Airway management is the cornerstone of anesthesia practice. Fiberoptic intubations (FOIs) are one advanced airway method that Certified Registered Nurse Anesthetists (CRNAs) must be able to use. However, the low volume, high risk nature of this skill may affect a practitioner’s ability to perform this type of intubation. Despite this, no standardized training programs had been developed for this skill. The purpose of this project was to develop and implement an evidence-based educational simulation training program that allowed CRNAs the opportunity to practice safe FOIs and evaluate its effect on competence and self-confidence.
A review of the literature suggested the use of high-fidelity simulation as an evidence-based educational strategy to provide FOI skill training for a low volume skill in a risk-free environment. A training program was developed including three protocols for awake intubations. Nine anesthetists conducted a timed FOI on a high-fidelity mannequin prior to an evidence-based training program using simulation. The CRNAs then received a lecture and practiced FOI skills on the mannequins. Following training, participants completed another timed FOI and also completed the National League of Nursing (NLN) Student Satisfaction and Self-Confidence in Learning Questionnaire where intubation time, satisfaction, and self-confidence were evaluated as outcome measures.
Mean time to conduct FOI intubations decreased 52.87 seconds after the simulation training (difference between pre- and post-training times: p=0.01). Additionally, the NLN questionnaire showed that students were satisfied with the formal educational program and there was a high level of self-confidence for the skill after training.
Results of this scholarly project showed that an evidence-based FOI training program for CRNAs using simulation can lead to positive outcomes of competence, self-confidence and satisfaction. The project indicates that a simulation training program can be successfully used as a standardized program for anesthesia providers for this important airway management skill.
Moore, K. C. (2013). Simulation Training for Fiberoptic Intubations. . Wright State University, Dayton, OH.