Plan-do-check-act was applied to improve the first success rate of radial artery catheterization in anesthesiology residents

Abstract

Abstract Background:In the Department of Anesthesiology, radial artery puncture and catheterization is a basic skill for every doctor. Invasive arterial puncture directly measures the blood pressure value through the catheter, realizing real-time accurate monitoring of blood pressure fluctuation in critically ill patients, which provides the basis for clinical diagnosis and treatment; at the same time, part of the test specimen can be retained through the end of the invasive arterial catheter, which reduces the complications brought about by frequent blood collection and puncture. Therefore, we need to improve the success rate of the first attempt of radial artery catheterization in anesthesiology standardized training residents. Objective:Improving the success rate of first attempt radial artery cannulation in anesthesiology standardized training residents. Methods:Forty anesthesia residents undergoing standardized residency training at Sichuan Provincial People's Hospital from January to May 2023 were randomly divided into a control group and a PDCA group, with 20 residents in each group. The control group received standardized training with routine management and radial artery puncture and catheterization teaching; the PDCA group received training with PDCA cycle management and radial artery puncture and catheterization teaching. The success rate of the first attempt of radial artery cannulation, duration of radial artery cannulation, ultrasound use rate, whether the items were prepared with missing items and complication rate of the standardized training residents in the two groups were recorded and analyzed. Results:One resident physician in the PDCA group did not participate in the assessment due to illness, so a total of 19 physicians in the PDCA group participated in the assessment, and all 20 physicians from the control group participated in the assessment.The first success rate of puncture in the PDCA group was 85% (17/20), which was significantly higher than that of 45% (9/20) in the control group (P=0.003).The time of radial artery cannulation after PDCA was 0.92(0.63,2.73) min, which was significantly shorter than that of 3.84(2.87,5.65) min in the control group (Z=4.68, P<0.05).The ultrasound utilization rate in the PDCA group was 45% (9/20), which was significantly higher than the 15% (3/20) in the control group (P<0.05). There was no statistically significant difference in item preparation omissions, assessment scores, and complication rates in the PDCA group of residents in the operational assessment compared to the control group. Conclusion:PDCA management helps to increase the success rate of radial artery cannulation on the first attempt, shorten the time to puncture and place the cannula, increase the rate of complete preparation of items, as well as reduce the rate of complications.