![]() Another study had physicians placing a radiopaque marker on a patient’s chest wall over the 4th or 5th ICS prior to the patient getting a chest X-ray. One study evaluated 50 junior physicians’ ability to properly identify the chest thoracostomy site using a photograph of a chest wall and showed that only 44% correctly located the 4th–5th intercostal space in the mid-axillary line. The classic technique uses landmarks on the body to identify the anatomically correct insertion site to avoid intraperitoneal insertion or lung injury. To prevent these risks, training programs design simulations to train their residents on the proper insertion techniques. Unfortunately, this life-saving procedure has a complication rate up to 30%, with complications raging from tube malposition, to bleeding, and organ injury. From this point, thoracostomy tube placement became a mandatory skill for all providers taking care of trauma patients. In 1876, Hewett was the first to use a completely closed intercostal drainage system, but it was not until World War II that tube thoracostomy became common in the treatment of injured patients. ![]() The goal of thoracostomy drainage remains unchanged since the time of Hippocrates however, the procedure itself has changed dramatically since fifth century B.C.E. In these patients, thoracostomy tube placement is performed to manage conditions such as pneumothorax, hemothorax, and pleural effusions. Despite its severity, less than 30% of penetrating chest trauma and 10% of blunt thoracic injuries require thoracostomy. Of these deaths, thoracic trauma accounts for nearly a quarter of all traumatic deaths. The leading cause of death for individuals in the United States younger than 40 years old is trauma, with approximately 140,000 deaths annually. Further studies are warranted to determine if this ultrasound-guided technique will decrease complications with chest tube insertion and improve patient outcomes. The ability to accurately locate the correct intercostal space for thoracostomy incision was improved under ultrasound guidance. On average, the traditional technique was placed 0.88 rib spaces away (95 CI 0.43–1.03), while the ultrasound-guided technique was placed 0.09 rib spaces away (95 CI 0.0–0.19). ![]() The participants correctly identified the pre-determined intercostal space using palpation 48% (16/33) of the time, versus the ultrasound group who identified the proper intercostal space 91% (30/33) of the time. The distance from the proper insertion site was measured and recorded in rib spaces. The participants were then asked to use ultrasound to identify the proper thoracostomy site and mark it with an opaque marker. The participants were then given a brief hands-on training session using ultrasound to identify the diaphragm and count rib spaces. The distance from the correct insertion site was measured in rib spaces. Participants were asked to identify the thoracostomy site by placing an opaque marker where they would make their incision. An experienced physician sonographer used ultrasound to locate a site at mid-axillary line between ribs 4 and 5 and marked the site with invisible ink that can only be revealed with a commercially available UV LED light. A healthy volunteer was used as the standardized patient for this study. Methodsģ3 emergency medicine residents and medical students volunteered to participate in this study during routine thoracostomy tube education. The goal of this study is to determine whether novice providers could more accurately identify the appropriate intercostal site for thoracostomy by ultrasound guidance. Traditional landmark thoracostomy technique has a known complication rate up to 30%.
0 Comments
Leave a Reply. |