Sites Brian D, Gallagher John D, Cravero Joseph, Lundberg Johan, Blike George
Department of Anesthesiology, Dartmouth Medical School, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
Reg Anesth Pain Med. 2004 Nov-Dec;29(6):544-8. doi: 10.1016/j.rapm.2004.08.014.
Ultrasound has become an increasingly popular modality in facilitating the performance of peripheral nerve blocks. There exists no literature that examines the learning curve of the ultrasound novice. In this prospective series, we evaluated the learning curve of inexperienced anesthesia residents in performing a simulated ultrasound-guided interventional procedure. In doing so, we hoped to identify reproducible patterns of human errors, which could potentially aid in the prevention of real-life iatrogenic injuries.
Ten subjects were prospectively enrolled. After a brief introduction to the ultrasound system, the subjects were asked to perform 6 sequential trials of a simulated breast cyst aspiration. For the first 3 trials, each subject attempted to place a 22-gauge b-bevel needle into any aspect of an olive buried inside the turkey breast. After completion of these 3 trials, the subjects were asked to place the needle into the exact midpoint of the olive wall closest to the transducer. Trials were videotaped and analyzed for task performance in terms of speed and accuracy.
All subjects successfully completed the 6 interventional trials. The mean time to perform the task was reduced by 38% and 48%, respectively, for the second and third trials. A composite score of accuracy showed an improvement of 36% and 59%, respectively, for the second and third trials. The most common committed error, which occurred in 7 of 10 subjects, was the failure to accurately image the needle while advancing. This resulted in excessive depth of penetration and inadvertent transfixation of the olive in 5 of these subjects.
Anesthesiology residents, with little or no ultrasound experience, can rapidly learn and improve their speed and accuracy in performing a simulated interventional ultrasound procedure. A concerning novice pattern was identified where the subjects advanced the needle even though it was not appropriately visualized in the ultrasound beam. This resulted in needle placement error, which could cause iatrogenic injury in the clinical setting.
超声在辅助外周神经阻滞操作方面已变得越来越流行。目前尚无文献研究超声新手的学习曲线。在这个前瞻性系列研究中，我们评估了缺乏经验的麻醉住院医师在进行模拟超声引导介入操作时的学习曲线。通过这样做，我们希望识别出可重复的人为错误模式，这可能有助于预防实际中的医源性损伤。
前瞻性纳入10名受试者。在对超声系统进行简短介绍后，要求受试者对模拟乳腺囊肿抽吸进行6次连续试验。在前3次试验中，每个受试者试图将一根22号b斜面针插入火鸡胸部内橄榄的任何部位。完成这3次试验后，要求受试者将针插入橄榄壁最靠近换能器的精确中点。试验过程被录像，并从速度和准确性方面分析任务表现。
所有受试者均成功完成了6次介入试验。第二次和第三次试验执行任务的平均时间分别减少了38%和48%。准确性综合评分在第二次和第三次试验中分别提高了36%和59%。最常见的错误发生在10名受试者中的7名，即推进针时未能准确成像。这导致其中5名受试者穿透深度过大并意外贯穿橄榄。
几乎没有或没有超声经验的麻醉住院医师能够快速学习并提高他们在进行模拟超声介入操作时的速度和准确性。识别出一种令人担忧的新手模式，即受试者在超声束中未适当显示针的情况下仍推进针。这导致了针放置错误，在临床环境中可能造成医源性损伤。
