Emergency Physician Performed Ultrasound-Guided Abdominal Paracentesis: A Retrospective Analysis

BACKGROUND

Emergency physicians commonly perform ultrasound-assisted abdominal paracentesis, using point of care ultrasound (POCUS) to identify ascites and select a site for needle insertion. However, ultrasound-guided paracentesis has the benefit of real-time needle visualization during the entire procedure. Our objective was to characterize the performance of emergency physician-performed ultrasound-guided paracentesis using POCUS, their ability to achieve good in-plane needle visualization, and factors associated with procedural success.

METHODS

A POCUS database was retrospectively reviewed for examinations where abdominal paracentesis was performed by an emergency physician at two academic urban emergency departments over a six-year period. Medical records were reviewed for demographics, presenting history, complications, and hospital course. Descriptive statistics were used to summarize the data.

RESULTS

131 patients were included in the final analysis. The success rate for ultrasound-guided paracentesis was 97.7% (84/86 [95% CI: 92-100%]) compared to 95.6% (43/45 [95% CI: 85-99%]) for ultrasound-assisted paracentesis (p=0.503). 58% (50/86) demonstrated good in-plane needle visualization; 17% (15/86) had partial or out-of-plane visualization; and 24% (21/86) did not demonstrate needle visibility on their saved POCUS images. All four procedural failures were performed by first- or second-year residents using a curvilinear transducer, while all procedures using a linear transducer were successful. The most common complications were ascites leak, infection at the site, and minor bleeding.

CONCLUSIONS

Emergency physicians with training in real-time needle guidance with ultrasound were able to use POCUS to perform ultrasound-guided paracentesis in the emergency department with a high success rate and no fatal complications. Based on our experience, we recommend performing ultrasound-guided paracentesis using a linear transducer, with attention to identifying vessels near the procedure site and maintaining sterile technique.

The Use of Point of Care Ultrasound in Diagnosis of Peritonsillar Abscess

The use of point of care ultrasound (POCUS) for diagnosis and treatment of peritonsillar abscess (PTA) is increasing 1. Proven advantages include improved diagnostic accuracy and treatment success rates as well as decreased otolaryngology consultation, computed tomography (CT) usage, return visits to the emergency department (ED), and length of stay 1. We present a case of a patient with a PTA that was diagnosed and successfully treated utilizing POCUS, avoiding the need for otolaryngology consultation and CT.

Ultrasound Diagnosis of a Retained Migrated Foreign Body Following Penetrating Injury to The Upper Thigh in a Child: A Case Report Demonstrating an Underused Indication for Diagnostic Ultrasound

We present a case of delayed diagnosis of retained glass foreign body in the inguinal region of a child using ultrasonography following penetrating trauma to the upper thigh. The foreign body had traversed significantly by the time of diagnosis, from the medial upper thigh to the inguinal region at the level of the inguinal ligament. Ultrasound can be an effective initial imaging modality for the diagnosis of foreign bodies in children, allowing the potential to reduce ionizing radiation exposure.

Diffusion and practice of ultrasound in emergency medicine departments in Italy

INTRODUCTION

This paper reports data from a cognitive survey on the diffusion, practice and organization of ultrasound (US) in emergency medicine departments (EMDs) in Italy. The study was carried out by the Emergency Medicine Section of the Italian Society for Ultrasound in Medicine and Biology (SIUMB) in collaboration with the Italian Society for Emergency Medicine and Urgent Care (SIMEU).

METHODS

We created a questionnaire with 10 items, relating to 4 thematic areas. The questionnaires were administered from September 2007 to February 2008, by email, telephone or regular mail. In August 2008 the data were subjected to nonparametric statistical analysis (Spearman's Rho and Pearson's chi-square - software SPSS).

RESULTS

We analyzed 170 questionnaires from the EMDs of all Italian regions. A US scanner is present in 64.7% of the ERs, emergency US (E-US) is practiced only in 47.6% of the ERs, and only in 24% of these more than 60% of the ER team members have training in US. The diffusion of US in other operative units of the EMDs ranges from 8.2% to 26.5%.

DISCUSSION

The presence of a US scanner in the ER is essential for the practice and training and is correlated with the level of the EMD. The use of US appears to be less common in less equipped hospitals, regardless of the size of the ER and the availability of radiological services. Wider diffusion of US and greater integration with other services for the installment of the required equipment is to be hoped for.