Real-time ultrasound-guided thoracentesis

Krackov, Rachel; Rizzolo, Denise

doi:10.1097/01.jaa.0000508210.40675.09

Cited by 14 publications

(4 citation statements)

References 19 publications

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“…Thoracentesis is typically the initial invasive procedure performed by pulmonologists to diagnose pleural effusions, as many laboratory tests can be run on the pleural fluid. When done under ultrasound guidance the risk of complications is very low (10). Thoracentesis can establish the etiology of pleural effusion in approximately 75% of cases (3).…”

Section: Thoracentesismentioning

confidence: 99%

Pleuroscopy or video-assisted thoracoscopic surgery for exudative pleural effusion: a comparative overview

Ali¹,

Light²,

Maldonado³

2019

J. Thorac. Dis

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Exudative pleural effusions, such as malignant and tuberculous pleural effusions, are associated with notable morbidity and mortality. Unfortunately, a significant number of these effusions will remain undiagnosed despite thoracentesis. Traditionally, closed pleural biopsies have been the next best diagnostic step, but the diagnostic yield of blind closed pleural biopsies for malignant pleural effusions is insufficient.When image-guided targeted biopsies are not possible, both pleuroscopy and video-assisted thoracoscopic surgery are reasonable options for obtaining pleural biopsies, but the decision to select one procedure over the other continues to raise much debate. Pleuroscopy (aka. medical thoracoscopy, local anaesthetic thoracoscopy) is a relatively common procedure performed by interventional pulmonologists in the bronchoscopy suite with local anesthesia, often as an outpatient procedure, on spontaneously breathing patients. Video-assisted thoracoscopic surgery, on the other hand, is performed by thoracic surgeons in the operating room, on mechanically ventilated patients under general anesthesia, though admittedly considerable overlap exists in practice. Both pleuroscopy and video-assisted thoracoscopic surgery have reported diagnostic yields of over 90%, although pleuroscopy more often leads to the unsatisfactory diagnosis of 'non-specific' pleuritis. These cases of 'non-specific' pleuritis need to be followed up for at least one year, as 10-15% of them will eventually lead to the diagnosis of cancer, typically malignant pleural mesothelioma. Both procedures have their pros and cons, and it is therefore of paramount importance that all cases be discussed as part of a multidisciplinary approach to diagnosis within a "pleural team" that should ideally include interventional pulmonologists and thoracic surgeons.

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Section: Thoracentesismentioning

confidence: 99%

Pleuroscopy or video-assisted thoracoscopic surgery for exudative pleural effusion: a comparative overview

Ali¹,

Light²,

Maldonado³

2019

J. Thorac. Dis

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“…This entails the operator determining the distance between the skin and the effusion, and thereafter marking the puncture site without directly visualizing the needle throughout the procedure. However, it is advisable to carry out the technique for small, septated, or loculated pleural effusions with the use of dynamic real-time ultrasonography control, in which the operator continuously monitors the needle’s position during the procedure [ 99 ]. Video 13 presents a complex pleural effusion on ultrasound.…”

Section: Reviewmentioning

confidence: 99%

Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine

Monteiro,

França de Santana,

Morais

et al. 2024

Cureus

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This narrative review explores the application of point-of-care ultrasound (POCUS) in palliative care and its feasibility in home care settings. POCUS has the potential to streamline diagnostic strategies without patient transfer to the hospital, expedite timely symptomatic relief, and reduce complications from specific palliative interventions. The advent of handheld ultrasound devices has made it an attractive diagnostic and interventional adjunct in acute palliative care. POCUS has gained widespread acceptance as part of routine care in emergency medicine and intensive care, guiding certain procedures and increasing their safety. The modernization and miniaturization of ultrasound equipment have made ultra-portable devices available, allowing for better-quality images at affordable prices. Handheld devices have the potential to revolutionize everyday clinical practice in home-based palliative care, contributing to important bedside clinical decisions. Palliative care patients often require diagnostic examinations in the last months of their lives, with CT being the most frequently performed imaging procedure. However, CT imaging is associated with high costs and burdens, leading to increased suffering and impaired quality of life. Clinical ultrasound, a dialogic imaging modality, offers a safer and more efficient approach to palliative care. POCUS applications, which are cost-effective, non-invasive, and well-tolerated, can be used to improve patient satisfaction and diagnostic understanding. POCUS is a valuable tool in palliative care, improving diagnostic accuracy and reducing the time to diagnosis for various pathologies. It is a standard of care for many procedures and improves patient safety. However, there are limitations to POCUS in palliative care, such as operator-dependent examination variability and limited availability of trained professionals. To overcome these limitations, palliative care physicians should receive mandatory training in POCUS, which can be incorporated into the core curriculum. Additionally, ultrasound teleconsulting can assist less experienced examiners in real-time examinations. The literature on POCUS in palliative care is limited, but research on patient-oriented outcomes is crucial. POCUS should be considered a supplement to good clinical reasoning and regulated radiological evaluations.

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“…3 With the advent of point-of-care ultrasound, use of real-time needle visualization techniques has been shown to improve results with success rates and reduce complications, the number of attempts, and time to access. [4][5][6][7] However, previous studies on ultrasound-guided CVC insertion were mostly related to IJV cannulation because the subclavian vein is not easily amenable to ultrasound due to its location. The axillary vein (AxV) can be clearly visualized in a more lateral infraclavicular position, which offers several potential advantages over blind, subclavian vein techniques.…”

Section: Assessing Ultrasound-guided Axillary Vein Cannulation Using ...mentioning

confidence: 99%

Assessing ultrasound-guided axillary vein cannulation using a cumulative sum analysis: A single operator experience

et al. 2021

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Background: Ultrasound-guided axillary vein (AxV) cannulation has been described as an effective alternative to internal jugular vein cannulation in adult cardiac surgical patients. However, the learning curve for this technique has not yet been addressed. This study aimed to determine the number of cases required to achieve proficiency in performing AxV cannulation among novice anesthesiologists. Methods: This prospective study included the first 60 patients who underwent ultrasound-guided AxV cannulation performed by a single third-year resident who was trained in adult cardiac anesthesia. This study investigated the number of cases required to gain technical proficiency by applying cumulative sum analysis on the learning curve (LC-CUSUM) of ultrasound-guided AxV cannulation. Results: Based on the assessment of the CUSUM plots, a descending inflection point for decreasing the overall procedural time for AxV cannulation was observed after patient 29. Regarding the procedural outcomes, comparing the early-experience group with the late-experience group (29 vs 31 cases), the former group had longer operating time (1526 s vs 1120 s, p < 0.001) and identification time (110 s vs 92 s, p < 0.001) and lower first-attempt success rate (8, 27.6% vs 30, 96.8%, p < 0.001) than the latter group. Conclusions: CUSUM demonstrated that at least 29 successful cases are required to achieve an expertized manipulation in ultrasound-guided AxV cannulation for inexperienced novices. The learning curve for ultrasound-guided AxV cannulation was observed in 29 cases. After adequate training, the overall procedural time and the first-attempt success rate, and puncture-related complications for AxV cannulation improved with increased experience.

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Real-time ultrasound-guided thoracentesis

Cited by 14 publications

References 19 publications

Pleuroscopy or video-assisted thoracoscopic surgery for exudative pleural effusion: a comparative overview

Pleuroscopy or video-assisted thoracoscopic surgery for exudative pleural effusion: a comparative overview

Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine

Assessing ultrasound-guided axillary vein cannulation using a cumulative sum analysis: A single operator experience

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