PURPOSE:Pneumothorax (PTX) is a known complication of invasive procedures with detrimental results in a critical patient. The use of ultrasound (U/S) guidance during invasive procedures has increased in recent years and is rapidly becoming the standard of care. Multiple studies have shown that U/S can also be used to evaluate for PTX immediately after such procedures, and chest radiograph (CXR) can be safely eliminated in uncomplicated situations. Our purpose is to examine the feasibility of replacing CXR with U/S when the procedure is performed by internal medicine residents at the bedside under intensivists’ supervision.
METHODS:We include patients who receive U/S guided central venous catheterization and thoracentesis, both performed by the medical residents. Immediately after the procedure, an intensivist evaluates for the Sliding-Sign and B-lines as a rule-out test for PTX. All patients receive a bedside A/P CXR as is hospital protocol. The U/S and CXR results are compared for all patients.
RESULTS:Nine thoracenteses and 14 central venous catheterizations were performed. Sliding-Sign or B-lines were demonstrated in all cases. In 22 cases, no PTX was noted on CXR. However, in 1 case, the CXR showed a possible PTX that was immediately ruled out by chest CT.
CONCLUSION:The bedside U/S is as sensitive as CXR to rule out PTX immediately after U/S guided procedures performed by medical residents. No false negatives were noted in our study.
CLINICAL IMPLICATIONS:Internal medicine residents can safely perform U/S guided central venous catheterization and thoracentesis with similar efficacy as reported in surgery, anesthesia, and radiology literature. Furthermore, the CXR can be replaced by immediate bedside U/S to rule out PTX after such procedures, even in community teaching hospitals. Also, it is valuable educational tool for our residents in that it broadens their anatomical knowledge and enhances their clinical and technical skills, while also benefiting patient safety.
DISCLOSURE:Michael Dinkels, None.