Concurrent Session 1B
Tracks
Meeting Room 2
| Wednesday, October 4, 2023 |
| 3:30 PM - 4:30 PM |
| Meeting Room 2 |
Details
Session chair: Trish Allen
Speaker
Cathi Montague
Nurse Consultant, Ipc
SA Health / Dassa
Lessons from experience: Hamstring Injuries in and beyond the ED - why assessment and care matters.
3:30 PM - 3:50 PMAbstract
Background/Introduction:
'Hamstrings' are comprised of three separate muscles at the back of the thigh and are very often underappreciated in how they support us to move and function.
Hamstring injuries may not be commonly seen in the emergency department (ED) and are often considered to be sporting related. However, mechanism of injury can vary, with different aspects of musculoskeletal anatomy affected. They can be tricky to differentiate.
Definitive diagnosis and management of hamstring pathologies can be time to treatment critical, with extensive injury rehabilitation requirements. Missed or delayed definitive diagnosis can have a significant injury related morbidity burden for the individual.
Aim/Purpose:
This presentation seeks to improve clinical care and patient outcomes through a focussed review of hamstring anatomy and function and mechanism of injury that informs clinical and radiological assessment findings. Clinician awareness is improved through increased understanding of care in the ED and of post-discharge injury care and rehabilitation pathways.
Methods/Intervention/Activity:
Recent experience of a complete proximal hamstring avulsion injury with missed diagnosis in the ED has afforded a learning journey for the author through the global academic literature and the extended care pathway.
Expert perspectives from a physiotherapy and surgical viewpoint have been explored, to afford multidisciplinary insight into injury management care pathways that can optimise recovery outcomes.
Results/Outcome:
Short- and longer-term health outcomes for individuals with hamstring injuries will be improved with clinician awareness of assessment, definitive diagnosis, ED discharge care and post ED care pathways. Injury experience of an ED clinician has afforded an opportunity to explore care and outcomes from a clinical, academic literature and lived perspective.
Conclusion/Recommendations:
Proximal hamstring avulsion injury is a rare injury and can be misdiagnosed. ED assessment and care that includes mechanism of injury and differential diagnosis awareness for less commonly seen injuries influences the subsequent lived experience of the patient.
'Hamstrings' are comprised of three separate muscles at the back of the thigh and are very often underappreciated in how they support us to move and function.
Hamstring injuries may not be commonly seen in the emergency department (ED) and are often considered to be sporting related. However, mechanism of injury can vary, with different aspects of musculoskeletal anatomy affected. They can be tricky to differentiate.
Definitive diagnosis and management of hamstring pathologies can be time to treatment critical, with extensive injury rehabilitation requirements. Missed or delayed definitive diagnosis can have a significant injury related morbidity burden for the individual.
Aim/Purpose:
This presentation seeks to improve clinical care and patient outcomes through a focussed review of hamstring anatomy and function and mechanism of injury that informs clinical and radiological assessment findings. Clinician awareness is improved through increased understanding of care in the ED and of post-discharge injury care and rehabilitation pathways.
Methods/Intervention/Activity:
Recent experience of a complete proximal hamstring avulsion injury with missed diagnosis in the ED has afforded a learning journey for the author through the global academic literature and the extended care pathway.
Expert perspectives from a physiotherapy and surgical viewpoint have been explored, to afford multidisciplinary insight into injury management care pathways that can optimise recovery outcomes.
Results/Outcome:
Short- and longer-term health outcomes for individuals with hamstring injuries will be improved with clinician awareness of assessment, definitive diagnosis, ED discharge care and post ED care pathways. Injury experience of an ED clinician has afforded an opportunity to explore care and outcomes from a clinical, academic literature and lived perspective.
Conclusion/Recommendations:
Proximal hamstring avulsion injury is a rare injury and can be misdiagnosed. ED assessment and care that includes mechanism of injury and differential diagnosis awareness for less commonly seen injuries influences the subsequent lived experience of the patient.
Biography
Cathi Montague has a very diverse range of nursing experiences across her career, including many years in E.D. Embracing and creating opportunities means there is always something to learn and contribute. Cathi is passionate about nursing practice, excellent patient care, critical thinking, team building and asking 'how can we do this better?'. She is a founding Director of CENA and a CENA Fellow. A rare traumatic injury in 2022 with significant impact has offered reflections on lived-experience of the implications of ED care outcomes, critical thinking, resilience, patient pathways and lessons from the other side. Cathi currently works as a Nurse Consultant for Infection Prevention and Control in a statewide service and is only just getting back to also working in her other positions as a casual RN in a private hospital ED and in a small rural hospital.
Dr Hui (Grace) Xu
Nurse Practitioner
Emergency Department, QEII Hospital
An innovative device for Difficult Venous Access in ED- Is this a good solution?
3:50 PM - 4:10 PMAbstract
Background: Peripheral intravenous catheter (PIVC) insertion is a core clinical practice in emergency departments (EDs). However, a quarter of ED patients have difficult intravenous access (DIVA) and over half require multiple insertions.
Aim: To compare a novel long AccuCath PIVC with a retractable coiled guidewire with a standard care PIVC in ED DIVA patients in terms of first insertion success and device failure.
Method: A prospective, two-arm, parallel-group randomised controlled trial (RCT) was conducted at two EDs in Australia. All adult DIVA patients who require PIVCs with informed consent were included. Eligible patients were randomised to receive either standard care or long AccuCath PIVC via web-based randomisation with allocation concealment. Statisticians and infectious disease physicians were blinded to treatment allocation. The primary outcome is first-time insertion success. Qualitative data about user experience was also collected via semi-structured interviews.
Results: 446 participants enrolled in the trial. The primary outcome, first attempt insertion success was higher in the standard care PIVC arm (76.6%) compared to the AccuCath arm (68.0%) [OR 0.65 OR 95%CI: 0.43-0.99]. Dwell time (secondary outcome) was significantly longer in the standard care PIVC arm (16.2 hours) compared to the AccuCath arm (8.3 hours) [Coef: -7.90 Coef 95%CI: -14.23 to -1.57]. The qualitative study found there are diverse experiences with Accu Cath PIVC and barriers associated with learning the new device in busy ED settings.
Conclusion: The long AccuCath PIVC did not improve the first insertion success rate.
Aim: To compare a novel long AccuCath PIVC with a retractable coiled guidewire with a standard care PIVC in ED DIVA patients in terms of first insertion success and device failure.
Method: A prospective, two-arm, parallel-group randomised controlled trial (RCT) was conducted at two EDs in Australia. All adult DIVA patients who require PIVCs with informed consent were included. Eligible patients were randomised to receive either standard care or long AccuCath PIVC via web-based randomisation with allocation concealment. Statisticians and infectious disease physicians were blinded to treatment allocation. The primary outcome is first-time insertion success. Qualitative data about user experience was also collected via semi-structured interviews.
Results: 446 participants enrolled in the trial. The primary outcome, first attempt insertion success was higher in the standard care PIVC arm (76.6%) compared to the AccuCath arm (68.0%) [OR 0.65 OR 95%CI: 0.43-0.99]. Dwell time (secondary outcome) was significantly longer in the standard care PIVC arm (16.2 hours) compared to the AccuCath arm (8.3 hours) [Coef: -7.90 Coef 95%CI: -14.23 to -1.57]. The qualitative study found there are diverse experiences with Accu Cath PIVC and barriers associated with learning the new device in busy ED settings.
Conclusion: The long AccuCath PIVC did not improve the first insertion success rate.
Biography
Dr Grace Xu is a senior Nurse Practitioner in emergency care, Implementation Science Research Fellow at the Queensland University of Technology/ Royal Brisbane and Women's Hospital, Adjunct Research Fellow in the Alliance for Vascular Access Teaching and Research (AVATAR) in Queensland Australia. Her research interests include implementation science, vascular access and staff wellness promotion.
Dr. Ulrich Steinwandel
Research And Teaching Scholar
Edith Cowan University
Evaluation of a Point-of-care ultrasound (POCUS) workshop for peripheral intravenous cannulation
4:10 PM - 4:30 PMAbstract
Background:
Point-of-care ultrasound (POCUS) is increasingly used as a non-invasive vascular access assessment method by clinicians from multiple disciplines worldwide, prior and during vascular access cannulations., It is essential to train and educate individuals who are novices in the techniques of cannulation so that they become proficient in performing this task subsequently on patients safely and successfully. With this project, we sought to determine if participants of a simulated POCUS workshop for vascular access can use this technique successfully in their individual clinical environment after their attendance of a half-day workshop.
Methods:
A mixed-methods longitudinal study design was chosen to evaluate a point-of-care ultrasound workshop for peripheral intravenous cannula insertion. The workshops used simulation models for cannulation in combination with multiple ultrasound devices from various manufacturers.
Results:
A total of 85 Individuals participated in eleven half-day workshops through 2021 and 2022. Workshop participants claimed that attending the workshop had significantly enhanced their clinical skill of using ultrasound for the purpose of cannulating a venous vessel.
Conclusions:
Globally, clinicians are increasingly using POCUS to establish vascular access in patients, and it is necessary that they receive sufficient and adequately structured and formal training to successfully apply this technique in their clinical practice. Offering a workshop which uses simulation models in combination with various POCUS devices to demonstrate this technique in a hands-on approach has proven to be useful to establish this newly learned skill in clinicians.
Point-of-care ultrasound (POCUS) is increasingly used as a non-invasive vascular access assessment method by clinicians from multiple disciplines worldwide, prior and during vascular access cannulations., It is essential to train and educate individuals who are novices in the techniques of cannulation so that they become proficient in performing this task subsequently on patients safely and successfully. With this project, we sought to determine if participants of a simulated POCUS workshop for vascular access can use this technique successfully in their individual clinical environment after their attendance of a half-day workshop.
Methods:
A mixed-methods longitudinal study design was chosen to evaluate a point-of-care ultrasound workshop for peripheral intravenous cannula insertion. The workshops used simulation models for cannulation in combination with multiple ultrasound devices from various manufacturers.
Results:
A total of 85 Individuals participated in eleven half-day workshops through 2021 and 2022. Workshop participants claimed that attending the workshop had significantly enhanced their clinical skill of using ultrasound for the purpose of cannulating a venous vessel.
Conclusions:
Globally, clinicians are increasingly using POCUS to establish vascular access in patients, and it is necessary that they receive sufficient and adequately structured and formal training to successfully apply this technique in their clinical practice. Offering a workshop which uses simulation models in combination with various POCUS devices to demonstrate this technique in a hands-on approach has proven to be useful to establish this newly learned skill in clinicians.
Biography
Dr. Ulrich Steinwandel has 33 years of clinical experience in hemodialysis and peritoneal dialysis as a nephrology nurse, working in Europe and in Australia. Over 8 years, Ulrich has also covered the Renal Research Coordinator position at Fremantle Hospital and Fiona Stanley hospital. He works currently as a Research and Teaching scholar at Edith Cowan University at the School of Nursing and Midwifery in Joondalup/Western Australia. Over the past two years he has delivered 22 hands-on practical workshops in Perth and regional areas of Western Australia for ultrasound guided cannulation using point-of-care ultrasound (POCUS) devices and the simulation of difficult vascular access (DIVA) conditions, predominantly delivered to junior doctors.
