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Comparison of Ultrasound-Guided Versus Blind Intrathecal Pump Refill among Novice Trainees

Comparison of Ultrasound-Guided Versus Blind Intrathecal Pump Refill among Novice Trainees. John Hanlon MSc MD FRCPC Michael Gofeld MD FIPP . Background. Intrathecal pump drug refill can result in significant adverse events

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Comparison of Ultrasound-Guided Versus Blind Intrathecal Pump Refill among Novice Trainees

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  1. Comparison of Ultrasound-Guided Versus Blind Intrathecal Pump Refill among Novice Trainees John Hanlon MSc MD FRCPC Michael Gofeld MD FIPP

  2. Background • Intrathecalpump drug refill can result in significant adverse events • Real-time ultrasound-guided pump access is a simple technique that may prevent such complications • The feasibility of teaching ultrasound-guided pump access to individuals with limited experience accessing intrathecal pumps is unknown

  3. Study Design • We evaluated the feasibility of ultrasound-guided intrathecal pump refill among seven novice trainees using unembalmed cadavers from the University of Washington Willed Body Program • Prior to the study phase, each participant received a five minute teaching session on blind and ultrasound-guided pump access

  4. Methods • Twenty random order pump access procedures performed by each subject: • 10 blind, 10 ultrasound-guided • Low frequency ultrasound probe (MTurbo, SonoSite) and Medtronic pump refill kit were used • Performance videotaped for: • total procedure time • time from needle insertion to the port accessed • Success or failure determined by an expert faculty member • Participants questioned about their procedural confidence at time of study and three months later

  5. Results – Table 1

  6. p < 0.01

  7. p < 0.05

  8. Results: Pocket fill and Confidence Number of unrecognized access failures (needle in subcutaneous tissue at procedure completion): • Ultrasound-guided: 1/70 (1.4%) • Blind: 3/70 (4.3%) Greater confidence in ability to access an intrathecal pump using a blind vs. ultrasound-guided approach? • Ultrasound-guided: 7/7 (100%) • Blind: 0/7 (0%)

  9. Three Month Follow-Up

  10. Limitations • Pre-clinical pilot study • Small number of participants • Cadaver model • Procedural time as an endpoint • Measurement • Needle passes and “patient comfort” unmeasurable • Economy of motion (path length / movements) not measured • Participant Bias

  11. Conclusions • Ultrasound-guided pump access is a simple technique that can be easily taught to trainees • While the overall procedure takes longer than a blind approach, it is still efficient and may result in improved patient comfort due to decreased time from needle insertion to port access • It is possible that Ultrasound-guided pump access may result in decreased inadvertent “pocket fills” • Confidence in the utility of ultrasound-guided pump access is retained at three months even in the absence of ongoing experience

  12. Acknowledgements • University of Washington Willed Body Program • Participants

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