Focusing on safety: Quality of widely available video instructional materials for point-of-care ultrasound guided procedures in Internal Medicine

Objective: Point-of-care ultrasound (POCUS) guidance is becoming the standard of care for bedside procedures. This change in practice is based on evidence showing increased success rate and added safety with ultrasound... [ view full abstract ]

Objective: Point-of-care ultrasound (POCUS) guidance is becoming the standard of care for bedside procedures. This change in practice is based on evidence showing increased success rate and added safety with ultrasound imaging. Many instructional materials for POCUS guided procedures exist today, however, their quality and utility may be variable. The aim of our study was to assess the quality and content of widely available videos for POCUS-guided central line insertion, thoracentesis, and paracentesis and whether there was adequate discussion of safety-related competencies.

Methods: We performed content analysis of instructional videos available on the internet for point-of-care ultrasound guided paracentesis, thoracentesis and internal jugular central line insertion. Searches were performed on Ovid Medline database, Ovid Medline Multimedia database, Google videos, and YouTube. The videos assessed for eligibility were determined using a discontinuation rule of 20: when 20 consecutive videos did not meet eligibility criteria and were excluded, no further videos were assessed. Searches were conducted in July 2015 and repeated in January 2016. Inclusion criteria were English language, video-based educational resources showing use of ultrasound to complete the whole or a part of the procedure. Procedures included were central venous catheterization, thoracentesis and paracentesis. Videos were excluded if there was evidence of copyright infringement, poor sound quality and duplicated results.

Results: 5050 videos were identified for POCUS guided central venous catheterization. 4976 were excluded by discontinuation rule. 76 were assessed for eligibility and 12 unique videos were included. The videos had an average global educational value of 4.5. In the videos, 16 of the 23 essential competencies were discussed. Indications to abort the procedure were discussed in 3 (25%) videos and 5 (42%) videos described the indications and contraindications to perform central venous catheterization. Only 4 (33%) videos discussed confirmation of catheter position with ultrasound after placement of catheter. For POCUS guided thoracentesis, 2111 videos were identified, and 78 assessed for eligibility. Finally, 8 videos were identified. The videos had an average score for global educational value of 4. Sixteen of 32 essential competencies were discussed in the videos. One video discussed indications to abort the procedure and only 3 (37%) videos discussed sterile technique. Only 1 video commented on how to recognize access to fluid. For POCUS guided paracentesis, 2621 videos were identified. With the discontinuation rule, 2563 videos were eliminated and 58 assessed for eligibility. 7 videos were included in the analysis. The average global educational value score was 4.1. Fifteen of 28 essential competencies were discussed. Only 1 video discussed indications to abort the procedure, 3 (43%) discussed starting a scan with sufficient depth to avoid missing far-field findings and 2 (29%) described the location of the inferior epigastric artery.

Conclusions: Ultrasound guidance for commonly performed procedures is now becoming the standard of care. A total of 27 videos of the POCUS guided procedures of interest were found. Most resources scored highly on the global educational value scale indicating their utility for general instruction. However, despite the main justification for use of POCUS being improved safety, there is a lack of safety-related information in the currently available resources. The next generation of instructional resources should shift the focus from basic instruction to emphasize prevention and identification of complications, which is the original impetus behind promotion of procedural ultrasound guidance.