The Use of Ultrasonography to Improve Epidural Education
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Literature recommends using ultrasonography (US) to assist anesthetists in finding and accessing the epidural space in individuals with atypical anatomy. Simulation allows for a safe environment to learn US on ultrasound-compatible neuraxial manikins. This Doctor of Nursing Practice (DNP) project compared perceived competence, confidence, satisfaction, and accuracy of epidural cannulation among student registered nurse anesthetists (SRNAs) using landmark technique versus those who received a neuraxial ultrasound in-service. Kolb’s Theory of Experiential Learning acted as the theoretical framework. A quasi-experimental design utilizing surveys along with skill assessments was used. One cohort performed epidurals on an ultrasound-compatible manikin using ultrasonography and the other cohort used traditional epidural techniques on the same manikin. An additional cohort of Certified Registered Nurse Anesthetists (CRNAs) completed an online survey on perceived confidence and competence of using US with epidural cannulation. Most CRNAs (62.5%) completing the online survey disagreed that they would be able to identify spinal anatomy using US while 62.5% agreed that US is helpful in guiding placement of epidurals in patients with atypical anatomy. For all inperson cohorts, there was a statistically significant improvement (P<0.05) for each topic in the perceived competence and confidence testing. Participants reported high levels of confidence and satisfaction. There lacked statistical significance between the control and intervention cohorts for needle insertion attempts and time cannulation times. Project results confirmed higher perceived competence and confidence scores after receiving an in-service on US applied to epidural insertion. Such in-services could be incorporated into anesthetist training in the clinical and classroom settings.