Knowledge and skills in setting up videolaryngoscopes
Emily Pallister, Achuthan Sajayan and Cyprian Mendonca conducted a survey among operating departmental practitioners at a teaching hospital, looking at ODP training in airway management and the general knowledge of videolaryngoscopes
Background
Videolaryngoscopes have been proven to be useful in managing difficult intubation [1–4]. They transmit the image to an external monitor, from a miniature video camera placed at the distal end, via a fibreoptic bundle or a system of prisms. Some of them have an inbuilt tube channel that directs the tracheal tube into the larynx. Others require a stylet to direct the tracheal tube into the larynx. At University Hospital Coventry and Warwickshire (UHCW) there are six different videolaryngoscopes available. These comprise three channelled videolaryngoscopes (Airtraq, King Vision and Pentax AWS) and three non-channelled videolaryngoscopes (C-MAC, McGrath and Glidescope). From an anaesthetist’s perspective these videolaryngoscopes are widely available to use in theatres, and commonly feature in the airway management plan for an anticipated difficult airway. Training sessions are regularly held in the Coventry Airway Lab for intubation practice on mannequins.
Although the set up and assembly of these devices can be self-explanatory, knowledge of their maintenance and cleaning are also essential for the operator and the operating department practitioner (ODP). These skills are taught in the airway lab sessions; however, infrequent or variable use of the devices in daily practice means that this knowledge can often be lost. A survey was designed to gauge the knowledge, training and confidence of ODPs in the use and maintenance of videolaryngoscopes. Their assistance in the management of a difficult airway can be invaluable, and as such there is a requirement to have up-to-date skills in the use and maintenance of any device that the anaesthetist may ask for. ODPs are invited to attend videolaryngoscope sessions and refreshers in the airway lab to keep their skills current. The survey tested whether the level of confidence with videolaryngoscopes among ODPs was substantiated by relevant training, and, therefore, whether training was proving accessible and appropriate.
Methods
A survey questionnaire was designed to ascertain knowledge on location and availability of videolaryngoscopes, experience and confidence in setting up of videolaryngoscopes among ODPs. They were also asked whether they have received any formal training in setting up and maintenance of videolaryngoscopes.
ODPs from main operating theatres were surveyed over a two-week period. The cohort questioned included ODPs from all main specialities including cardiac, general, vascular, trauma and orthopaedic, gynaecology and neurosurgery. ODPs were asked how long they had been working as an ODP to see if there was correlation between the results and years of experience, and whether they had attended airway courses in the past two years.
From a list of seven possible videolaryngoscopes, ODPs were asked to identify the six available at UHCW. They were asked which of these they had used, and which they had received formal training for. ‘Formal training’ was described as having attended a lecture on the use of this videolaryngoscope, or having received training in a session in the airway lab or similar. Participants were then asked if they knew which, if any, of the videolaryngoscopes were available on the difficult airway trolley, and how they would find any given videolaryngoscope. At the end of the survey participants were invited to give any feedback they wished on the training they had received to date. The results were analysed using a Microsoft Excel spreadsheet.
Results and discussion
In total, 28 ODPs participated in this survey. There are estimated to be around 40 ODPs working within the department. Most commonly the respondents had been working either less than five, or over ten years as an ODP. Eleven (39 per cent) respondents stated that they had been to a training session on videolaryngoscopes in the airway lab. Another eight ODPs had been on the Coventry airway management course, and eight on the SMART anaesthesia course, although it is noted that some ODPs had been on more than one course (Figure 1).
All six videolaryngoscopes were correctly identified by 96 per cent of respondents. All of the ODPs surveyed were able to recognise that the Airtraq and Pentax AWS were available, with 27 respondents correctly identifying the other four. The majority of them (79 per cent) had assisted the anaesthetist in using all six of the videolaryngoscopes. The videolaryngoscope that the respondents had most experience with was the Pentax AWS (26 respondents; 93 per cent). The level of confidence in setting up videolaryngoscopes was high and closely reflected the experience demonstrated, and 75 per cent (21) of respondents felt confident in the use of all videolaryngoscopes, with only two respondents (7 per cent) stating ‘not sure’ to this question. It was noted that the ODPs who had attended airway courses in the past two years were more likely to indicate confidence with the videolaryngoscopes. This demonstrates the effectiveness of local airway training in improving confidence with these devices (Figure 2).