TY - CHAP M1 - Book, Section TI - Recommendations for Education and Training in Ultrasound-Guided Regional Anesthesia A1 - Bailin, Michael A1 - Spanakis, Spiro PY - 2000 T2 - Guidelines AB - |PrintRecommendations for Education and Training in Ultrasound-Guided Regional AnesthesiaComments by Brian D. Sites, MDOrganizationPopulationTen Steps to an Ultrasound-Guided Nerve BlockRecommended Technique for Ultrasound ScanningCore Competencies of UGRATraining GuidelinesSourceAmerican Society of Regional Anesthesia and European Society of Regional Anesthesia and Pain Therapy1. Private practice anesthesiologists1. Visualize key landmark structures including blood vessels, muscles, fascia, and bone.1. Find landmark vascular structure (possibly assisted by color Doppler), bone, or muscle.Patient Care:Perform gentle ultrasound exams, providing appropriate sedationDemonstrate proper patient selectionUse appropriate monitoring during UGRADemonstrate proper nerve localization techniquesPerform effective and safe nerve blocksPractice Pathway for Training:Participation in an accredited continuing medical education (CME) event of 8 hrs.Practice ultrasound scanning techniques and learn sonoanatomy by imaging oneself and colleagues.Practice needle insertion techniques using simulators and phantoms.Whenever possible, spend time with experienced individuals observing and learning techniques of UGRA.Incorporate ultrasound into a pre-existing regional anesthetic practice. If the infrastructure exists within a given institution, the Joint Committee recommends that the novice's initial clinical experience be mentored and supported by an individual experienced in UGRA. Have exposure to continuing education and quality improvement through defined departmental and CME events.[go to full text of guideline]2. Academic anesthesiologists2. Identify the nerves or plexus on short axis imaging.2. Find nerve or plexus on short axis imaging (transverse scan).Ultrasound Knowledge:Understand the general principles of ultrasound physicsUnderstand benefits and limitations of UGRA techniquesUnderstand differences between in-plane vs. out-of-plane techniques and their indications Understand key artifacts and pitfall errors associated with UGRADevelop an intimate knowledge of 2D ultrasound anatomy of the major neurovascular structures of the upper and lower extremitiesAppreciate common non-neural pathologic states that are diagnosed by ultrasound: atherosclerotic disease and venous thrombosisEstablish familiarity with the major scientific literature related to UGRALearn techniques for UGRAUnderstand the applications of color Doppler interrogationUnderstand equipment specificationsInfection control and equipment cleaningResidency Pathway:Participate in a comprehensive UGRA curriculum.Perform enough UGRA techniques to successfully accomplish the defined competencies.Review static and video images of ultrasound-guided blocks that demonstrate key aspects of the curriculum.3. Anesthesiologists in training (residents)3. Confirm normal anatomy and recognize anatomical variation(s).3. Place machine focus on target structures.Interpersonal/Communication Skills:Communicate sensitively and effectively with patients and their families regarding ultrasound findingsExplain any complexities of UGRA in terms that the patient can understandDemonstrate team leadership/management skills for the management of an effective regional anesthesia service4. Individuals involved with medical education and training4. Plan for a needle approach that avoids unnecessary tissue trauma.4. Place depth setting at 1 cm deep to target structures.Professionalism:Be open to constructive criticism regarding ultrasound skills5. Maintain an aseptic technique with respect to the ultrasound equipment.5. Adjust gain, time gain compensation (TGC), and frequency as necessary.System-Based Practice:Recognize costs associated with UGRA practiceCollaborate with other members of the health care team to ensure quality patient careUse evidence-based, cost-conscious strategies in caring for all patients6. Follow the needle under real time visualization as it advances toward the target.6. Initiate the "PART" maneuvers to optimize image quality: PRESSURE: varying degrees of transducer pressure on skinALIGNMENT: sliding movement of the transducer to define the lengthwise course of the nerveROTATION: the transducer ... SN - PB - The McGraw-Hill Companies, Inc. CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=5010005 ER -