jalloh, Fatmata; Minetti, Michael; Skiada, Dimitra; Smith, Jennifer; Talving, Peep; Frankel, Heidi
Critical Care Medicine:
doi: 10.1097/01.ccm.0000439190.67801.f4
Oral Abstract Session: Administration & Education: PDF Only

Introduction: Emerging data suggests that Acute Care Nurse Practioners (ACNP) have successfully been integrated into Intensive Care Units (ICU) across the United States. While the ACNP scope of practice and how to bill for procedures has been described, the ideal method to train and credential ACNPs to perform invasive procedures has not. We describe our initial experience training ACNPs to perform invasive critical care procedures utilizing our Fresh Tissue Dissection Lab (FTDL) and simulation program. Methods: Seven ACNP were given a self-directed didactic followed by a four-hour practicum utilizing perfused fresh tissue cadavers. The cadavers were perfused via femoral artery and vein cannulation with colored pressurized fluids simulating arterial and venous blood. Procedures performed included central venous landmark guided subclavian (SC) and ultrasound (US) guided internal jugular (IJ) vein catheter insertion, orotracheal intubation, tube thoracostomy, thoracentesis, and paracentesis. Pretest and posttest knowledge assessments were administered. Overall and specific procedural confidence was evaluated utilizing a retrospective pre-practicum and post-practicum analysis with a 5-point Likert scale (1, least confident and 5, most confident). Results: The mean years of clinical experience for the group was 4.1 years (range 4 months to 13 years). Each ACNP scored a 100% on both the pretest and posttest knowledge assessment. The overall procedural confidence for all procedures improved by 1.44, from 2.53 (SD+/- 0.629) to 3.97 (SD+/- 0.320) (p <0.001). For the insertion of central lines, overall confidence improved by 1.17 (p=0.013), for all other procedures confidence improved by 1.5 (p=0.01). Conclusions: Our initial experience utilizing our FTDL and simulation program to train ACNPs showed improved confidence scores after both the self-directed didactic and the FTDL practicum. The FTDL perfused pressurized model allowed differentiation of venous and arterial vessels during landmark guided SC vein and US guided IJ vein catheterization. This practicum has been integrated into our ACNP credentialing process to perform ICU procedures independently. Further study is needed to determine the ideal method to train and credential ACNPs to perform invasive procedures independently in the intensive care unit.

(C) 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins