Authors

  1. Potera, Carol

Abstract

A small study finds better outcomes than those of surgeons.

 

Article Content

Advanced practice registered nurses and physician assistants perform chest tube insertions as well as trauma surgeons do. This finding, from the first published study to look at advanced practice providers who perform tube thoracostomy, suggests that they can compensate for physician shortages in EDs, trauma centers, and ICUs.

 

Physicians generally perform tube thoracostomies, an invasive procedure that expands the lung or removes fluids to treat a collapsed lung and requires skill and precision.

 

At the Wesley Medical Center in Wichita, Kansas, specially trained and credentialed advanced practice providers insert chest tubes under direct or indirect physician supervision. Bevis and colleagues compared 71 tube thoracostomies carried out on 51 patients by five advanced practice providers and seven trauma surgeons over a six-month period. Three radiologists judged indicators of misplacement such as tube kinking, abutment to the mediastinum, insertion site bleeding, or loss of pulse. The judges didn't know who performed each insertion.

 

The rate of complications was 12% for surgeons and 8% for advanced practice providers. The only difference between practitioner types was in the placement of tubes extending caudad (toward the feet) from the insertion site, a complication that may impair drainage of the thoracic cavity. Surgeons were responsible for this complication in seven of 33 insertions (21%) and advanced practice providers in one of 38 (2.6%). This difference was not statistically significant because of the small number of occurrences.

 

The authors conclude that employing advanced practice providers "may be a safe and reasonable solution for staffing trauma centers."

 

Carol Potera

 
 

Bevis LC, et al. Am J Crit Care 2008;17(4): 357-63.

NewsCAP

 

Preparing for all-new strains of flu. The Food and Drug Administration (FDA) recently approved the 2008-2009 U.S. influenza vaccine, which contains three new viral strains. None was in last year's vaccine; changing all three strains is unusual-typically only one or two strains are updated from year to year. The Centers for Disease Control and Prevention (CDC) reported that two of last year's circulating flu strains were poorly matched with the viruses in the 2007-2008 vaccine, reducing its effectiveness. Two of the new strains are in the current vaccine being used in the southern hemisphere's ongoing flu season. Each year, the FDA, CDC, and the World Health Organization, among others, identify which virus strains they believe will cause the most illness in the upcoming flu season. Based on their conclusions, the FDA decides in February which three strains manufacturers should include in their vaccines.