Page 59 - 2022 Spring JSOM

success rates or times to completion. Further, we hypothesized each individual participant. Per the manufacturer’s recommen-
that there would be no statistically significant differences be- dations, participants were instructed first to ensure that the
tween lighting conditions in perceived difficulty for IV and IO NVGs were focused two-thirds of the way to infinity, then at-
placement, user confidence, or user preference. tach the Tarsier Eclipse to NVG tube, close the Tarsier Eclipse
aperture to the smallest opening, and slowly open the Tarsier
Eclipse to allow the appropriate amount of light needed, as
Methods
determined by the participant.
Setting
This study was conducted at the Naval Medical Center San Di- Intravenous Access Mannequins
ego (NMCSD). This study complied with the ethical guidelines Multi-Venous IV Training Arms (Laerdal Medical) with over-
of the AMA and NMCSD, including Institutional Research lying modified IV Suture Sleeves (Strategic Operations) that
Board approval. Written informed consent was acquired employ dyed red water as simulated blood were used. IV ac-
from each participant prior to data collection. All materials cess also required nitrile gloves, elastic tourniquet, alcohol
were provided by the participants, supplied by the NMCSD pad, 18-gauge IV needle with catheter, MicroClave Clear neu-
Bioskills Simulation Center, or purchased by the authors. tral connector (ICU Medical), window transparent film dress-
ing (6 × 7cm), 10mL syringe, and gauze sponge (5.1 × 5.1 cm).
Participants
The participants were 23 United States Navy medical personnel Intraosseous Access Mannequins
who met the inclusion criteria indicating previous Tactical Com- SimMan 3G (Laerdal Medical) simulation legs were used for
bat Casualty Care (TCCC) training, although exact courses tibial IO access. IO access also required the ChloraPrep Frepp
were not collected, and being familiar with the use of NVGs. (Becton, Dickinson) 1.5mL applicator (2% chlorhexidine glu-
Tests of power using G*Power software indicated a minimum conate/70% isopropyl alcohol), nitrile gloves, EZ-IO Power
of 18 participants would be needed to achieve 80% power. To Driver, EZ-IO 25-mm 15-gauge needle set, and EZ-Connect
15
ensure adequate power, we included 23 participants. Extension Set (Teflex).

Most (18/23; 78%) participants were US Special Operations Procedures
(SO) medics, with 17% (4/23) Special Amphibious Recon-
naissance Corpsmen (SARCs), and 4% (1/23) Field Medical Room Preparation
A simulation laboratory was adapted for low-light conditions
Service Technicians (FMSTs). Participants averaged 8.5 (±1.2) by covering all possible light sources, so that ambient light was
years of military service. None of the participants was color- reduced to <0.3 lux, as confirmed by a lux meter. Two IV sim-
blind, and 9% (2/23) reported wearing contact lenses. Partic- ulation arm stations and two IO simulation leg stations were
ipants ranged from familiar to expert with headlamps (mean arranged in the room, separated by physical barriers.
[M] = 4.7 ± 0.1 on 1-to-5 scale ranging from no familiarity to
expert) and with NVGs (M = 4.4 ± 0.1). Most (18/23; 78%)
had no familiarity with the focusing adaptors (M = 1.6 ± 0.3). Informed Consent
In a lighted room adjacent to the simulation lab, participants
All participants reported using headlamps and NVGs in oper- signed a consent form that provided an overview of the study
ational environments, while 3 of 23 (13%) reported prior use and detailed participant rights to privacy, confidentiality, and
of NVG+A in operational environments.
withdrawal from the study at any time or to refuse to answer
any survey questions. Prior to signing the consent form, an
Materials
ombudsman was available to address all participant questions
Tactical Headlamp and concerns. Following informed consent, participants com-
The Storm Headlamp (Black Diamond) is lightweight (110 g pleted the pretest survey.

with four AAA batteries), measures 2.54 × 5.08 × 2.54 cm,
and has a maximum output of 350 lumens. White, red, green, Training and Instructions
and blue hues are available, but only green light was used in After providing informed consent and completing the pre-
our study, based on prior research demonstrating green as the testing survey, participants entered the darkened simulation
optimal hue for medical procedures of the hues available with laboratory room. Following the 10-minute dark-adaptation
this headlamp, and to match the green phosphor color of the period, participants familiarized themselves with the equip-
NVGs described below. 16–18 ment by green chem light illumination and were provided in-
structions on the procedural steps listed here:
Night Vision Goggles IV Procedure Steps
AN/PVS-31 dual-tube green phosphor NVGs weigh 595 g and
measure 11.55 × 7.62 × 6.6 cm. These NVGs were provided 1. Identify venous access point.
by the study participants and were attached to participants’ 2. Apply tourniquet.
helmets by the participants themselves. 3. Clean access site with alcohol wipe.
4. Insert IV catheter.
5. Connect MicroClave Clear neutral connector.
Adaptors 6. Apply window transparent film dressing.
Tarsier Eclipse (Matbock) focusing adaptors weigh 453 g,
measure 5 × 5 × 2.5 cm, and were provided by the study team. 7. Attach 10mL syringe to the MicroClave Clear neutral
The rubber housing slides onto the objective lens of the AN/ connector.
PVS-31 NVGs and retains its position by friction. The adap- IO Procedure Steps
tors are focused by rotating the outside housing to increase 1. Identify tibial IO insertion site.
or decrease the aperture of the iris. The aperture was set by 2. Clean insertion site with ChloraPrep.

IO and IV Access Using Night Vision Goggle Focusing Adaptors | 57