The Case for Simulation Based Training for Bedside Hospital Procedures

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central Line, Central line insertion, central line placement, central lines, Central Venous Catheter, central venous catheters, E-FAST, emergency procedures, emergency procedures course, FAST exam, Featured, First-attempt success rate, hospital procedures, hospital procedures course, Hospitalist, HPC, HPC Conference, HPC Updates, Lumbar Puncture, medical procedures, medical procedures course, paracentesis, Paracentesis, POCUS, safety checklists, Simulation Based Training, Simulation-based procedural training, Thoracentesis, Ultrasound, Ultrasound for Pneumothorax, Ultrasound-Guided Central Line Insertion, Ultrasound-guided lumbar puncture, Ultrasound-Guided Lumbar Punctures, Ultrasound-Guided Paracentesis, ultrasound-guided procedures, Ultrasound-Guided Thoracentesis
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For decades the mantra for procedural education in medicine has been “see one-do one-teach one”.  Those of us who learned bedside procedures and point-of-care ultrasound by this model understand that this approach does not optimize safe and competent performance.   At…
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In plane ultrasound-guided central line placement is preferred over out-of-plane technique

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central Line, HPC Updates, internal jugular line, subclavian line, ultrasound-guided procedures
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A study from an urban EM residency program determined that in-plane ultrasound-guided central venous catheterization is superior to out-of-plane ultrasound-guided central line placement. This study was only a single center study that was a randomized crossover study of ER residents…
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In plane ultrasound-guided central line placement is preferred over out-of-plane technique

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central Line, Featured Procedure, HPC Updates, ultrasound-guided procedures
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A study from an urban EM residency program determined that in-plane ultrasound-guided central venous catheterization is superior to out-of-plane ultrasound-guided central line placement. This study was only a single center study that was a randomized crossover study of ER residents…
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Bedside Ultrasound Increases the Success Rate for Difficult Lumbar Punctures

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured Procedure, HPC Updates, Lumbar Puncture, PROCEDURE OF THE WEEK, Ultrasound-Guided Lumbar Punctures, ultrasound-guided procedures
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The traditional landmark-guided needle lumbar puncture technique was first described by Heinrich Quincke in 1891[1]This technique utilizes the iliac crest and the posterior lumbar spinous processes to determine the optimal sites for spinal needle introduction in either the L3-4 or…
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Ultrasound-guided Central Venous Access: Are Landmarks a Thing of the Past?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central Line, central line placement, Central Venous Catheter, Featured Procedure, HPC Updates, Procedure Blog of the Week, Ultrasound-Guided Central Line Insertion, ultrasound-guided procedures
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Point-of-care ultrasound is one of the most rapidly evolving areas of medicine.  In addition to becoming the “stethoscope of the future” for bedside diagnostic evaluations, ultrasound has improved the safety and efficiency of a wide range of procedures.  The use…
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Paracentesis: Do I Really Need the Ultrasound?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Featured, HPC Updates, Paracentesis, Ultrasound-Guided Paracentesis, ultrasound-guided procedures
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In residency, I spent a great deal of time at the bedside assessing for shifting dullness in patients who may have had ascites.  Today, when I ask residents about shifting dullness, I often get blank stares.  “Why would I do…
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What is the true complication rate for thoracentesis?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – HPC Updates, Pneumothorax, Thoracentesis, ultrasound-guided procedures
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Thoracentesis is one of the most common bedside procedures performed in U.S. hospitals.  There are about 173,000 thoracenteses performed each year in the U.S.  A systematic review and meta-analysis in 2010 concluded that thoracentesis-related pneumothorax occurs 6% of the time…
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Ultrasound Guided Peripheral IV and Sterile Technique

Dr. Rick Rutherford, M.D., FAAFP
More Articles – HPC Updates, Ultrasound-Guided Peripheral IV Insertion, ultrasound-guided procedures
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Is Aseptic Technique for Ultrasound Guided Peripheral Lines Enough? Widespread use of ultrasound guided peripheral intravenous catheters will reduce reliance on central lines, thus decreasing the central line device utilization ratios (DUR).  In theory and practice, high DURs correlate with…
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Ultrasound-Guided Radial Arterial Line

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Arterial Lines, HPC Updates, ultrasound-guided arterial lines, ultrasound-guided procedures
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Ultrasound for Radial Arterial Line?   Do I really need to use an ultrasound for radial arterial lines?  For years I have used ultrasound guidance for brachial and femoral arterial line placement because the risk associated with puncturing or lacerating…
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Ultrasound-Guided Peripheral IVs: An Alternative to Central Venous Catheters?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Ultrasound-Guided Peripheral IV Insertion, ultrasound-guided procedures
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One of the most common indications for placing a central venous catheter is “no IV access”.  I certainly have placed numerous central lines for this reason.  Unfortunately, this practice is not without consequences.  In addition to patient discomfort and mechanical…
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Ultrasound-guided Thoracentesis Reduces the Rate of Pneumothorax and Tube Thoracostomy

Joseph Esherick, M.D., FAAFP, FHM
More Articles – HPC Updates, Thoracentesis, ultrasound-guided procedures, Ultrasound-Guided Thoracentesis
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Numerous studies have shown that ultrasound guidance lowers the rate of complications and increases the success rate for virtually every hospital procedure compared with traditional landmark-based techniques. This has proved to be the case for ultrasound-guided central lines, ultrasound-guided paracentesis,…
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