Critical Care Medicine — Core of Discipline

C6 Performing procedures: Chest tube, paracentesis, lumbar punctures, and temporary transvenous pacemaker insertion

Key Features:
- This EPA focuses on chest tube insertion, paracentesis, and lumbar punctures, determining the clinical necessity of the procedure, and performing it appropriately, including chest tube insertion (open and Seldinger); lumbar puncture; paracentesis; temporary transvenous pacemaker insertion.
- This EPA includes using ultrasonography for procedural guidance where appropriate.

Assessment Plan:
Direct observation by attending or consultant physician, or TTP resident
Use Form 2. Form collects information on:
- Procedure: chest tube (open); chest tube (Seldinger); lumbar puncture; paracentesis; temporary transvenous pacemaker insertion
- Setting: clinical; simulation
Collect 6 observations of achievement
- At least 2 paracenteses
- At least 2 lumbar punctures
- At least 1 open chest tube
- At least 1 Seldinger chest tube
- At least 1 temporary transvenous pacemaker insertion (clinical preferred, simulation acceptable)

Form

F2: Procedure

Milestones

• ME 3.1. Preprocedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required

• ME 3.4. Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications

• ME 1.3. Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them

• ME 3.4. Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues

• ME 3.4. Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended

• ME 3.4. Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

• ME 3.4. Postprocedure plan: Appropriate complete post procedure plan

• COL 1.3. Professional and effective communication/utilization of staff

Context Variables

• Procedure (single-choice)
  • paracentesis
  • chest tube (open)
  • lumbar puncture
  • chest tube (Seldinger)
  • temporary transvenous pacemaker insertion
• Setting (single-choice)
  • clinical
  • simulation

Requirements

• Collect 6 observations of achievement (minimum 6)
• At least 2 paracentesis (minimum 2)
  • Only counts when Procedure is paracentesis
• At least 2 lumbar punctures (minimum 2)
  • Only counts when Procedure is lumbar puncture
• At least 1 open chest tube (minimum 1)
  • Only counts when Procedure is chest tube (open)
• At least 1 Seldinger chest tube (minimum 1)
  • Only counts when Procedure is chest tube (Seldinger)
• At least 1 temporary transvenous pacemaker insertion (minimum 1)
  • Only counts when Procedure is temporary transvenous pacemaker insertion