Palpation-Guided Landmark

Palpation-guided landmark identification is the most widely used method for lumbar procedures. Unfortunately, as previously discussed the first-time success rates for epidurals placed using palpation-based landmark identification are significantly low ranging from 61-64% (Da Fonseca et al., 2002). Current literature supports the positive impact of neuraxial ultrasonography on the efficacy and precision of epidural placement (Chan et al., 2011). Yet, observation and statistics of these procedures shows that anesthesia providers are not utilizing ultrasound-guided imagery when placing epidurals despite literature recommendations (Arellano et al.

, 2019). Considering this, there is an urgent need to discern the barriers to neuraxial ultrasonography in improving the precision and efficacy of epidural anesthetic placement. More data is necessary to conclusively uncover the barriers for CRNAs' and anesthesiologists' not using ultrasonography to place epidural anesthetics albeit, funding, availability of the ultrasound machine, time sensitivity or lack of education, confidence or experience manipulating the ultrasound machine.

This project is aimed to identify the barriers for use of ultrasonography in neuraxial anesthesia through a web-based survey.

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The first objective is to identify if there are educational barriers to using ultrasonography in different provider groups, CRNA versus Physicians. The second goal is to determine patient related barriers to the utilization of ultrasound versus palpation-based landmark identification that would favor one technique to the other (emergency cesarean sections, obesity, spinal deformity etc.). The last aim is to develop a survey is to discern anesthesia providers perceived barriers to ultrasonography use such as lack of equipment, funding or hospital policy in relation to the two techniques.

A web-based survey will be administered to CRNAs and anesthesiologists currently practicing at facilities throughout Buffalo and the surrounding areas through work email accounts that provides a link to where the participants can take the survey anonymously. The survey will be conducted on a survey website (Surveymonkey or Qualtrics) and will be formatted for anonymous response in order to protect the identity of the participants. An electronic consent will be obtained prior to participation. The access to the providers will be requested through the nurse anesthesia program's clinical coordinator for contact information for directors of the anesthesia departments at the facilities in Western New York. With this access, the researcher plans to make contact with the directors of the anesthesia departments in order to introduce the project and request its dispersion in each individual facility to anesthesia providers.

In hopes to decrease participant bias and misinterpretation, the survey will be tested on 3 currently practicing nurse anesthetists to ensure proper question structure and that adequate data to access barriers can be compiled from the survey. The survey will also be tested on multiple browsers and computers to ensure functionality on different platforms. It will be estimated to take no longer than thirty minutes to complete and the questions will be developed to investigate the anesthesia provider's demographics, preferred method of practice and learning, and perceived barriers of using ultrasonography to preform neuraxial anesthesia as well as opinion on which situations warrant the use of one technique over the other. The survey also is designed to identify information on the facility in which the anesthesia providers work. These steps will enable the researcher to determine the desired outcome, which is to identify the barriers to practice neuraxial anesthesia with ultrasound guidance (Arellano et al., 2019).

The survey data will be evaluated through the survey website that has data analysis qualities in its program system. With this software, qualitative data will be analyzable through statistics. The open-ended responses will be analyzed by the researcher. By evaluating the barriers of the two neuraxial techniques for epidural placement it will uncover variations in neuraxial anesthesia administration, areas where interventions can be developed in order to improve patient care and satisfaction through ultrasound use, and also provide clarity for which technique is preferred for certain types of patients and cases. This research is important because it can contribute to the effectiveness, timeliness and safety of care through evaluating the barriers ultrasound imagery in epidural placement.