Arterial Line Placement Pitfalls Can Be Demonstrated and Visualized With an Inexpensive, Wearable Trainer

2022 ◽  
Author(s):  
Olivia Paradis ◽  
Lauren Bitterman ◽  
Kimberly H. Park ◽  
Stacey Ernest ◽  
Amy Russell ◽  
...  
Keyword(s):  
Arterial Line ◽  
Line Placement

Ultrasound Guided Procedures and Radiologic Imaging for Pediatric Anesthesiologists

2021 ◽  
Keyword(s):  
Lung Ultrasound ◽  
Central Line ◽  
Arterial Line ◽  
Ultrasound Guided ◽  
Pediatric Airway ◽  
Skill Sets ◽  
Additional Information ◽  
Line Placement ◽  
Extensive Training ◽  
Radiologic Imaging

Ultrasound Guided Procedures and Radiologic Imaging for Pediatric Anesthesiologists is intended as a ready resource for both experts and novices. It will be useful to those with extensive training and experience as well as beginners and those with distant experience or training. A wealth of knowledge in the human factors of procedure design and use has been applied throughout to ensure that desired information can be easily located, that steps are clearly identified and comprehensible, and that additional information of high relevance to procedure completion is co-located and salient. This book begins with the basics but quickly progresses to advanced skill sets. It is divided into four parts. Part I starts with a primer on ultrasound machine functionality as well as procedural chapters on lung ultrasound to detect a mainstem intubation or pneumothorax and gastric ultrasound to assess gastric contents in incompletely fasted patients. Part II covers ultrasound guided peripheral intravenous line placement through the incremental advancement method, ultrasound guided arterial line placement, and ultrasound guided central line placement. Part III details several ultrasound guided regional anesthesia techniques. Part IV covers radiology of the pediatric airway and mediastinum, lungs, gastrointestinal, genitourinary, musculoskeletal, and neurologic systems.

Variability in Critical Care–Related Charge Markups in Medicare Patients

2018 ◽  
Vol 84 (10) ◽  
pp. 1622-1625 ◽  
Author(s):  
Joshua Tseng ◽  
Harry C. Sax ◽  
Rodrigo F. Alban
Keyword(s):  
Internal Medicine ◽  
Critical Care ◽  
Endotracheal Intubation ◽  
Chest Tube ◽  
Critical Care Medicine ◽  
Tube Placement ◽  
Arterial Line ◽  
Fee For Service ◽  
Related Services ◽  
Line Placement

Charge markups for health care are variable and inflated several times beyond cost. Using the 2015 Medicare Provider Fee-For-Service Utilization and Payment Data file, we identified providers who billed for critical care hours and related procedures, including CPR, EKG interpretation, central line placement, arterial line placement, chest tube/thoracentesis, and emergent endotracheal intubation. Markup ratios (MRs), defined as the amount charged divided by the amount allowable, were calculated and compared; 42.1 per cent of physicians billing for critical care–related services were specialized in emergency medicine (EM). EM had the highest overall MR (median 4.99, IQR 3.60–6.88) and provided most of the services. MRs differed between genders in select cases (critical care hours: anesthesiology, EM, internal medicine, pulmonary and critical care medicine; CPR, pulmonary and critical care medicine; chest tube placement/thoracentesis, internal medicine). These differences in MR did not correspond to higher rates of Medicare allowable amounts ( P = NS). In conclusion, charge markups significantly varied by physician specialty. EM physicians had the highest MRs for most critical care–related services, including critical care hours, EKG interpretation, CPR, central venous line placement, and emergent endotracheal intubation. EM physicians also provided most of these services. Charge markups are associated with adverse consequences and represent potential targets for cost containment and consumer protection.

Wrist Hyperextension Leads to Median Nerve Conduction Block

2004 ◽  
Vol 100 (2) ◽  
pp. 287-291 ◽  
Author(s):  
Anne L. Chowet ◽  
Jaime R. Lopez ◽  
John G. Brock-Utne ◽  
Richard A. Jaffe
Keyword(s):  
Median Nerve ◽  
Nerve Conduction ◽  
Action Potentials ◽  
Conduction Block ◽  
Neutral Position ◽  
Arterial Line ◽  
Line Placement ◽  
Compound Action Potentials ◽  
Contralateral Hand ◽  
The Right

Background It is common practice to hyperextend the wrist to facilitate insertion of a radial intra-arterial catheter. This position may be maintained for prolonged periods. Although there has been much discussion about optimal patient management to protect the ulnar nerve and brachial plexus, little attention has been paid to the median nerve during wrist hyperextension. The authors report the effects of wrist hyperextension on conduction in the median nerve. Methods Median nerve conduction was studied in 12 awake, healthy volunteers using standard nerve conduction tests consisting of the measurement of compound sensory and motor action potentials, as well as their amplitudes and latencies. With the contralateral hand as a control, the right wrist was placed in hyperextension (angled between 65 and 80 degrees), and compound action potentials were recorded to determine the onset and magnitude of effects. Subsequently, the hand was released from hyperextension and recovery was recorded. Results In 83% of subjects, hyperextension resulted in a significant decrease in compound sensory action potential amplitudes, sufficient to qualify as conduction block (16.6% of baseline). The average time to conduction block was 43 +/- 13.2 min. All subjects who manifested conduction block showed marked improvement 5 min after release from hyperextension. Conclusions Wrist hyperextension for arterial line placement and stabilization is likely to result in profound impairment of median nerve function. Although the effects were transient in this study, the results suggest that prolonged hyperextension may be associated with significant changes in median nerve conduction. To minimize the chance for nerve injury, the authors recommend that wrists be returned promptly to the neutral position following arterial line placement.

scholarly journals Prospective Comparison of Ultrasound-Guided Versus Palpation Techniques for Arterial Line Placement by Residents in a Teaching Institution

2019 ◽  
Vol 11 (2) ◽  
pp. 177-181 ◽  
Author(s):  
Yar Luan Yeap ◽  
John W. Wolfe ◽  
Jennifer Stewart ◽  
Kevin M. Backfish
Keyword(s):  
Elective Surgery ◽  
Baseline Heart Rate ◽  
Arterial Line ◽  
Teaching Institution ◽  
Line Placement ◽  
Prospective Comparison ◽  
Baseline Systolic Blood Pressure ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Emergent Surgery

ABSTRACT Background  Arterial line insertion is traditionally done by blind palpation. Residents may need multiple attempts for successful insertion, leading to longer procedure times and many failed attempts. Objective  We hypothesized that ultrasound guidance (USG) would be faster and more successful than traditional blind palpation (TBP) for radial artery line placement by residents. Methods  Patients undergoing elective surgery requiring a radial arterial line were randomized to either the USG or TBP groups. Exclusion criteria included a need for arterial line placement in an awake patient, emergent surgery, or American Society of Anesthesiologists (ASA) physical status class VI. After the induction of anesthesia, a postgraduate year 3 (PGY-3) or PGY-4 anesthesia resident placed an arterial line by either USG or TBP. Results  A total of 412 patients and 85 of 106 residents (80%) in the training program were included. The 2 groups were similar with respect to sex, weight, height, ASA class, baseline systolic blood pressure, and baseline heart rate. USG was faster than TBP (mean times 171.1 ± 16.7 seconds versus 243.6 ± 23.5 seconds, P = .012), required fewer attempts (mean 1.78 ± 0.11 versus 2.48 ± 0.15, P = .035), and had an improved success rate (96% versus 90%, P = .012). Conclusions  We found that residents using USG in an academic institution resulted in significantly faster placement of the arterial lines, fewer attempts, and fewer catheters used.

Predictors of Prehospital On-Scene Time in an Australian Emergency Retrieval Service

2019 ◽  
Vol 34 (03) ◽  
pp. 317-321
Author(s):  
Patrick T. Fok ◽  
David Teubner ◽  
Jeremy Purdell-Lewis ◽  
Andrew Pearce
Keyword(s):  
Model Building ◽  
South Australia ◽  
Therapeutic Interventions ◽  
Arterial Line ◽  
Patient Age ◽  
Line Placement ◽  
Patient Âgé ◽  
Time Required ◽  
The Impact ◽  
Rotary Wing

AbstractIntroduction:Prehospital physicians balance the need to stabilize patients prior to transport, minimizing the delay to transport patients to the appropriate level of care. Literature has focused on which interventions should be performed in the prehospital environment, with airway management, specifically prehospital intubation (PHI), being a commonly discussed topic. However, few studies have sought additional factors which influence scene time or quantify the impact of mission characteristics or therapeutic interventions on scene time.Hypothesis/Problem:The goal of this study was to identify specific interventions, patient demographics, or mission characteristics that increase scene time and quantify their impact on scene time.Methods:A retrospective, database model-building study was performed using the prehospital mission database of South Australian Ambulance Service (SAAS; Adelaide, South Australia) MedSTAR retrieval service from January 1, 2015 through August 31, 2016. Mission variables, including patient age, weight, gender, retrieval platform, physician type, PHI, arterial line placement, central line placement, and finger thoracostomy, were assessed for predictors of scene time.Results:A total of 506 missions were included in this study. Average prehospital scene time was 34 (SD = 21) minutes. Four mission variables significantly increased scene time: patient age, rotary wing transport, PHI, and arterial line placement increased scene time by 0.09 (SD = 0.08) minutes, 13.6 (SD = 3.2) minutes, 11.6 (SD = 3.8) minutes, and 34.4 (SD = 8.4) minutes, respectively.Conclusion:This study identifies two mission characteristics, patient age and rotary wing transport, and two interventions, PHI and arterial line placement, which significantly increase scene time. Elderly patients are medically complex and more severely injured than younger patients, thus, may require more time to stabilize on-scene. Inherent in rotary wing operations is the time to prepare for the flight, which is shorter during ground transport. The time required to safely execute a PHI is similar to that in the literature and has remained constant over the past two years; arterial line placement took longer than envisioned. The SAAS MedSTAR has changed its clinical practice guidelines for prehospital interventions based on this study’s results. Retrieval services should similarly assess the necessity and efficiency of interventions to optimize scene time, knowing that the time required to safely execute an intervention may reach a minimum duration. Defining the scene time enables mission planning, team training, and audit review with the aim of improved patient care.

scholarly journals Thrombotic complications after radial arterial line placement in systemic sclerosis: A case series

2016 ◽  
Vol 46 (2) ◽  
pp. 196-199 ◽  
Author(s):  
Julie J. Paik ◽  
Ram Hirpara ◽  
Jennifer A. Heller ◽  
Laura K. Hummers ◽  
Fredrick M. Wigley ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Case Series ◽  
Arterial Line ◽  
Radial Arterial Line ◽  
Line Placement ◽  
Thrombotic Complications

scholarly journals Using Learner-Centered, Simulation-Based Training to Improve Medical Students’ Procedural Skills

2017 ◽  
Vol 4 ◽  
pp. 238212051668482 ◽  
Author(s):  
Serkan Toy ◽  
Robert SF McKay ◽  
James L Walker ◽  
Scott Johnson ◽  
Jacob L Arnett
Keyword(s):  
Medical Students ◽  
Lumbar Puncture ◽  
High Reliability ◽  
Intraclass Correlation ◽  
Central Line ◽  
Arterial Line ◽  
Procedural Skills ◽  
Learner Centered ◽  
Line Placement ◽  
Simulation Based

Purpose: To evaluate the effectiveness of a learner-centered, simulation-based training developed to help medical students improve their procedural skills in intubation, arterial line placement, lumbar puncture, and central line insertion. Method: The study participants were second and third year medical students. Anesthesiology residents provided the training and evaluated students’ procedural skills. Two residents were present at each station to train the medical students who rotated through all 4 stations. Pre/posttraining assessment of confidence, knowledge, and procedural skills was done using a survey, a multiple-choice test, and procedural checklists, respectively. Results: In total, 24 students were trained in six 4-hour sessions. Students reported feeling significantly more confident, after training, in performing all 4 procedures on a real patient ( P < .001). Paired-samples t tests indicated statistically significant improvement in knowledge scores for intubation, t(23) = −2.92, P < .001, and arterial line placement, t(23) = −2.75, P < .001. Procedural performance scores for intubation ( t(23) = −17.29, P < .001), arterial line placement ( t(23) = −19.75, P < .001), lumbar puncture ( t(23) = −16.27, P < .001), and central line placement ( t(23) = −17.25, P < .001) showed significant improvement. Intraclass correlation coefficients indicated high reliability in checklist scores for all procedures. Conclusions: The simulation sessions allowed each medical student to receive individual attention from 2 residents for each procedure. Students’ written comments indicated that this training modality was well received. Results showed that medical students improved their self-confidence, knowledge, and skills in the aforementioned procedures.

scholarly journals Contemplating and innovating the arterial line placement in COVID times

2021 ◽  
Vol 15 (2) ◽  
pp. 231
Author(s):  
Vishal Mangal ◽  
KaminderBir Kaur ◽  
Kiran Kalshetty ◽  
Debashish Paul ◽  
Shalendra Singh
Keyword(s):  
Arterial Line ◽  
Line Placement
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