On The Cover

During a delicate orthopedic procedure, New Jersey CRNA Nicholas Blanck, MSN, APN, (foreground) provides vigilant, hands-on care to his patient on the anesthesia side of the surgical curtain. (Photo by Christopher Bettin, MA.)

Articles

  • Intrathecal Spread of Injectate Following an Ultrasound-Guided Selective C5 Nerve Root Injection in a Human Cadaver Model Ultrasound-guided selective C5 nerve root blocks have been described in several case reports as a safe and effective means to anesthetize the distal clavicle while maintaining innervation of the upper extremity and preserving diaphragmatic function. In this study, cadavers were injected with 5 mL of 0.5% methylene blue dye under ultrasound guidance to investigate possible proximal and distal spread of injectate along the brachial plexus, if any. Following the injections, the specimens were dissected and examined to determine the distribution of dye and the structures affected.
    Keywords: Brachial plexus, clavicle fracture, intrathecal injection, selective C5 nerve block, ultrasound guidance.
    Version: 2016;84(2):80-84. Authors: Christian R. Falyar, DNAP, CRNA, Caroline Abercrombie, MD, Robert Becker, BS, Chuck Biddle, PhD, CRNA
  • Effect of Ultrasound-Guided Placement of Difficult-to-Place Peripheral Venous Catheters: A Prospective Study of a Training Program for Nurse Anesthetists Patients with difficult intravenous access (DIVA) often experience discomfort because of failed attempts to place peripheral venous catheters (PVCs); however, ultrasound guidance may improve this problem with catheter placement. The aim of this study was to evaluate the use of ultrasound when operated by nurse anesthetists for these patients. This prospective observational study with a pre/post design focused on inpatients with DIVA referred for PVC placement, a service provided by nurse anesthetists in most Scandinavian hospitals.
    Keywords: Catheter, central venous catheter, peripheral venous catheter, ultrasound-guided placement.
    Version: 2016;84(2):86-92. Authors: Kohyar Partovi-Deilami, CRNA, Jesper K. Nielsen, MD, Ann M. Møller, MD, PhD, DMSc, Sara-Sophie S. Nesheim, MD, Vibeke L. Jørgensen, MD, PhD
  • Local Anesthetic Adjuvants Providing the Longest Duration of Analgesia for Single-Injection Peripheral Nerve Blocks in Orthopedic Surgery: A Literature Review Inadequate pain relief after surgery may delay surgical recovery, decrease patient satisfaction, increase length of stay, raise the risk of hospital readmissions, and increase overall healthcare costs. One way to decrease postoperative pain for patients undergoing orthopedic surgery is through use of peripheral nerve blocks. The purpose of this literature review is to evaluate local anesthetic adjuvants to peripheral nerve blocks. A review of published studies using PubMed, MEDLINE, and Cochrane search engines was performed using predefined data fields. Based on this literature review, recommendations for practice are provided.
    Keywords: Anesthetic adjuvant, analgesia, local anesthetics, nerve block, regional anesthesia.
    Version: 2016;84(2):95-103. Authors: LCDR Jason A. Patacsil, DNP, CRNA, NC, USN, Maura S. McAuliffe, PhD, CRNA, FAAN, Leah S. Feyh, DNAP, CRNA, Lorie L. Sigmon, DNP, FNP
  • Design of an Evidence-Based “Second Victim” Curriculum for Nurse Anesthetists The “second victim” phenomenon—when a healthcare provider experiences adverse events because of the adverse events of a patient—is not well known or understood among healthcare professionals, including Certified Registered Nurse Anesthetists (CRNAs). No published research is currently available on the impact of second victim specifically in CRNAs, but it is known that second victim poses major challenges for healthcare professionals. Therefore, it is important to acknowledge its occurrence and to develop an educational curriculum based on the available evidence.
    Keywords: Anesthesia, adverse events, second victim.
    Version: 2016;84(2):107-113. Authors: Regina G. Daniels, DNP, MSN, CRNA, Ruth McCorkle, PhD, RN, FAAN
  • Use of Personal Electronic Devices by Nurse Anesthetists and the Effects on Patient Safety Distractions during anesthesia delivery may threaten patient safety. Personal electronic devices (PEDs) have become an integral tool used by 90% of adults. Adaptation of PEDs has permitted their integration into current anesthesia practice. Although technologic advancements have improved accessibility to resources and communication, they also serve as a source of distraction. The purpose of this article is to illustrate the critical need for further research in order to analyze safety risk.
    Keywords: Anesthesia, media policy, operating room, patient safety, personal electronic devices.
    Version: 2016;84(2):114-119. Authors: Lauren R. Snoots, MSN, CRNA, Brenda A. Wands, PhD, MBA, CRNA
  • Using a Structured Assessment Tool to Evaluate Nontechnical Skills of Nurse Anesthetists Nontechnical skills are critical for good anesthetic practice but are seldom addressed explicitly in clinical training. The purposes of this study were (1) to evaluate the reliability and validity of the observation-based assessment tool Nurse Anaesthetists’ Non-Technical Skills system (N-ANTS) and (2) to evaluate the effect of training nurse anesthetist supervisors in the use of N-ANTS.
    Keywords: Assessment, nontechnical skills, nurse anesthetist, operating room, training.
    Version: 2016;84(2):122-127. Authors: Helle Teglgaard Lyk-Jensen, MSc, CRNA, RN, Peter Dieckmann, Dipl Psych, PhD, Lars Konge, MD, PhD, Rikke Malene H. G. Jepsen, MD, PhD, Lene Spanager, MD, PhD, Doris Østergaard, MD, DMSc
  • AANA Journal Course: Update for Nurse Anesthetists—Part 1—Thromboelastography: Clinical Application, Interpretation, and Transfusion Management The coagulation cascade is a dynamic process dependent on many factors. It involves interaction between primary hemostasis, platelet clot formation, secondary hemostasis, thrombin generation, and fibrinolysis. The assessment of this process is particularly important in the surgical patient to properly manage hemostatic issues.
    Keywords: Coagulation, coagulation cascade, hemostatic issues, thromboelastography.
    Version: 2016;84(2):129-134. Authors: Shawn Collins, DNP, PhD, CRNA, Carolyn MacIntyre, MS, CRNA, Ian Hewer, MSN, MA, CRNA