Biasucci - Training e certificazione

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L’importanza del

‘training’

e della

certificazione

Daniele G. Biasucci

Neurorianimazione

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Lesson Learned from Flight Deck

• Since the ’60s, aviation accidents dramatically decreased after the implementation of standardized training based mostly on simulation • Aviation (and nuclear) industries has developed high-fidelity simulation training programs improving the non-technical skills of teams

through Crew Resource Management programs

(CRM).

• “It is frightening to speculate the level of

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§ Complications during US-guided CVC placement can occur

§ Understanding how these complications can occur provides the operator with a mechanism to prevent their occurrence

§ Operator training and experience are important in determining the complications

associated with the procedure

§ Operator inexperience or the use of unsuitable equipment, particularly in the more challenging patient, may increase rather than decrease complications

§ There is a learning curve associated with

sonography, and guidance based on misinformation can harm our patients

AB Levitov

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Feller-Kopman, 2007

• 2 h of didactics

• 2 h of laboratory training

• 5-10 proctored examinations • Knobology

• Examinations of normal vascular anatomy on healthy volunteers • Visualization of abnormal anatomy (obese patient, intraluminal

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Training Oggi

• _{Didactic Lectures =}

_Knowledge

• Laboratory Training

–

_{Ultrasound examination on healthy volunteer}

–

Hands-on Simulation

• _{Proctoring Phase}

–

Direct observation

–

Tutored procedures on real patients

• Personal ‘untutored’ Learning Curve

• Final Clinical Audit

Simulation

Training

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US-GUIDED

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q

_{Studio prospettico in cieco}

q

25 specializzandi in training

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§

_{Durante la venipuntura ecoguidata si possono verificare complicanze}

§

_{Conoscere queste complicanze permette di evitarle}

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• CEUS Vs CXR

• Sensitivity: 33% (95% CI, 0%-71%)

• Specificity: 98% (95% CI, 95%-100%)

• Negative predictive value: 94% (95% CI,

89%-100%)

• Positive predictive value 67% (95% CI, 13%-100%)

“CEUS by itself cannot substitute CXR

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Ecocardiografia e Tip location

• _{Manca standardizzazione della tecnica}

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NIR

• _{Mancano sufficienti studi randomizzati che}

comprovino la efficacia e la costo-efficacia

• Necessità di training appropriato

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Thrombosis

Prevention

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Human

Factors

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