Misplaced needle thoracostomy

Pentecost, Genevieve; Coughenour, Jeffrey P.; Sampson, Christopher

doi:10.1016/j.visj.2020.100746

Cited by 2 publications

(2 citation statements)

References 3 publications

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“…NT is not without risk. Incorrect placement of NT can result in iatrogenic injury to underlying structures [ 1 , 2 ] and lead to grievous complications or death. Additionally, NT may fail due to poor technique, patient body habitus, and catheter length [ 3 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study

Dewar

Rogers³

et al. 2022

Ultrasound J

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Background Simulated needle thoracostomy (NT) using ultrasound may reduce potential injury, increase accuracy, and be as rapid to perform as the traditional landmark technique following a brief educational session. Our objective was to determine if the use of an educational session demonstrating the use of handheld ultrasound to Emergency Medical Services (EMS) staff to facilitate NT was both feasible, and an effective way of increasing the safety and efficacy of this procedure for rural EMS providers. Methods A pre/post-educational intervention on a convenience sample of rural North American EMS paramedics and nurses. Measurement of location and estimated depth of placement of needle thoracostomy with traditional landmark technique was completed and then repeated using handheld ultrasound following a training session on thoracic ultrasound and correct placement of NT. Results A total of 30 EMS practitioners participated. Seven were female (23.3%). There was a higher frequency of dangerous structures underlying the chosen location with the landmark technique 9/60 (15%) compared to the ultrasound technique 1/60 (1.7%) (p = 0.08). Mean time-to-site-selection for the landmark technique was shorter than the ultrasound technique at 10.7 s (range 3.35–45 s) vs. 19.9 s (range 7.8–50 s), respectively (p < 0.001). There was a lower proportion of correct location selection for the landmark technique 40/60 (66.7%) when compared to the ultrasound technique 51/60 (85%) (p = 0.019). With ultrasound, there was less variance between the estimated and measured depth of the pleural space with a mean difference of 0.033 cm (range 0–0.5 cm) when ultrasound was used as compared to a mean difference of 1.0375 cm (range 0–6 cm) for the landmark technique (95% CI for the difference 0.73–1.27 cm; p < 0.001). Conclusions Teaching ultrasound NT was feasible in our cohort. While time-to-site-selection for ultrasound-guided NT took longer than the landmark technique, it increased safe and accurate simulated NT placement with fewer identified potential iatrogenic injuries.

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Section: Introductionmentioning

confidence: 99%

Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study

Dewar

Rogers³

et al. 2022

Ultrasound J

View full text Add to dashboard Cite

show abstract

“…Importance NT is not without risk. Incorrect placement of NT can result in iatrogenic injury to underlying structures [1,2] and lead to grievous complications or death. Additionally, NT may fail due to poor technique, patient body habitus, and catheter length [3][4][5][6].…”

Section: Introduction Backgroundmentioning

confidence: 99%

Prehospital Portable Ultrasound for Safe and Accurate Pre-hospital Needle Thoracostomy: A Pilot Educational Study

Dewar

Rogers³

et al. 2022

Preprint

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Background:Simulated needle thoracostomy (NT) using ultrasound would reduce potential injury, increase accuracy, and be as rapid to perform as the landmark technique following a brief educational session. Our objective was to determine if the use of an educational session demonstrating the use of handheld ultrasound to Emergency Medical Services (EMS) staff to facilitate NT is an effective way of increasing the safety and efficacy of this procedure for rural EMS providers.Methods:A pre/post educational intervention on a convenience sample of rural EMS paramedics and nurses. Measurement of location and estimated depth of placement of needle thoracostomy with traditional landmark technique was completed and then repeated using handheld ultrasound following a training session on thoracic ultrasound and correct placement of NT.Results:A total of 30 EMS practitioners participated. Seven were female (23.3%). There was a higher frequency of dangerous structures underlying the chosen location with the landmark technique 9/60 (15%) compared to the ultrasound technique 1/60 (1.7%) (p = 0.08). Mean time-to-site-selection for the landmark technique was shorter than the ultrasound technique at 10.7s (Range 3.35-45s) vs. 19.9s (range 7.8-50s), respectively (p < 0.001). There was a lower proportion of correct location selection for the landmark technique 40/60 (66.7%) when compared to the ultrasound technique 51/60 (85%) (p = 0.019). With ultrasound, there was less variance between the estimated and measured depth of the pleural space with a mean difference of 0.033 cm (Range 0-0.5 cm) when ultrasound was used as compared to a mean difference of 1.0375 cm (Range 0–6 cm) for the landmark technique (95% CI for the difference 0.73–1.27 cm; p < 0.001).Conclusions:Teaching ultrasound NT was feasible in our cohort. While time to site selection for ultrasound-guided NT took longer than the landmark technique, it increased safe and accurate simulated NT placement with fewer identified potential iatrogenic injuries.

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Misplaced needle thoracostomy

Cited by 2 publications

References 3 publications

Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study

Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study

Prehospital Portable Ultrasound for Safe and Accurate Pre-hospital Needle Thoracostomy: A Pilot Educational Study

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