Singapore, 8 February 2023 – When patients are warded, they may need an intravenous (IV) cannula – a small plastic tube that is inserted into a vein – for the delivery of medication or fluids. The procedure of inserting the cannula, known as cannulation, can be stressful for patients who are afraid of needles and equally daunting for new nurses. If circumstances are not ideal, the procedure may cause the patient pain, bruising, or other complications such as inflammation. This is a common procedure which may take new nurses much training to master.
IV cannulation training is typically conducted using a silicone mannequin arm. This, however, may soon be vastly augmented, as training in Singapore General Hospital (SGH) will be enhanced with IV NIMBLE (Nursing Innovation in Mobility-based Learning), leveraging on digital technology and data analytics. It is an immersive gamified training module co-developed by a team of SGH nurses with industry partners, Serious Games Asia (SGA) and Microtube Technologies to make learning realistic, and reflective.
Project Lead Ms Andrea Choh, Senior Nurse Manager, SGH, clearly remembers her first patient, “As a new nurse then, I had to cannulate a renal patient. They tend to have very thin veins and it was very challenging to do so. Despite having gone through rigorous training, I unfortunately failed and had to ask for help from a more senior nurse. I felt so bad for the patient. Thankfully, the patient was kind and understanding of the situation. Through IV NIMBLE, we hope new nurses, and even medical students needing to learn cannulation, will feel more confident and be better equipped with the skills to do so after training.”
In conventional training, the cannula is inserted into a silicone mannequin arm without any interaction with a role-playing simulated patient or provision of real-time feedback. In a great leap forward, IV NIMBLE comprises a virtual patient avatar for nurses to practice talking to patients, a 3D-printed hand that mimics the texture of normal human skin and tissue, and a pressure sensor glove that gauges the pressure as cannulation is performed. IV NIMBLE also comes with an analytics dashboard which captures data for trainees and trainers to review and identify areas for improvement.
About 120 nurses completed their IV cannulation training using IV NIMBLE as part of a trial in June and July 2021. With the feedback gathered, the team is working on an enhanced version to include 3D-printed hands with commonly seen medical conditions and of elderly whose skin tends to be more fragile. More virtual patient avatars and scenarios will also be added.
IV NIMBLE can also be further adapted in future for training of other important skills, such as venepuncture for blood collection, chest tube insertion, or other invasive procedures.
The development of IV NIMBLE prototypes is supported by a grant from the Singapore University of Social Sciences’ Institute for Adult Learning through its InnovPlus Challenge, and the SingHealth Duke-NUS Academic Medicine Innovation Institute Adoption Grant.
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Singapore General Hospital