Iatrogenic Pneumothorax Prevention with POCUS

Iatrogenic Pneumothorax Complications: Zero

The prestigious Memorial Hermann Healthcare System achieved zero iatrogenic pneumothorax complications for one year. Learn how they achieved this feat in several of its hospitals and eight of its community hospital emergency departments. 

Improving Quality of Care and Patient Safety While Saving Money

Multiple studies have demonstrated that ultrasound guidance improves the success rate and safety of invasive procedures including central venous lines, paracentesis and thoracentesis. Avoiding complications is not only is good for patient care, it reduces the overall cost of care for hospitals. A recent study conducted by United BioSource Corporation (UBC) demonstrated this cost reduction. Two recent studies, presented at the 2011 National Patient Safety Foundation (NPSF) Annual Meeting, found significant economic savings when ultrasound guidance was used as part of the care pathway. The largest studies of their type, they examined both paracentesis and thoracentesis and found fewer complications in the ultrasound guided group as well as substantial cost savings. As an example, a single iatrogenic pneumothorax increased hospital costs by more than $2,700 and a single bleeding complication during a paracentesis increased hospital costs over $20,000. Furthermore, both groups with complications had significantly longer hospital length of stays. Read more below on the economic and safety benefits of patients receiving ultrasound guidance for their thoracentesis or paracentesis.

Evidence Shows Ultrasound Guidance Reduces Paracentesis and Thoracentesis

Real-time ultrasound guidance significantly improves first-pass procedural success and improves patient safety for a number of needle-based procedures, including central lines, thoracentesis and paracentesis.

For the 69,859 patients who underwent a paracentesis, suffering a bleeding complication boosted hospital costs to nearly $30,000, about triple the cost for patients without a complication ($9,476) and length of hospital stay almost doubled, from a mean of 5.2 days for a patient without a bleeding complication to a mean of 9.5 days for a patient with one. Read the paracentesis abstract

For the 61,261 patients included in the analysis who underwent a thoracentesis, ultrasound guidance reduced the incidence of a pneumothorax by 19%. This complication increased a patient's hospital cost to $13,784, compared to $11,032 for a patient who didn't suffer a pneumothorax. In addition, the mean length of hospital stay was 7.9 days for a patient with a pneumothorax, versus 6.5 days for a patient without it. Read the thoracentesis abstract

The studies, "Clinical and Economic Advantage of Ultrasound Guidance Among Patients Undergoing Paracentesis" and "Clinical and Economic Advantage of Ultrasound Guidance Among Patients Undergoing Thoracentesis" were completed for Sonosite by the United BioSource Corporation (UBC), a global scientific and medical affairs organisation. Researchers from the UBC Centre for Epidemiology and Database Analytics used the national Premier Perspective® automated hospitilisation claims database to access thousands of patients' records in over 600 hospitals from across the country.

The Recommendations are Clear

Based on this robust evidence, multiple government organisations and societies advocate ultrasound guidance:

• AHRQ – Agency for Healthcare Research and Quality
• NICE – National Institute for Health and Clinical Excellence
• CDC – Centres for Disease Control and Prevention
• American College of Surgeons
• American College of Emergency Physicians
• American College of Chest Physicians
• American Board of Internal Medicine
• Association for Vascular Access

Let Us Help You Lessen Line Placement Complications at Your Hospital

Sonosite is committed to quality care and partners with hospitals to achieve that goal. To facilitate the process, Sonosite has created the Central Line Management Programme. This evidence-based programme includes AHRQ, CDC and IHI recommendations and addresses both mechanical and infective complications of central venous catheters, allowing you to decrease:

A) Accidental punctures causing pneumothorax, haemothorax, or carotid injury
B) Central line associated bloodstream infections (CLABSI)