Ultrasound-guided thoracostomy site identification in healthy volunteers

• Published in: Critical ultrasound journal Vol. 10; no. 1; pp. 28 - 5
• Main Authors: Taylor, Lindsay A., Vitto, Michael J., Joyce, Michael, Tozer, Jordan, Evans, David P.
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 15.10.2018; Springer Nature B.V; SpringerOpen
• Subjects: Catheters; Critical Care Medicine; Diagnostic Radiology; Emergency medical services; Emergency Medicine; Imaging; Insertion; Intensive; Interventional Radiology; Light emitting diodes; Medical students; Medicine; Medicine & Public Health; Original; Original Article; Radiology; Ribs; Ultrasonic imaging; Ultrasonic testing; Ultrasound; Traditional Landmark; Tube Thoracostomy; Rib Spacing; Ultrasound-guided Technique; Novice Providers
• ISSN: 2036-3176; 2036-7902; 2524-8987
• DOI: 10.1186/s13089-018-0108-1

Background Traditional landmark thoracostomy technique has a known complication rate up to 30%. The goal of this study is to determine whether novice providers could more accurately identify the appropriate intercostal site for thoracostomy by ultrasound guidance. Methods 33 emergency medicine residents and medical students volunteered to participate in this study during routine thoracostomy tube education. A healthy volunteer was used as the standardized patient for this study. 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. Participants were asked to identify the thoracostomy site by placing an opaque marker where they would make their incision. The distance from the correct insertion site was measured in rib spaces. The participants were then given a brief hands-on training session using ultrasound to identify the diaphragm and count rib spaces. The participants were then asked to use ultrasound to identify the proper thoracostomy site and mark it with an opaque marker. The distance from the proper insertion site was measured and recorded in rib spaces. Results 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. 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) [P = 0.003]. Conclusions The ability to accurately locate the correct intercostal space for thoracostomy incision was improved under ultrasound guidance. Further studies are warranted to determine if this ultrasound-guided technique will decrease complications with chest tube insertion and improve patient outcomes.