Background:
The systematization of the teaching and training of internal medicine residents should be done with the standardization of techniques, simulations, use of manikins and theoretical lessons. A procedure team was created in a tertiary teaching hospital at south Brazil with the objective of minimizing risks to the patient at the same time optimizing the learning and the use of equipments such as the ultrasound.
Methods:
Cross-sectional, analytical and descriptive study, performed by residents and preceptors, submitted to the Ethics and Research Committee of the Nossa Senhora da Conceição Hospital, to describe the procedures and characteristics of the patients, evaluating the team performance, pointing out errors and complications.
The procedures performed by the team were evaluated between March and September 2015. All central venous access procedures (jugular, subclavian, axillary and femoral), thoracentesis, paracentesis and lumbar puncture performed in the internal medicine service from March to September From 8 am to 6 pm were included for analysis in the study. Procedures performed durining the weekend or when the attending physician opted for the procedure not performed by the team were excluded. Whenever possible the procedure was performed following the bundle – in a specific room, supervised, with maximum aseptic barrier, guided by ultrasound and monitored by checklist. The characteristics of the patients and complications of the procedures were observed.
Results:
A total of 251 procedures were analyzed. Of these, the majority was central venous access (n = 132), followed by paracentesis and lumbar puncture (n = 43 each one) and thoracentesis (n = 33). In the patients submitted to central venous access and thoracentesis, ultrasound was used in 89.4% and 97% of the cases, respectively. The complication rates observed were lower or similar to those expected in the specialized literature (10.7% considering all procedures) and mortality varied from 45 to 74%, depending on the proposed procedure.
Conclusions:
Central venous access guided by ultrasound has increased success and reduced complication rates, decreased the time required to perform the procedure and result in overall cost savings. In the other analyzed procedures, although in a smaller number, the low rate of associated complications was also verified in comparison with other databases. The high mortality of patients undergoing invasive procedures in our study reflects the severity of the illness. According to this, the need for invasive procedures can be a prognostic factor of mortality. For comparison, the in-hospital mortality rate in the study period was 10.2%. A Team to perform procedures is a useful tool to minimize the risks of associated complications in a learning environment.