Automated training system to help SGH nurses master IV drip treatment

By Osmond Chia

2/9/2023 4:13:00 PM | Tomorrow's Medicine

The article is contributed/written by

The IV Nimble programme takes training to administer IV drips closer to reality and helps trainees learn flexibly with the help of bots. ST PHOTO: KUA CHEE SIONG

SINGAPORE - Trainee nurses at Singapore General Hospital (SGH) will soon use a new automated platform that takes the guesswork out of administering intravenous (IV) drips during training.

The system – comprising a sensor-equipped glove, a digital patient in the form of an avatar and a 3D-printed hand with human-like texture – will evaluate how well nurses can insert a needle and converse with patients.

Dubbed IV Nimble (Nursing Innovation in Mobility-based Learning), the programme takes training to administer IV drips closer to reality and helps trainees learn flexibly with the help of bots. The platform will be fully rolled out for training by the end of 2023.

IV tubes – or cannulas – are inserted into the vein to deliver medication or fluids to patients. Project lead and senior nurse manager Andrea Choh, 40, told the media on Wednesday at SGH that inserting the cannula into a patient’s veins can be stressful for patients and nurses.

She recalled her first time administering an IV drip, when she failed to poke a needle into a patient who had thin veins and had to seek help from a senior nurse.

She said: “If circumstances are not ideal, the procedure may cause the patient pain, bruising or other complications, like inflammation. Cannulation is a common procedure that may take new nurses much training to master.”

She added: “Through IV Nimble, we hope more nurses will feel more confident and better equipped with the skills to do so after training.”

The new system is a step forward technologically from earlier props used in cannulation training. Previously, an instructor would guide nurse trainees to insert a needle into a dummy arm, but it was tough to tell if a trainee precisely hit or missed the vein, as they are able to judge only from the surface, said Ms Choh.

With IV Nimble, sensors embedded in the trainee’s glove track the precise movement and pressure applied by the trainee when sliding the needle into the veins of a 3D-printed hand.

These readings are presented on a dashboard on a laptop, informing the trainee if he had done the procedure accurately and the areas to improve. It indicates when trainees are “fishing”, which means shifting the needle repeatedly to locate the vein, which could bruise a patient.

During the procedure, trainees also speak to the avatar to practise how to allay any concerns about the treatment and ask the patient for information, like his name and which hand he prefers to use.

Training is also gamified, providing trainees with different skin textures and vein sizes to vary the difficulty of administering cannulation.

Some 120 nurses completed their IV cannulation training using IV Nimble as part of a trial between June and July 2021. The trainees’ feedback was taken to improve the platform.

Staff nurse Dyal Singh, 37, who tested the system, said it is more realistic than the props used previously in training, allowing him to better prepare for real-life scenarios. The software alerts trainees when they have inserted the IV needle too far into the vein, piercing through it by mistake instead of sliding into the vein to deliver the IV drip fluid, he said.

“The system is more dynamic and helps me to develop the motor skills I need when handling cannulation treatment,” he said.

By the end of 2023, SGH will roll out an improved version of IV Nimble, which will be wireless and include a variety of skin types and avatar profiles and behaviours to help nurses prepare for the field.

It can also be further adapted for other medical training scenarios, like blood collection, chest tube insertion and other invasive procedures.