KNOWLEDGE IN ACCESS TO THE DEFINITIVE AND VASCULAR PERIPHERAL AERIAL OF PREHOSPITAL CARE STUDENTS

Abstract We evaluated the knowledge of access to the definitive airway and peripheral vascular of the Technologists in Prehospital Care in training, through a knowledge questionnaire. The sample was applied to the 84 students enrolled and active in the Prehospital Care Technology program of the Corporación Universitaria Rafael Nuñez in the second period of 2018 from the second to the sixth semester. When evaluating the students it was found that they have little empowerment of the basic knowledge to perform invasive procedures in the peripheral vascular pathway, highlighting the lack of protocols, management and function of crystalloid solutions, venoclisis equipment and catheters according to their enumeration which are used. There was also a lack of knowledge in protocols for airway management, adequate management of endotracheal intubation equipment, indications and contraindications for definitive endotracheal intubation and the benefits it generates in patients.


Introduction
Prehospital care is understood as the help given to people where their life is in danger and / or affecting their mental and physical integrity; It is provided in order to achieve the limitation of functional organic damage from the first contact until arrival and delivery to a facility for medical care (Bossers et al., 2015). There are several alternative methods for the management of the patient's airway in which the final one is endotracheal intubation. The decision to use an alternative device should be made after the assessment of the airway taking into account the possible benefits and risks to establish a plan that seeks the best interest of the patient in a given situation (Suleimenov et al., 2017;Zhang et al., 2013;Kothari et al., 1999). On the other hand, in the circulation the knowledge and skill of good vascular access is necessary for the stabilization of the patient. Obtaining a peripheral vascular access has two fundamental purposes: therapeutic and diagnostic. In the prehospital setting, its use is aimed at therapeutic purposes, among which the main ones are the administration of fluids to restore blood volume. Following correctly the main care protocols in the aforementioned procedures to the patient who requires it, would increase the likelihood that care will be effective (Posada et al., 2019;Balikuddembe et al., 2017;Marrugo, 2017).
The Prehospital Care Technologist is a person able to act effectively during the initial stabilization of the patient. The knowledge, skills and dexterity allow you to approach, prevent and reduce mortality in the patient caused by diseases or traumas. Among the knowledge that the Technologist in Prehospital Care must have is access to the airway and vascular access of the human body (Sahoo et al., 2018;Chaitach et al., 2014;Tuma et al., 2014). The airway allows to incorporate oxygen to the body, which is transported to the lungs that contain inside the pulmonary alveoli, where it is then taken to the blood and in conjunction with the Circulatory System is distributed through all other structures vital. The insufficient supply of oxygenated blood to the brain; Hypoxemia is one of the causes of death in traumatized patients (Hassan et al., 2019;Cotogni & Pittiruti, 2014). The prevention of this requires a permeable and safe airway with adequate ventilation. To carry out this requires knowledge and technique implementing simple and complex devices (intubation) with some protocols that allow procedures to be performed (Ebrahimian et al., 2014;Villalba & Vargas, 2017). At the time of fluid replacement, the channeling of a peripheral vein is used, this is a technique that allows have a permeable pathway of the patient's vascular system, through this is administered serotherapy, medication and nutrition (Oludara et al., 2014;Casares, 2004;Salleras & Fuentes, 2016;Gutiérrez & Vilches, 2017).
An erroneous procedure could cause an additional risk to the patient and diminish the possibility of success in his attention. For this reason, the aim of the present study is to evaluate the knowledge of access to the definitive airway and peripheral vascular pathway that the Technologists in Prehospital Care in training of the CURN have during the second period of 2018, taking into account that currently T-APH we are immersed in different scenarios where it is necessary to apply the main knowledge in the management of the airway and vascular. The participating students would be those who have passed the subjects: Introduction to Prehospital Care, Basic Health Care Training in APH, Prehospital Care I, Prehospital Care II and Prehospital Care III.

Material and Methods
Knowledge in access to the definitive and vascular peripheral aerial of prehospital care students The following work is considered within cross-section descriptive studies. The students of the program Technology in Prehospital Care of the Rafael Núñez University Corporation. The sample will apply to the 84 students enrolled and active in the Pre-Hospital Care Technology program of the CURN in the second period of 2018 from the second to the sixth semester (Table 1). Exclusion criteria: CURN T-APH students who have not completed and passed the subjects that are NOT related to a definitive airway: introduction in prehospital care and basic healthcare training in peripheral vascular prehospital care: introduction in prehospital care.
Ethical considerations: This research was based on the principles of ethics, it was taken into account the prior consent of the same to participate, taking into account all aspects established in this regard there is no academic or commercial conflict in the search to improve the quality of the aspects studied the Technology Program in Prehospital Care.

Results and Discussion
The results obtained from the application of the instrument to the students of Technology in Prehospital Care in the second period of 2018 are presented below. See graphs 1 to 29 and Tables 1 to 30.

1.
Obtaining vascular access is a quick and easy procedure that has a time: 77 answers   The back of the hand and continue on the forearm and elbow flexure.
Hand flexion, arterial elasticity and capillary refill.
Signs of phlebitis, pain and continuous forearm Capillary refill, signs of phlebitis and pain.
Flexure of the knee and arterial elasticity.
Prepare the equipment, feel the vein, wash the hands.
Put on gloves, prepare the equipment, inform the patient about the procedure.
Explain the procedure to the patient, wash hands, put on gloves.
Feel the vein, clean the area and channel. Knowledge in access to the definitive and vascular peripheral aerial of prehospital care students 4. Every few hours the venoclysis equipment is changed. 82 answers.     Knowledge in access to the definitive and vascular peripheral aerial of prehospital care students

2.
Primary mnemonic to evaluate the difficulty in endotracheal intubation: 45 answers

4.
Prolonged attempts at failed intubation create complications in patients as: 45 answers. Knowledge in access to the definitive and vascular peripheral aerial of prehospital care students Correct answer Wrong answer They did not respond 13 Students (28.9%) 32 Students (71.1%) 0 Students Source: Author

6.
According to the PHTLS, the factors that contribute to a difficult intubation are: 45 answers  Endotracheal intubation is the preferred method to control and secure the airway since it allows 44 answers

1.
Do you believe that the hours of practice in airway access provided by the program during the semester are enough for your training as a technologist in APH. 45 answers. Knowledge in access to the definitive and vascular peripheral aerial of prehospital care students   Knowledge in access to the definitive and vascular peripheral aerial of prehospital care students Knowledge in access to the definitive and vascular peripheral aerial of prehospital care students

Conclusions
When evaluating the students we found that they have little empowerment of the basic knowledge to perform invasive procedures in the peripheral vascular pathway, highlighting the lack of protocols, management and function of crystalloid solutions, venoclisis equipment and catheters according to their enumeration which are used. There was also a lack of knowledge in protocols for airway management, adequate management of endotracheal intubation equipment, indications and contraindications for definitive endotracheal intubation and the benefits it generates in patients. The students highlight in the answers of each of the additional questions that the hours offered during the semesters for the invasive procedures are not enough for the training as Technologists in Prehospital Care, it is deduced that this is part of the reason for the deficiency in the knowledge that are evident in the results obtained.