Evaluating the Effectiveness of Gastric Ultrasound Training for Practicing Certified Registered Nurse Anesthetists
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Abstract
Introduction/Purpose: The purpose of this project was to train Certified Registered Nurse Anesthetists (CRNAs) in the use of gastric ultrasound to evaluate stomach contents in patients at risk for aspiration prior to surgery. GLP-1 agonists delayed gastric emptying, which increased the risk for aspiration on induction of anesthesia, necessitating a reliable tool for preoperative assessment of gastric contents. The proposed solution was the implementation of gastric ultrasound, an inexpensive, non-invasive, simple skill, recognized for its accuracy in determining gastric contents.
Methods: The literature review underscored the rising use of GLP-1 agonists, their impact on gastric emptying, and the inadequacy of existing fasting guidelines. Gastric ultrasound, identified as a valuable point-of-care tool, lacked integration into anesthesia training. The study outlined a targeted intervention to educate practicing CRNAs, focusing on the Indication, Acquisition, Interpretation, and Medical-Decision Making (I-AIM) framework for gastric ultrasound interpretation. The project design involved a pre– and post-intervention assessment using a questionnaire and the Ultrasound Competency Assessment Tool (UCAT). The educational intervention included a didactic presentation and hands-on training. CRNAs scanned a standardized volunteer model under various gastric states, and their competency was reevaluated two months later. The project’s setting was an anesthesia group in Boise, Idaho, serving a diverse patient population.
Results: Nine Certified Registered Nurse Anesthetists (CRNAs) participated in this study to evaluate their competency in performing gastric ultrasound after completing a structured training program. Before the training, participants completed a pre-questionnaire to assess their baseline knowledge and experience with ultrasound. None of the participants had received formal education in Point-of-Care Ultrasound (POCUS) or gastric ultrasound, though 78% reported using ultrasound in their clinical practice for nerve blocks and invasive line insertions. Their self-rated entrustment scores averaged 1.67 (SD = 0.50), indicating low confidence and competence. Following the training intervention, the CRNAs were evaluated six weeks later using the UCAT. In preparation, all participants scored a 3. For image acquisition, the mean score was 2.56 (SD = 0.53), and for clinical integration, the mean score was 2.11 (SD = 0.60). Entrustment scores significantly improved, with a mean post-training score of 2.75 (SD = 0.46). A paired t-test confirmed the significance of this improvement, t(8) = -5.50, p = 0.00057.
Discussion: This study evaluated the effectiveness of a structured training program in enhancing CRNAs' competency in performing gastric ultrasound. The pre-educational questionnaire highlighted a gap in formal training, with most participants lacking experience in POCUS and gastric ultrasound. Post-training evaluations showed significant improvements in preparation, image acquisition, and clinical integration, demonstrating the program's effectiveness. The significant increase in entrustment scores indicated that CRNAs gained confidence and competence in performing gastric ultrasound independently. The results suggest that a structured training program can effectively equip CRNAs with the skills needed to integrate gastric ultrasound into clinical practice, improving patient safety and clinical outcomes. To further enhance skill retention and autonomy, follow-up practice sessions are recommended, including refresher training, extended hands-on practice, simulation scenarios, and competency reassessment.