Abstract

Refresher training for junior doctors about peripheral cannulation: what�s the benefit and what�s important?

Author(s): Dr Eleanor M Woodford Guegan,Dr Olga Zolle,Ms Fleur Kitsell,

Introduction: Peripherally inserting an intravenous cannula is a clinical skill commonly performed by junior doctors and is associated with the risk of hospital-acquired infection and thrombophlebitis. Previous studies have identified that refresher training sessions about clinical skills are important for junior doctors, but have not focussed on peripheral cannulation in depth. This study investigated how useful junior doctors found refresher training sessions and identified important components of such sessions.

Methods: Ethics approval was granted for a mixed-methods qualitative and quantitative study. Staff attending peripheral cannulation training sessions at seven participating acute UK National Health Service (NHS) Trusts, between October 2008 and July 2009, were asked to complete a questionnaire. Semi-structured interviews were held with specialist clinical skills trainers, key hospital staff (such as Medical Directors) and medical students, to identify the important facets of such training sessions.

Results: 228 questionnaires were returned from junior doctors; 96% had previous experience of inserting a peripheral cannula and 95% had received previous education. Following the training session 82% would adapt their insertion technique. 62% had received previous education about aspects of continuing care and 77% would subsequently adapt their continuing care practice following the training session. 62% had increased their overall knowledge and 54% found it useful to practice on the clinical skills mannequin. Eighteen staff participated in semi-structured interviews to explore facets of peripheral cannulation training. Important themes were pre-qualification experience, the importance of training about continuing care practices, benefits of refresher training and delivery of refresher training sessions.

Discussion: Refresher training sessions about peripheral cannulation were of value to the vast majority of junior doctors surveyed. An improved insertion technique and increased familiarisation with a Trust’s equipment were cited as changes following the training session. This highlights the need for an optimum sterile technique to prevent healthcare associated infection and reflects recent developments in cannulation equipment. Little research has been undertaken on the role of doctors in providing ongoing care of peripheral cannulae following insertion. Benefits from the training session included increased familiarisation with the Visual Infusion Phlebitis (VIP) scores, increased vigilance and better documentation. Training sessions should be structured to impart the major benefits of practising the technique and familiarisation with the equipment, whilst optimising the best use of time. Conclusion: With regards to peripheral cannulation, refresher training sessions for junior doctors are of great benefit. Practice guidelines have been developed in order to highlight key facets associated with delivering peripheral cannulation refresher training sessions; pre-planning, approach on the day and subsequent follow-up.