Teaching Clinical Competency: Evaluating POCUS-Guided Versus Landmark Techniques for Thoracostomy Tube Placement in...

To evaluate the effectiveness of teaching novice learners the competency of small-bore wire-guided thoracostomy tube (SBWGTT) placement using point-of-care ultrasound (POCUS)-guided and blind, landmark-guided techniques and assess the complications associated with each technique.

Crossover randomized study.

Clinical skills teaching of second-, third-, and fourth-year veterinary students.

Sixteen canine cadavers of various breeds, ages, and sexes.

Thirty second, third and fourth-year DVM students were enrolled. Online and in-person training was completed before collection of cadaver data. Each student was randomized into two of four cadaver groups: POCUS-guided (U) and landmark-guided (L) protocols for either pleural effusion (PE) or pneumothorax (PN). Students placed SBWGTTs into canine cadavers with iatrogenic pleural space pathology (10 mL/kg of air and 10 mL/kg of fluid infused into each hemithorax); results were recorded.

Placement time, confidence in SBWGTT placement and ease of placement (using weighted scales), and complications (determined by necropsy) were recorded. Data were parametric. One SBWGTT was missing at necropsy. LPE SBWGTT placement (mean ± SD: 5.2 ± 1.1 min) was faster than UPE (7.9 ± 2.8 min, p = 0.0083) and UPN placement (9.0 ± 2.7 min, p = 0.0001). LPN placement (4.6 ± 1.6 min) was faster than UPN (p < 0.0001) and UPE placement (p = 0.0009). Eleven SBWGTTs were placed extrapleurally with no difference among groups. Four UPE SBWGTTs had intrathoracic complications, which were not different between groups (p > 0.05). Novices felt more confident that SBWGTTs were within the pleural space when using POCUS: UPN (mean ± SD: 7.2 ± 2.4) versus LPN (4.4 ± 2.6, p = 0.0232); LPE (4.6 ± 2.68) versus UPE (7.1 ± 2.9, p = 0.0326).

POCUS-guided SBWGTT placement performed by novices was slower with similar complication rates and higher confidence scores.