Hemoptysis associated with percutaneous transthoracic needle biopsy: Development of critical events checklist and procedure outcomes Journal Article
| Authors: | Robson, P. C.; O'Connor, D.; Pardini, P.; Akard, T. F.; Dietrich, M. S.; Kotin, A.; Solomon, A.; Chawla, M.; Kennedy, M.; Solomon, S. B. |
| Article Title: | Hemoptysis associated with percutaneous transthoracic needle biopsy: Development of critical events checklist and procedure outcomes |
| Abstract: | Background: A percutaneous transthoracic needle biopsy (PTNB) is performed to obtain tissue for a pathologic diagnosis. A PTNB is necessary before the initiation of many cancer treatments. There is a risk of hemoptysis, the expectoration of blood, with the possibility for adverse, life-threatening outcomes. A critical event checklist is a cognitive aid used in an emergency to ensure critical steps are followed. To date, there are no known checklists published for management of PTNB-related, life-threatening hemoptysis. The purpose of this report is to describe the development and implementation of a critical event checklist and the adoption of the checklist into hemoptysis management. Methods: In March 2017, a process improvement team convened to evaluate the hemoptysis response using the Plan-Do-Study-Act methodology. The checklist was evaluated and updated through September 2019. The team educated interventional radiology (IR) clinicians on the new checklist and conducted simulations on its use. A retrospective chart review was performed on hemoptysis events between the 10-year period of October 1, 2008 and September 30, 2018 to evaluate the adoption of the checklist into practice. Results: There were 231 hemoptysis events occurring in 229 patients (2 with repeat biopsies). Before implementing the protocol and checklist, there were 166 (71.9%) hemoptysis events. After implementation, there were 65 (28.1%) events. The median amount of documented blood expectorated with hemoptysis was 100 mL (IQR 20.0-300.0). Twenty-six patients were admitted after PTNB for reasons related to the hemoptysis event (11.3%). During the procedure, four (1.7%) patients with hemoptysis suffered a cardiac arrest. Before implementation of the protocol and critical events checklist, nurses positioned patients in the lateral decubitus (LD) position in 40 of 162 (24.7%) cases. After implementation of the critical events checklist, nurses positioned patients in the LD position 42 of 65 cases (64.6%) (OR = 5.57(95% CI 2.99-10.367), p < .001). Discussion: IR nurses successfully adopted the checklist into management of hemoptysis events. The reported incidence of hemoptysis suggests a need for IR teams to prepare for and simulate hemoptysis events. Future research is needed to evaluate the change in patient outcomes before and after critical events checklist implementation. © 2021 Association for Radiologic & Imaging Nursing |
| Keywords: | outcomes; hemoptysis; critical events checklist; percutaneous transthoracic needle biopsy |
| Journal Title: | Journal of Radiology Nursing |
| Volume: | 40 |
| Issue: | 3 |
| ISSN: | 1546-0843 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2021-09-01 |
| Start Page: | 221 |
| End Page: | 226 |
| Language: | English |
| DOI: | 10.1016/j.jradnu.2021.04.002 |
| PROVIDER: | scopus |
| PMCID: | PMC8409504 |
| PUBMED: | 34483778 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 October 2021 -- Source: Scopus |
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