T o d e sig n a p ro ficien cy-b a se d v a sc u la r su rg e ry sim ulation training curriculum in e n d o v a scu la r intervention (superficial fem oral artery a n gio p lasty) and open v a sc u la r s u rg e ry (sa p h e n o fe m o ra l junction d isse ctio n ), four stu d ies w ere perform ed.
In the first study, a p ro ce d u re -sp e cific ch ecklist for superficial fem oral artery a n giop lasty ( S F A ) w a s d evelo p ed and validated. In the se co n d study, the im pact of an a ssista n t on the te ch n ica l skills of the prim ary operator perform ing S F A a n g io p la stie s w a s a s s e s s e d . T h e first and the se co n d stu d ies w ere e sse n tia l to d e sig n a p ro ficien cy-b a se d sim ulation training curriculum for S F A a n gio p lasty and to study the transfer of e n d o v a scu la r tech n ical sk ills after p ro ficie n cy-b a se d sim ulation training to the interventional suite (third study). T h e fourth study d e s c rib e s the transfer of b a s ic open v a scu la r su rg e ry te ch n ica l sk ills after p ro ficien cy-b a se d sim ulation training in sap h e n o fem o ral junction ( S F J ) d isse ctio n to the operating theatre. T h is ch ap ter will d e sc rib e the m aterials and m ethods u se d in e a ch of the four studies.
2.1 O b jective s
2.2 D e v e lo p m e n t a n d a s s e s s m e n t o f a p r o c e d u r e -s p e c if ic c h e c k lis t fo r s u p e r fic ia l fe m o ra l a rte ry a n g io p la s t y u s in g an e n d o v a s c u la r s im u la to r
2.2.1 D e v e lo p m e n t o f a p re lim in a r y p r o c e d u r e - s p e c if ic c h e c k lis t fo r s u p e r fic ia l fe m o ra l a rte ry a n g io p la s t y
In early 2 0 1 0 , two co n su lta n ts in interventional rad iolo gy and o n e consultant in v a sc u la r su rg e ry e sta b lish e d the e sse n tia l ste p s to perform an antegrade S F A a n gio p lasty, e xclu d in g the ste p s required to g a in arterial a c c e s s . T h is list of e sse n tia l ste p s w a s b a se d on 20 y e a rs ’ co llective e x p e rie n ce in perform ing S F A a n gio p lasty. T h is resulted in a prelim inary 28-item p ro ce d u re -sp e cific ch ecklist. T a b le 2.1 lists the item s in the prelim inary ch ecklist.
T a b le 2.1. List of the item s in the prelim inary p ro ce d u re -sp e cific ch ecklist for S F A a n g io p lasty
T a s k d e s c r ip t io n
1
. C h e c k patient history with regard to antico agulatio n , claudication, duration of sym p to m s etc.2
. C h e c k p re-procedure im aging (ex: M RA , C T A , D uplex). 3. C h o o s e appropriate initial guidew ire4. P re p a re initial guidew ire (ex: wet guidew ire with h ep arin e-salin e solution).
5. Insert guidew ire to appropriate level with appropriate ca re for o b struction/vessel traum a.
6
. C h o o s e appropriate w orking catheter.7. P re p are w orking cath eter (ex: flush catheter with h ep a ra n ise d saline).
8
. F e e d w orking catheter over guidew ire to appropriate level: catheter d o e s not p a s s beyond tip of wire.9. W ithdraw initial guidew ire leavin g w orking cath eter in place.
10. Inject contrast m aterial to outline lesion (ro a d m a p should be taken at this tim e) and define the extent o f the lesion u sin g roadm ap.
11 .C h o o s e appropriate guidew ire to c ro s s lesion. 12. P re p a re guidew ire for u se .
13. Insert guidew ire through w orking catheter. U s e ro ad m ap to help c ro s s the lesion and avoid subintim ai disection. C r o s s lesion.
14. M anipulate w orking cath eter to be positioned distal to lesion. 15. E x c h a n g e c ro s s in g guidew ire with w orking guidew ire.
16. M ake su re guidew ire d o e s not travel into crural arteries or side b ra n ch e s of popliteal.
17. Give 50 to 75 units/kg of Heparin.
18. W ithdraw w orking cath eter leavin g guidew ire in place. 19. C h o o s e appropriate balloon s iz e for angiop lasty. 20. P re p are balloon catheter.
21. Insert balloon cath eter a c ro s s lesion m aking su re guidew ire d o e s not travel distally.
22. Inflate balloon by m e ch a n ica l inflation d evice .
23. U se flu ro sco p y g u id a n c e while perform ing balloon angiop lasty. 24. D e c o m p re ss balloon fully with 2 0 c c syrin ge.
25 . R e m o v e balloon o ver guidew ire leavin g guid ew ire in place. 26. Inject co ntrast m aterial to c h e c k lesion post angiop lasty. 27. C h e c k run-off post angiop lasty.
28. R e m o v e instrum ents u n d er flu ro sco p y g u id a n ce .
2.2.2 C o n te n t v a lid it y o f the d e v e lo p e d c h e c k lis t : A m o d ifie d D e lp h i p r o c e s s
A modified D elphi m ethod w a s then u sed to validate the co nten ts of the ch ecklist. T h is m ethod is d e sig n e d to a ch ie ve c o n s e n s u s am o n g experts on critical d e c isio n s (C la yto n , 1997). In brief, a principal investigator runs the study by adm inistering repeated su rve y rounds to a panel of e xp e rts who are blinded to e a ch other’s identity. T h is e n h a n c e s gro u p d e cisio n -m a kin g by elim inating individual influ ence (R A N D S c ie n c e and T e c h n o lo g y P o licy Institute, 2001 ). In the first round, e xp erts are a sk e d to a n sw e r sp e cific q u estio n s and g iv e fe e d b a ck . T h e e xp e rts’ input is then a n a ly se d and the ch e ck list m odified a cco rd in g ly by the principal investigator w ho co n d u cts a se co n d round for further co m m e n ts and fe e d b a ck . S e v e ra l ro un d s are co nd u cted until a c o n s e n s u s is reach ed am on g the panel.
In this study, five co n su lta n ts in interventional rad iolo gy b a se d in E u ro p e w ere a p p ro ach e d by e-m ail. An invitation letter w a s se n t to e a c h expert individually. A n expert w a s defined a s a rad iolo gy/vascu lar su rg e o n
consultant who h a s perform ed a m inim um of two hundred S F A a n g io p la stie s in the past five y e a rs. A fter obtaining the e xp e rts’ a gre e m e n t for their
participation in the study, the prelim inary 28-item ch e ck list w a s sen t to e a ch individual from the panel. T h e exp erts did not know e a c h other’s identity.
E x p e rts w ere a sk e d to s c o re e a c h item b ase d on a 1 to 9 Likert-like sco re a s