RESUMO
BACKGROUND: A growing body of literature supports the use of ultrasound (US) to assist central venous catheter (CVC) placement, and in many settings, this has become the standard of care. However, this remains a relatively new and uncommonly performed procedure for pediatric emergency medicine physicians. OBJECTIVES: This study aims to describe the change over time in percentage of CVC procedures performed with US assistance per 10,000 patient visits in a pediatric emergency department. METHODS: We describe the development of an emergency US program in a pediatric emergency department and investigate how US use for CVC placement in internal jugular and femoral veins changed from July 2007, when US became available, until December 2011. Data related to CVC procedures were obtained from a procedure database maintained for quality assurance purposes. RESULTS: The percentage of CVC procedures performed with US assistance increased significantly over time (P < 0.001). CONCLUSIONS: The development of an emergency US program was associated with significantly increased physician use of US for CVC placement.
Assuntos
Cateterismo Venoso Central/métodos , Serviços de Saúde da Criança/organização & administração , Educação Médica Continuada/organização & administração , Medicina de Emergência/educação , Serviço Hospitalar de Emergência/organização & administração , Corpo Clínico Hospitalar/educação , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Ultrassonografia de Intervenção/métodos , Boston , Cateterismo Venoso Central/estatística & dados numéricos , Cateterismo Venoso Central/tendências , Criança , Bolsas de Estudo , Veia Femoral/diagnóstico por imagem , Hospitais Pediátricos , Humanos , Veias Jugulares/diagnóstico por imagem , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Centros de Atenção Terciária , Ultrassonografia de Intervenção/estatística & dados numéricos , Ultrassonografia de Intervenção/tendênciasRESUMO
We present a case of a 3-year-old male with history of minor trauma, who was brought in by ambulance from the playground where he had an acute mental status change and was noted to be hypotensive on initial evaluation. History and examination did not indicate a clear etiology of his symptoms. Point-of-care emergency ultrasonography revealed free fluid in the abdomen and expedited the care of the child's unexpected intra-abdominal hemorrhage from an occult abdominal tumor. This case demonstrates the ability of practitioners to expedite and focus care with the use of rapid assessment with ultrasonography in the pediatric emergency department.