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Evidence-based guidelines. Peripherally inserted central catheter (PICC) videos uploaded were more likely to have followed evidence-based guidelines than central venous catheter (CVC) videos. The median rating for PICC videos was significantly higher than CVC videos. Mann- Whitney U test p 1⁄4 0.03. 

Evidence-based guidelines. Peripherally inserted central catheter (PICC) videos uploaded were more likely to have followed evidence-based guidelines than central venous catheter (CVC) videos. The median rating for PICC videos was significantly higher than CVC videos. Mann- Whitney U test p 1⁄4 0.03. 

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Background Video sharing networks such as YouTube have revolutionized communication. Whilst access is freely available uploaded videos can contain non peer-reviewed information. This has consequences for the scientific and health care community, when the challenge in teaching is to present clinical procedures that follow empirical methods. Objecti...

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... venous cannulation as the search term representing CVCs and peripherally inserted central catheter insertion as the search term representing PICCs. We reviewed the fi rst 50 consecutive videos that the YouTube search engine returned using central venous cannulation . Once we viewed the fi rst video we returned back to the search results page and clicked on the subsequent video until we viewed 50 videos. We identi fi ed each video ’ s source by using the uniform resource identi fi er unique to each YouTube video. We then entered the uniform resource identi fi er of each CVC video that met our inclusion criteria (ie, clinical insertion videos of CVC or PICC), into a spreadsheet program (Microsoft Excel; Microsoft Corp, Redmond, WA). We excluded mannequin and animation videos. We performed the same procedure with the term peripherally inserted central catheter and also excluded mannequin and animation videos. We critiqued and scored included videos according to an assessment tool (see Table 1) established by the authors utilizing evidence-based guidelines from the Centers for Disease Control and Prevention, the Australian Clinical Excellence Commission, and the United Kingdom ’ s National Institute for Health and Clinical Excellence. 20-22 Each set of guidelines advocated the use of maximal barrier precautions; monitoring the insertion with real-time ultrasound; applying skin antisepsis with chlorhexidine gluconate 2%; and donning personal protective equipment, such as a cap, mask, and protective eyewear. Each video for CVC and PICC insertion techniques/instruction were scored for the presence of each assessment criterion, with 1 point awarded for each criterion covered. If all steps were covered, the highest score possible was 10. Data critique and scores were computed into a fi nal rating out of 10. Data were exported into SPSS version 20 (SPSS IBM Company, Armonk, NY) for statistical testing. The quality of the procedural moments between CVC and PICC insertions, as outlined in Table 1 concerned us and we wanted to fi nd out if the quality of insertion type differed with respect to evidence based guidelines. We further focused our critique on use of maximal barrier precautions; use of ultrasound for PICC and CVC placement; and use of skin antisepsis, as outlined in our measurement tool. All of these procedures were evident in the included CVC and PICC videos. This is our rationale for our speci fi c focus on 3 signi fi cant procedures. We also wanted to measure the difference in number of views per month from upload to September 21, 2012, to assess popularity of CVC and PICC videos. The Mann-Whitney U test assessed the median rating video score between CVC and PICC insertion videos viewed. Con fi dence intervals (calculated at 95%) were used to estimate the range in the views per month and adherence to evidenced- based guidelines. c 2 Distribution and the Fisher exact test were used to assess differences in adherence to each evidence-based element. Twenty-seven CVC videos met the inclusion criteria for review. These contained an aggregated 708,993 views and 166 minutes 53 seconds of footage. 21 PICC insertion videos were included for fi nal critique. These videos reviewed totalled 301,920 hits and consisted of a total of 189 minutes 44 seconds of footage. There was a signi fi cant difference ( p 1⁄4 0.007) between the type of central venous access device viewed per month (median number of times the videos were viewed was CVC 1⁄4 328 and PICC 1⁄4 62) (see Figure 1). The mean number of minutes uploaded of CVC and PICC videos was 7.59 minutes, with the longest video being 15.31 and the shortest 0.36 seconds. PICC videos had a mean running time of 6 minutes 16 seconds, whereas CVC videos returned a mean running time of 9 minutes 40 seconds. Of the total 27 CVC videos assessed, only 9 (33.3%) promoted real-time ultrasound guidance during insertion. This was different to PICC insertions where 18 (85.7%) used ultrasound guidance ( p < 0.001). The proportion of videos where chlorhexidine gluconate was not identi fi ed as a necessary step in site preparation was different between the CVC and PICC insertion videos ( p 1⁄4 0.009; Fisher exact). Only 5 (18%) CVC videos viewed displayed effective skin preparation supported by current empirical guidelines. Only 2 (10%) PICC videos viewed lacked full sterile drapes; however, we did not fi nd a difference between the 2 groups ( p 1⁄4 0.327). In our critique, poor adherence to aseptic technique was found in both groups ( p 1⁄4 0.940) with 11 (41%) CVC videos compromised aseptic technique, whereas 8 (38%) PICC videos compromised aseptic technique (see Table 2). PICC videos uploaded were more likely to have followed evidence-based guidelines. We found better adherence to evidence-based guidelines in the PICC video group compared with the CVC group. This is re fl ected in the median rating for PICC was signi fi cantly higher than CVC (Mann-Whitney U test p 1⁄4 0.03) (see Figure 2). This study is the rst attempt to our knowledge that reviews the procedural aspects of central venous cannulation from a popular social media and VSN site. Instructional videos of CVC and PICC insertion procedures uploaded to VSNs should follow empirical guidelines that include bundles of care. The Association of Vascular Access launched a dedicated YouTube Channel at the 26th scienti fi c meeting in San Antonio, TX in 2012. It intends to publish evidence-based vascular access videos and related procedures using current evidence- based practices. The CVC insertions videos we viewed should concern authors of vascular access guidelines, as well as clinicians and patient safety groups. Advocates for best practice, using evidence-based guidelines, should be made aware that trans- lating evidence-based guidelines from “ bench to bedside ” is a real concern. The 27 CVC insertion videos reviewed revealed poor operator adherence to evidenced-based guidelines for real-time ultrasound guided CVC insertion. This lack of adherence to use of ultrasound guidance may be attrib- uted to clinicians being unaware of such guidelines. The use of ultrasound has developed interesting critical questions and debate with its potential to mitigate procedural risk. 23,24 Others advocate for comprehensive training and use of adjunct diag- nostics (eg, combination of manometry/pressure transduction) to prevent inadvertent carotid puncture. 25,26 The fi rst scienti fi c paper detailing the effectiveness and ef fi cacy of the use of real-time ultrasound in central line placement was published in 1986. 27 A decade later, a meta-analysis providing the superior bene fi ts of real-time ultrasound insertion would improve the evidence base for ultrasound use. 28 In 2002, the National Institute for Health and Clinical Excellence published guidelines concerning the use of ultrasound-guided central line insertion. 29 Since then clinicians have witnessed technological advances in the past decade that improve safety when inserting CVCs and PICCs, and ultrasound has proven to be successful in reducing insertion-related complications and catheter malposition. 30 Poor insertion techniques, as were viewed in this study, will misrepresent the importance of vascular access procedures. This, combined with a lack of operator experience to recognize the insertion pitfalls, can lead to procedural complications such as pneumothorax, accidental arterial puncture, and catheter tip malposition. This can disrupt an understanding and awareness of standards expected in post-insertion procedures. We believe this will lead to intravascular infection during the dwell time of a vascular access device in particular when skin preparation and solutions are sub optimal. 31 Several investigators have identi fi ed clinician procedural volume (ie, the number of devices inserted) as an important predictor of reduced adverse events. 32-36 Increased experience with PICC placement has been shown to improve both procedural and patient outcomes. 36 As such, evidenced-based instructional videos are critical in improving insertion related outcomes with PICCs and CVCs. The emergence of a Global Medical Education Project 37 is proof of the bene fi ts and future of open access online medical educational resources supporting evidence- based procedures. It is well established in the literature that 2% chlorhexidine gluconate and 70% isopropyl alcohol is the appropriate, most effective solution for skin preparation before insertion of a vascular access device. 38-40 In the CVC video group, only 18% ( n 1⁄4 5) accurately displayed skin preparation advocated by current empirical standards. 38,41 A successful evidence- based vascular access procedure includes many individual facets, ranging from pre-insertion assessment to safe removal of the device. The actual needle insertion takes up only a small, but signi fi cant part of the procedure. Our study results should be interpreted in the context of some limitations. We only present the outcomes from 1 VSN. Further, our results represent the keyword(s) search strategy outlined in our methods. YouTube and other VSNs can be a useful resource to display best practice for the insertion of CVCs and PICCs to large numbers, but our critique of CVC and PICC videos high- light the lack of adherence to current empirical guidelines. Health care professionals should compare and measure vascular access videos based on current empirical guidelines. That such a signi fi cantly high percentage of videos from our sample displayed insertion techniques without real time ultrasound use is of concern. The videos we analyzed were misleading and may be unhelpful for clinicians who advocate best practices in vascular access. The Association for Vascular Access has established its own dedicated YouTube vascular access channel. Submissions on all facets of vascular access are encouraged. These submis- sions will be subject to peer review by clinician and ...

Citations

... This small pilot study was designed to guide future ultrasound-guided PIVC insertion training in our institution. The In-plane technique score (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) small sample size and subsequent failure to reach significance in several areas are inherent limitations. The assessors were not blinded to the educational arm of the participants they were assessing and this may have biased their evaluations. ...
Article
Full-text available
Introduction: Ultrasound is recommended to guide insertion of peripheral intravenous vascular cannulae (PIVC) where difficulty is experienced. Ultrasound machines are now common-place and junior doctors are often expected to be able to use them. The educational standards for this skill are highly varied, ranging from no education, to self-guided internet-based education, to formal, face-to-face traditional education. In an attempt to decide which educational technique our institution should introduce, a small pilot trial comparing educational techniques was designed. Methods: Thirty medical students were enrolled and allocated to one of three groups. PIVC placing ability was then observed, tested and graded on vascular access phantoms. Results: The formal, face-to-face traditional education was rated best by the students, and had the highest success rate in PIVC placement, the improvement statistically significant compared to no education (p = 0.01) and trending towards significance when compared to self-directed internet-based education (p<0.06). Conclusions: The group receiving traditional face-to-face teaching on ultrasound-guided vascular access, performed significantly better than those not receiving education. As the number of ultrasound machines in clinical areas increases, it is important that education programs to support their safe and appropriate use are developed.
... When people search YouTube for information about a medical condition, most of the information they find is not educationally useful 4,6,43-45 and a substantial portion of it is either inaccurate 7,20,43 or it goes counter to accepted medical practices. 46 When broadcast drug advertisements crossover and are made available on YouTube, consumers are getting information that meets the stringent FDA requirements for DTC pharmaceutical advertisements. This can be seen in the huge percent of time and words that are devoted to the disclaimer (40% of the time and 44% of the words). ...
Article
The medical research community has shown substantial concerns about the quality of healthcare information available on the video-on-demand website of YouTube. In order to look at the role that advertising is having on this knowledge dissemination channel, the current paper presents the results of a content analysis of 100 pharmaceutical advertisements found on YouTube. From this analysis, concerns arose over mismatches in terms of the content and style of the advertisements. The possibility that YouTube pharmaceutical advertise- ments actually drive consumers away from proper medical care is explored. This paper concludes that, rather than having broadcast advertisements cross-over to YouTube, the medical community may be better served by developing longer, more content base advertisements for the medium of video-on-demand.
... 3 This is compounded with the fact that information in medical textbooks and even contemporary online media that could potentially assist with teaching infusion therapy and PIVC management is also lacking. 4,5 The practices associated with risk factors for PIVC failure could be reduced if larger numbers of appropriately skilled clinicians were able to care for PIVCs and manage this common procedure. 6 In 2013, a vascular access-focused elective course, Peripheral Intravenous Access and Care (8035NRS) was commenced for Queensland students enrolled in any of Griffith University's master's degree programs. ...
Article
Peripheral intravenous catheter (PIVC) insertion and subsequent care have been highlighted as areas for improvement in the management of intravascular devices; however, only the fundamentals of PIVC care are routinely taught to registered nurses in Australia. In 2013, a vascular access-focused elective postgraduate course, Peripheral Intravenous Access and Care (8035NRS) was commenced for students enrolled in any of the Griffith University master's degree programs. It was developed with the intent to translate research knowledge into practice by providing access to the latest research findings and current best practices in peripheral intravenous access. Topics covered preinsertion, insertion, and postinsertion care and were developed for the online environment, which is known to be conducive to individual student learning styles. Learning activities included viewing short videos delivered by local and international clinical researchers. This course is the first known university-provided, postgraduate academic course on this subject in Australia, and possibly 1 of the few available internationally. The course succeeded in its aim of increasing knowledge and skills about safe, evidence-based PIVC insertion and care to registered nurses. Its development and implementation at the postgraduate level may be regarded as a strategy to provide a greater understanding regarding scope and relevance for nursing practice and for informed decision making on optimum integration at the undergraduate level. This ultimately will increase positive patient outcomes and the patient experience of vascular access.
... 3 This is compounded with the fact that information in medical textbooks and even contemporary online media that could potentially assist with teaching infusion therapy and PIVC management is also lacking. 4,5 The practices associated with risk factors for PIVC failure could be reduced if larger numbers of appropriately skilled clinicians were able to care for PIVCs and manage this common procedure. 6 In 2013, a vascular access-focused elective course, Peripheral Intravenous Access and Care (8035NRS) was commenced for Queensland students enrolled in any of Griffith University's master's degree programs. ...
Article
Peripheral intravenous catheter (PIVC) insertion and subsequent care have been highlighted as areas for improvement in the management of intravascular devices; however, only the fundamentals of PIVC care are routinely taught to registered nurses in Australia. In 2013, a vascular access-focused elective postgraduate course, Peripheral Intravenous Access and Care (8035NRS) was commenced for students enrolled in any of the Griffith University master's degree programs. It was developed with the intent to translate research knowledge into practice by providing access to the latest research findings and current best practices in peripheral intravenous access. Topics covered preinsertion, insertion, and postinsertion care and were developed for the online environment, which is known to be conducive to individual student learning styles. Learning activities included viewing short videos delivered by local and international clinical researchers. This course is the first known university-provided, postgraduate academic course on this subject in Australia, and possibly 1 of the few available internationally. The course succeeded in its aim of increasing knowledge and skills about safe, evidence-based PIVC insertion and care to registered nurses. Its development and implementation at the postgraduate level may be regarded as a strategy to provide a greater understanding regarding scope and relevance for nursing practice and for informed decision making on optimum integration at the undergraduate level. This ultimately will increase positive patient outcomes and the patient experience of vascular access.
Article
Purpose Instructional videos of medical procedures can be a useful guide for learners, demonstrating proper and safe technique. Open publishing sites such as YouTube are readily accessible, however the content is not peer reviewed and quality of videos vary greatly. Our aim was to evaluate a learner’s ability to interpret the quality of openly published content by comparing their rating of the most popular central line insertion videos on YouTube to expert evaluations. Method YouTube search results for “central line placement” sorted by views or relevance compiled a list of the four most common videos. A fifth gold standard video, published by the New England Journal, was included, however was not found in the top results. Eleven expert practitioners from varying medical specialties (Critical Care, Surgery, Anesthesia, & Emergency Medicine) evaluated the 5 videos, utilizing a 22-item Likert scaled questionnaire emphasizing: preparation, sterility, anatomy, technique, & complications. Videos were compared as a composite average of the individual items on the survey. The highest, lowest, and 3rd ranked videos were evaluated by 45 residents (“learners”) in varying specialties (Internal Medicine, Emergency Medicine, Surgery, Anesthesia) and post graduate year (PGY). Learners assessed the videos using the same scale. A Welch T-test assessed statistical significance between the two groups. Subgroup analysis compared experts against different PGY and specialty cohorts. Results The lowest scored video among the experts and learners was the most popular on YouTube, with 858,933 views at the time of inclusion. Though lowest in rank, this video was judged higher by learners than the experts (2.63/5 vs 2.18/5, P = 0.0029). The 3rd ranked video by experts with 249,746 views on YouTube, was also rated higher by learners (3.77/5 vs 3.45/5, P = 0.0084). The gold standard video by NEJM had 320,580 views and was rated highest by both the experts and learners (4.37/5 vs 4.28/5, P = 0.518). Subgroup analysis showed similar results with learners rating the videos overall better than experts, this was particularly true in the PGY-1 subgroup. Conclusion The most popular central line insertion video was the worst rated by both experts and learners. Learners rated all the videos better than the expert. YouTube videos demonstrating medical procedures including central line insertion should come from peer reviewed sources if they are to be incorporated into educational curriculum.
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