Complete data were available for 62 participants. Table 1 describes the demographics of the participants. As shown, there was a wide range of experiences and training. Table 2 provides information on the knowledge base of the participants with respect to PIVC placement. Results showed that most participants were knowledgeable about the mechanics of PIVC placement and were aware of the potential complications.
Table 2
Knowledge of PIVC placement (N = 62)
|
SD
|
D
|
Neither
|
A
|
SA
|
Know venous anatomy of arm
|
4 (6.6)
|
5 (8.2)
|
9 (14.8)
|
24 (39.3)
|
19 (31.1)
|
Familiar with equipment for PIVC
|
3 (4.9)
|
5 (8.2)
|
1 (1.6)
|
11 (18.0)
|
41 (66.1)
|
Knows proper procedure for PIVC
|
2 (3.3)
|
2 (3.3)
|
4 (6.6)
|
10 (16.4)
|
43 (70.5)
|
Knows techniques to verify placement
|
4 (6.6)
|
3 (4.9)
|
4 (6.6)
|
15 (24.6)
|
35 (57.4)
|
Knows common complications
|
4 (6.6)
|
3 (4.9)
|
4 (6.6)
|
18 (29.05
|
32 (52.5)
|
SD = Strongly Disagree; D = Disagree; Neither = Neither disagree nor agree; A = Agree; SA = Strongly agree; Data are n (%)
Prior to using the MR trainer, participants were asked to rate their confidence in placing the PIVC. Results demonstrated a high overall confidence (8.40 ± 2.0 out of 10 where 10 = extremely confident).
The actions of the participants in placing the PIVC are described in Table 3, scored using a checklist approach. As shown, participants were very successful in following the correct procedures for catheter placement. First attempt catheter placement was successful in 48 (77.4%) of cases. Only 11 (17.7%) and 3 (4.8) of participants caused ‘extravasation’ and ‘hematoma’ formation on their first attempt.
Table 3
Participant checklist evaluation (N = 62)
|
n (%)
|
Correctly place needle at insertion site
|
62 (100)
|
Hold needle at correct angle to skin
|
62 (100)
|
Advance needle
|
62 (100)
|
Lower the angle of insertion
|
62 (100)
|
Advance needle further into vein
|
60 (96.8)
|
Thread catheter and remove needle
|
59 (95.2)
|
First attempt outcomes
Correct placement
Hematoma
Extravasation
|
48 (77.4)
3 (4.8)
11 (17.7)
|
Subsequent successful attempts
1
2
|
10 (16.1)
1 (1.6)
|
After 2 e-mail reminders, 59/62 (95.2%) participants responded to the two-week follow-up survey. The responses are shown in Table 4. As shown, a majority of participants reported that exposure to the MR trainer improved their overall experience with PIVC placement and, over three-quarters believed it to be a potentially important bridge to ultrasound use. The participants’ responses to the Qualtrics evaluation survey are described in Table 5. Results from this survey suggest an overwhelming interest in using MR technology as a tool for medical procedure training.
Table 4
Two- week follow-up evaluation (N = 59)
|
n (%)
|
#Numbe of PIVCs since using MR
None
1–5
6–10
11–20
>20
*Successful PIVC placements since using MR
0–25%
26–50%
51–75%
76–100%
*PIVC Success compared with Pre-MR experience
Worse
About the same
Better
*How confident with PIVC since using MR
Less confident than before
About the same as before
More confident than before
MR useful in improving overall PIVC placement experience
Strongly disagree
Disagree
Neither disagree nor agree
Agree
Strongly agree
MR trainer good adjunct to ultrasound
Strongly disagree
Disagree
Neither disagree nor agree
Agree
Strongly agree
|
11(18.6)
15 (25.4)
14 (23.7)
8 (13.6)
11 (18.6)
0 (0.0)
1 (1.7)
8 (13.8)
37 (63.8)
0 (0.0)
42 (71.2)
7 (11.9)
0 (0.0)
45 (84.9)
7 (13.2)
3 (5.1)
8 (13.6)
23 (39.0)
24 (40.7)
1 (1.7)
0 (0.0)
0 (0.0)
9 (15.3
33 (55.9)
17 (28.8)
|
*Based on the number of participants who performed at least one PIVC placement in the 2 weeks following experience with the MR trainer
|
|
Table 5
Participants’ Perceptions of the Mixed Reality (MR) Trainer
|
SD
|
D
|
Neither
|
A
|
SA
|
MR anatomy was realistic
Ability to identify landmarks useful
|
2 (3.2)
2 (3.2)
|
4 (6.5)
3 (4.8)
|
6 (9.7)
7 (11.3)
|
42 67.7)
42 (67.7)
|
8 (12.9)
8 (12.9)
|
Ability to see internal structures useful
|
0 (0.0)
|
1 (1.6)
|
2 (3.2)
|
40 (64.5)
|
19 (30.6)
|
MR trainer was easy to use
|
0 (0.0)
|
4 (6.5)
|
7 (11.3)
|
32 (51.6)
|
19 (30.6)
|
MR trainer was enjoyable
|
0 (0.0)
|
2 (3.2)
|
7 (11.3)
|
24 38.7)
|
29 (46.8)
|
MR improved ability to place IV
|
2 (3.2)
|
5 (8.1)
|
18 (29.0)
|
25 (40.3)
|
12 (19.4)
|
MR features support learning
|
0 (0.0)
|
1 (1.6)
|
4 (6.5)
|
37 (59.7)
|
20 (32.3)
|
MR interactivity promotes learning
MR novelty promotes learning
MR useful tool for skills training
|
0 (0.0)
0 (0.0)
1 (1.6)
|
0 (0.0)
1 (1.6)
0 (0.0)
|
4 (6.5)
7 (11.3)
12 (19.4)
|
36 (58.1)
32 (51.6)
26 (41.9)
|
22 (35.5)
22 (35.5)
23 (37.1)
|
Include MR in medical training
MR useful bridge to ultrasound
|
0 (0.0)
0 (0.0)
|
0 (0.0)
2 (3.2)
|
4 (6.5)
5 (8.1)
|
30 (48.4)
29 (46.8)
|
28 (45.2)
26 (41.9)
|
SD = Strongly Disagree; D = Disagree; Neither = Neither disagree nor agree; A = Agree; SA = Strongly agree; Data are n (%) |
Open-ended comments from participants regarding their perceptions of the MR trainer were overall very positive. A majority of these comments were related to the ability to see the internal anatomy, accurately judge the angle of needle placement and advancement, and the real-time feedback. The following comments were taken verbatim.
The level of detail of the anatomy of the venous system and the responsiveness from the MR when changing needle angles.
Good feedback/real time depiction of how micro movements can impact needle tip position.
The ability to measure angles and correlate visually, as it can be difficult to blindly make small angles.
Realistic feel, hands on opportunity without the pressure of hurting/missing on a patient.
Dislikes were minimal but focused primarily on the positioning of the QR code card on top of the needle which sometimes affected the way the needle could be held comfortably. It is expected that further iterations of this technology would mitigate this concern.
“It was slightly difficult to hold the IV angiocath with that QR code attached.
It was a little glitchy on my experience. I was not able to hold the needle as I would in real life given the placement of the marker, which detracted from the applicability of the device to a real- world situation. I also recommend wearing gloves during the simulation to make the experience more realistic (often we med students practice without gloves and it becomes very hard to perform the same steps with them on).
Doesn’t recreate the hardest part about IV placement which is how to handle the needle being in the vein while the catheter is still out of the vein.
Would be nice to eventually use the goggles and do the whole procedure with MR.
Participants were also asked to consider any potential barriers to implementation of the MR technology into clinical practice. A sample of the comments included the following:
Good to introduce early in training. Might be difficult to get some practitioners with lots of experience for something they feel they already mastered
Resistance to technology among some team members as with any innovation. As they say, not all people like change.
It may encourage too much focus on the screen rather than actual device position, making translation to practice tenuous.
Cost
Following use of the MR trainer, participants were asked to compare it with other forms of training that they had received in the past. Results showed that 39 (62.9%) found the MR technology to be superior/far superior to other procedural skills training methods. Only 3 (4.8%) stated that the MR technology was worse than other methods. Having experienced the MR trainer, participants were also asked how they would prefer to receive PIVC training in the future. While 12 (19.4%) reported that they would prefer training solely with the MR trainer, 32 (51.6%) reported that they would prefer a combination of instructional videos together with the MR trainer, and 13 (21.0%) would prefer videos, didactics, and the MR trainer. This suggests that a combination of videos and the MR trainer with or without didactic lectures was deemed the preferred method of instruction for PIVC placement.