Securing Cannulas in Combat: a simulation-based mixed method study

A pragmatic mixed-method design with two phases will be used to compare the Ranger IV method to the S-Wrap technique to reduce PIVC dislodgement rates during TCCC simulations. In Phase 1, the effectiveness of each method to prevent cannula dislodgement in vitro will be evaluated. Specifically, we will investigate the pull-out force in vitro of two PIVC securement methods. Pull-out force is defined in this study as the tensile force (N) required to produce PIVC dislodgement; this attempts to replicate how a PIVC administration line may become caught on a fixed object (e.g. tree branch, stretcher, body armour) in an austere combat setting. Pig skin (i.e. pork belly) will be used as a surrogate for human skin because it shares similar epidermal and dermal thickness ratios to human skin. In Phase 2, an observational audit of TCCC training will be conducted to understand the quality and safety of each method. At the completion of the final TCCC simulated practice scenario (approx 2 hour), focus groups with health care professionals will occur to explore their experiences of simulated PIVC insertion and securement practices. This study will be conducted in conjunction with existing defence health training courses and participants completing the simulated tactical care of the casualty course (TCCC) will be invited to participate. Due to the TCCC course requirements, all participants receive familiarisation training and will practise both the Ranger IV and S-Wrap PIVC securement methods and cannulate simulated casualties via a Laerdal™ training arm. During the combat field phase of TCCC course students who choose to participate in the study will be randomly allocated by their instructor to use either the Ranger IV method or the S-Wrap method. Consenting participants will have demographic data collected: e.g. rank, previous experience in cannulation, method approach used during TCCC, and current healthcare qualifications. The quality and safety of PIVC securement will be monitored, the recruitment target is 30 participants, and data collection will occur for each participant and to reach recruitment goal should take six months. Participants will be observed for evidence of PIVC insertion and securement complications using an observational field guide. The field guide has been developed for this study to focus observations and will be pilot tested prior to use. Maintaining situation awareness is a fundamental component of TCCC; thus, the time taken to complete the securement method will also be included in the field guide.