1. Potera, Carol


A small study finds better outcomes than those of surgeons.


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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.



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