RESUMO
In a study with 76 anesthesia providers on a mixed reality simulator, central venous access via the supraclavicular approach to the subclavian vein, without ultrasonography required less attempts compared to the infraclavicular approach. Participants had shorter times to venous access and larger improvements in confidence. Results from this simulation-based study indicate that the supraclavicular approach may deserve consideration as an alternative approach for central venous access in deployed military environments. The use of ultrasonography during the supraclavicular approach to the subclavian vein is also described which may improve its safety profile. This technique could be more appropriate in scenarios when central venous access is preferred over intraosseous access for patients being transported to another location for further care.
Assuntos
Cateterismo Venoso Central/métodos , Simulação de Paciente , Cateterismo Venoso Central/normas , Florida , Humanos , Medicina Militar/educação , Segurança do Paciente/normas , Veia Subclávia/anatomia & histologia , Ultrassonografia de Intervenção/métodosRESUMO
INTRODUCTION: The preoperative encounter may offer a cost-effective opportunity for diabetes screening. METHODS: Three hundred forty-seven fasting patients had a preoperative glucose measurement determined from blood residue left on the IV needle, measured with an Accu-Chek glucometer (Roche Diagnostics, Indianapolis, IN). RESULTS: After excluding patients with a diabetes history, 4.0% had a glucose measurement between 100 and 125 mg/dL, at a cost of $14.22 per identification, and 1.2% had a glucose measurement more than 125 mg/dL, at a cost of $32.00 per identification. CONCLUSIONS: This preoperative blood glucose screening test was implemented at a cost of approximately one-tenth of current methods.