Bedside pleural procedures by pulmonologists and non-pulmonologists: a 3-year safety audit
| Autor: | Oon Cheong Ooi, Jason Phua, Sandhya Mujumdar, Tow Keang Lim, Venetia Ong, Chia Meng Teoh, Kay Choong See, Pyng Lee, Louis Sutrisno Widjaja, Kay Leong Khoo |
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| Rok vydání: | 2014 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty COPD business.industry medicine.medical_treatment General surgery Thoracentesis medicine.disease Hemothorax Thoracostomy respiratory tract diseases Patient safety Pneumothorax medicine Complication Intensive care medicine business Pulmonologists |
| Zdroj: | Respirology. 19:396-402 |
| ISSN: | 1323-7799 |
| DOI: | 10.1111/resp.12244 |
| Popis: | Background and objective Pleural procedures such as tube thoracostomy and chest aspirations are commonly performed and carry potential risks of visceral organ injury, pneumothorax and bleeding. In this context limited information exists on the complication rates when non-pulmonologists perform ultrasound-guided bedside pleural procedures. Bedside pleural procedures in our university hospital were audited to compare complication rates between pulmonologists and non-pulmonologists. Methods A combined safety approach using standardized training, pleural safety checklists and ultrasound-guidance was initially implemented in a ∼1000-bed academic medical centre. A prospective audit, over approximately 3.5 years, of all bedside pleural procedures excluding procedures done in operating theatres and radiological suites was then performed. Results Overall, 529 procedures (295 by pulmonologists; 234 by non-pulmonologists) for 443 patients were assessed. There were 16 (3.0%) procedure-related complications, all in separate patients. These included five iatrogenic pneumothoraces, four dry taps, four malpositioned chest tubes, two significant chest wall bleeds and one iatrogenic hemothorax. There were no differences in complication rates between pulmonologists and non-pulmonologists. Presence of chronic obstructive pulmonary disease (COPD) independently increased the risk of complications by nearly sevenfold. Conclusions Results from this study support pleural procedural practice by both pulmonologists and non-pulmonologists in an academic medical centre setting. This is possible with a standard training program, pleural safety checklists and relatively high utilization rates of ultrasound guidance for pleural effusions. Nonetheless, additional vigilance is needed when patients with COPD undergo pleural procedures. |
| Databáze: | OpenAIRE |
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