Background: Many specialties utilize procedural performance checklists as an aid to teach residents and other learners. Procedural checklists ensure that the critical steps of the desired procedure are performed in a specified manner every time. Valid measures of competency are needed to evaluate learners and ensure a standard quality of care. The objective of this study was to employ the modified Delphi method to derive a procedural checklist for use during placement of ultrasound-guided femoral arterial access. Methods: A 27-item procedural checklist was provided to 14 experts from three acute care specialties. Using the modified Delphi method, the checklist was serially modified based on expert feedback. Results: Three rounds of the study were performed resulting in a final 23-item checklist. Each item on the checklist received at least 70% expert agreement on its inclusion in the final checklist. Conclusion: A procedural performance checklist was created for ultrasound-guided femoral arterial access using the modified Delphi method. This is an objective tool to assist procedural training and competency assessment in a variety of clinical and educational settings.
The purpose of this study was to determine whether lack of volume responsiveness, defined as 15% change in LVOT VTI, is associated with increased risk of mortality, admission to an intensive care unit (ICU), or rapid response team activation within 24 hours of hospital arrival (composite outcome measure). We hypothesize that septic patients who are not volume responders will be more critically ill and therefore at greater risk of experiencing the composite outcome.Methods: This is a prospective observation study of septic patients conducted in an academic emergency department (ED). Patients were eligible for enrollment if they met Sepsis 3 definition and were receiving intravenous fluids. Patients received a point-of-care echocardiogram to measure LVOT VTI. Three measurements were taken and the average was recorded. After patients received a 500mL fluid bolus, a repeat ultrasound was conducted to re-measure VTI. Volume responsiveness was defined as >15% increase in VTI. Chart review was performed on all enrolled patients to determine whether the composite outcome occurred within 24 hours of ED arrival.Results: At total of 126 patients with repeat ultrasound exams were included in this analysis; 49.2% were female and median age was 74 years. Overall, 56 (44.4%) patients experienced the composite primary outcome within 24 hours, and 30 (23.8%) patients had a delta VTI of >15%. Among the patients who experienced the composite outcome, 82.1% of them had a delta VTI of 15%, compared with 71.4% of patients who did not experience the composite outcome (p-value ¼ 0.160). In a multivariable logistic regression modeling adjusting for lactate and systolic blood pressure, delta VTI of 15%, compared with delta VTI >15%, was significantly associated with higher odds of mortality, ICU admission, or rapid response team activation within 24 hours (OR: 2.643; 95% CI: 1.002, 6.967).Conclusion: Septic ED patients who are not volume responsive, based on percent change in VTI, are more likely to experience mortality, be admitted to an ICU, or have a rapid response team activation within 24 hours of ED arrival. Our findings suggest that early VTI may be used in septic patients to predict their clinical course. Future endeavors may evaluate if initial change in VTI could be used to help emergency physicians identify this critically ill cohort and facilitate earlier ICU disposition and vasopressor administration.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.