TY - JOUR
T1 - Improving the performance time and accuracy of ultrasound-guided interventions
T2 - A randomized controlled double-blind trial of the line-of-sight approach and the “APPLES” mnemonic
AU - Norbury, John W.
AU - Karr, Natalie C.
AU - Sindhi, Vivek
AU - Rathbun, Kimberly M.
AU - Charles, Stephen C.
AU - McIver, Michael B.
AU - Morrison, Eric J.
N1 - Funding Information:
We thank John Powers and Kelly Harrell, PhD, for their assistance in arranging the research sessions, Daniel Moore, MD, and Kori Brewer, PhD, for their guidance and assistance in the procurement of study materials, Suzanne Hudson, PhD, for her statistical support, and the people who donated their bodies for the study and their families. This work was funded in part by a 2017 Brody School of Medicine sustainability appropriation. This work was presented in part as posters at the 16th Annual Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine; November 16–18, 2017; Lake Buena Vista, Florida; and the 2018 National Conference and Exhibition of the American Academy of Pediatrics; November 2–8, 2018; Atlanta, Georgia.
Publisher Copyright:
© 2018 by the American Institute of Ultrasound in Medicine.
PY - 2018/12
Y1 - 2018/12
N2 - Objectives—To determine whether the line-of-sight approach improved the performance time and accuracy of ultrasound (US)-guided needle placement targeting the subdeltoid bursa in a cadaver among novice operators compared to the side approach. A secondary objective was to determine whether participants thought the APPLES (angle, position, perpendicular, line up, entry, sweep) mnemonic was a helpful guide for performing the procedure. Methods—Medical students and residents were randomized into either a line-of-sight or side approach group and then crossed over to the other group. The procedure time was determined by 2 blinded reviewers. A survey was administered to determine which method participants preferred and whether they thought the APPLES mnemonic was helpful. A paired t test was used to compare the performance time, and the McNemar test was used to compare the accuracy of the methods. Results—Among the 110 participants, the performance time with the line-of-sight approach (mean, 14.4 seconds; SD, 9.95 seconds) was significantly decreased compared to the side approach (mean, 18.6 seconds; SD, 10.1 seconds; P =.00029). Additionally, participants who only hit the target using one method were more likely to hit the target in 30 seconds using the line-of-sight approach (P =.035). In total, 72.7% of participants preferred the line-of-sight approach over the side approach, and 88.2% of participants thought that APPLES mnemonic was useful. Conclusions—This study highlights the finding that positioning of the operator is important in performing US-guided interventions, and the line-of-sight approach may improve the performance time and accuracy among novice operators. Furthermore, the APPLES mnemonic serves as a useful educational tool for teaching US-guided interventional procedures.
AB - Objectives—To determine whether the line-of-sight approach improved the performance time and accuracy of ultrasound (US)-guided needle placement targeting the subdeltoid bursa in a cadaver among novice operators compared to the side approach. A secondary objective was to determine whether participants thought the APPLES (angle, position, perpendicular, line up, entry, sweep) mnemonic was a helpful guide for performing the procedure. Methods—Medical students and residents were randomized into either a line-of-sight or side approach group and then crossed over to the other group. The procedure time was determined by 2 blinded reviewers. A survey was administered to determine which method participants preferred and whether they thought the APPLES mnemonic was helpful. A paired t test was used to compare the performance time, and the McNemar test was used to compare the accuracy of the methods. Results—Among the 110 participants, the performance time with the line-of-sight approach (mean, 14.4 seconds; SD, 9.95 seconds) was significantly decreased compared to the side approach (mean, 18.6 seconds; SD, 10.1 seconds; P =.00029). Additionally, participants who only hit the target using one method were more likely to hit the target in 30 seconds using the line-of-sight approach (P =.035). In total, 72.7% of participants preferred the line-of-sight approach over the side approach, and 88.2% of participants thought that APPLES mnemonic was useful. Conclusions—This study highlights the finding that positioning of the operator is important in performing US-guided interventions, and the line-of-sight approach may improve the performance time and accuracy among novice operators. Furthermore, the APPLES mnemonic serves as a useful educational tool for teaching US-guided interventional procedures.
KW - Education
KW - Interventional procedures
KW - Line-of-sight approach
KW - Novice operator
KW - Ultrasound
KW - Ultrasound-guided interventional procedures
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U2 - 10.1002/jum.14653
DO - 10.1002/jum.14653
M3 - Article
C2 - 29665109
AN - SCOPUS:85062021412
SN - 0278-4297
VL - 37
SP - 2909
EP - 2914
JO - Journal of Ultrasound in Medicine
JF - Journal of Ultrasound in Medicine
IS - 12
ER -