Ultrasound-guided thoracostomy site identification in healthy volunteers

Taylor, Lindsay; Vitto, Michael J.; Joyce, Michael; Tozer, Jordan; Evans, David P.

doi:10.1186/s13089-018-0108-1

Cited by 9 publications

(16 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An area of compression over the left sternal border at either the sixth ICS or the inter-nipple line would result in compressions over the LV in the majority of our study participants. We report both of these anatomic locations because, despite evidence of improved LV localization at the sixth ICS, palpation of ICSs is challenging and has been found for chest tube insertion [ 26 ]. In contrast, the intersection of the left sternal border at the inter-nipple line presents a readily identifiable anatomic landmark for first responders.…”

Section: Discussionmentioning

confidence: 99%

A Novel Anatomic Landmark to Target the Left Ventricle During Chest Compressions in Cardiac Arrest

Olszynski

Bryce

Hussain

et al. 2021

Cureus

View full text Add to dashboard Cite

Background Resuscitation guidelines recommend that chest compressions be performed over the lower sternum. Current computed tomography and magnetic resonance imaging studies suggest that the current area of compression does not target the left ventricle (LV). Using transthoracic ultrasound, we sought to identify potential anatomic landmarks that would result in compressions over the LV in the majority of our study participants. Methodology We recruited 64 healthy men and women (over the age of 40) from the Simulated Patient Program at the University of Saskatchewan. Using ultrasound, we identified the LV and the associated surface anatomy in terms of intercostal space (ICS) and parasternal or mid-clavicular lines. We also collected biometric data including body mass index, chest circumference, and the corresponding inter-nipple line ICS. Results The LV was located along the left sternal border in 62 (96.9%) participants. The most frequent LV location was along the left sternal border at the sixth ICS in 26 (40.6%) participants, with 13 (20.3%) at the fifth and 10 (15.6%) participants at the seventh ICS. In two (3.1%) participants, the LV was found along the mid-clavicular zone at the fifth ICS. The area from the fifth to seventh ICS on the left sternal border, typically covered by an adult palm centered at the sixth ICS, overlaid 49 of 64 (76.6%, 95% confidence interval [CI]: 64.3-86.2%) identified LV locations. By comparison, centering the heel of the palm over the inter-nipple line at the left sternal border would cover the LV in 46 (71.9%, 95% CI: 59.2-82.4%) participants. Conclusions A novel area of compression over the left sternal border at the inter-nipple line would result in compressions over the LV in nearly three-quarters of our study participants. Future research should investigate whether this proposed area of compression is applicable to a broader population including those with cardiac and thoracic disease.

show abstract

Section: Discussionmentioning

confidence: 99%

A Novel Anatomic Landmark to Target the Left Ventricle During Chest Compressions in Cardiac Arrest

Olszynski

Bryce

Hussain

et al. 2021

Cureus

View full text Add to dashboard Cite

show abstract

“…Prehospital POCUS is becoming more widely adopted for its diagnostic abilities to aid in decision-making in traumatically injured patients [16][17][18]. Therefore, It would seem that the natural progression for the usage of POCUS in the eld would be to apply it procedurally.…”

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

View full text Add to dashboard Cite

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.

show abstract

“…The ultrasound-guided group identified the correct thoracostomy site in 91% of cases as compared to only 48% using the landmark technique. 13 Patients undergoing active trauma assessment and resuscitation differ markedly from healthy volunteers. Thus, in this study, we assessed the ability of emergency medicine trainees to correctly identify the proper location for tube thoracostomy placement on randomized trauma patients at a single level 1 trauma center.…”

mentioning

confidence: 99%

Novel Approach to Ultrasound‐Guided Thoracostomy

Taylor

Stenberg

Tozer

et al. 2021

J of Ultrasound Medicine

Self Cite

View full text Add to dashboard Cite

Objectives-Thoracostomy is often a required treatment in patients with thoracic trauma; however, performing a thoracostomy using traditional techniques can have complications. Ultrasound can be a beneficial tool for identifying the correct thoracostomy insertion site. We designed a randomized prospective study to assess if ultrasound guidance can improve thoracostomy site identification over traditional techniques.Methods-Emergency medicine residents were randomly assigned to use palpation or ultrasound to identify a safe insertion site for thoracostomy placement. The target population comprised of hemodynamically stable trauma patients who received an extended focused assessment with sonography for trauma (EFAST) and a chest computed tomography (CT) exam. The resident placed a radiopaque marker on the skin of the patient where a safe intercostal space was believed to be located, either by palpation or ultrasound. Clinical ultrasound faculty reviewed the CT to confirm marker placement relative to the diaphragm. A Fischer's exact test was used to analyze the groups.Results-One hundred and forty-seven patients were enrolled in the study, 75 in the ultrasound group and 72 in the landmark group. This resulted in the placement of 271 total thoracostomy site markers, 142 by ultrasound and 129 by palpation and landmarks. The ultrasound group correctly identified thoracostomy insertion sites above the diaphragm in 97.2% (138/142) of patients, while the palpation group identified a safe insertion site in 88.4% (114/129) of patients (P = .0073).Conclusion-This study found that emergency medicine residents are more likely to identify a safe tube thoracostomy insertion site in trauma patients by using ultrasound, as compared to using landmarks and palpation.

show abstract

Ultrasound-guided thoracostomy site identification in healthy volunteers

Cited by 9 publications

References 18 publications

A Novel Anatomic Landmark to Target the Left Ventricle During Chest Compressions in Cardiac Arrest

A Novel Anatomic Landmark to Target the Left Ventricle During Chest Compressions in Cardiac Arrest

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

Novel Approach to Ultrasound‐Guided Thoracostomy

Contact Info

Product

Resources

About