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ACEP Now: Vol 42 – No 01 – January 2023FIGURE 2: Our block cart allows clinicians
to perform UGNBs without looking for
various components. (Click to enlarge.)
Design
Block Cart: A user-based design approach will reduce barriers needed to perform USGNBs. Keeping all supplies needed for performing an USGNB in one location (either in a tray, bag or in a cart) will make the process of performing USGNBs easier. A block cart should be mobile, well organized, and routinely restocked to ensure its functionality. It should contains all of the equipment needed to perform USGNBs (skin preps, protective adhesive barriers, needles/block needles, syringes, sterile gel, marking pens), in addition to a diverse array of local anesthetics, adjuncts, and stocking of intralipid in case of rare but life-threatening complications (see Figure 2).
Documentation/Templates: Documentation of your USGNB is required for communication to other providers/services as well as for accurate and consistent billing. Clear templated notes in the electronic medical record will allow the clinician to document important information (indication for the block, block type, laterality, anesthetic amount used, complications, time the block was performed etc.). This information allows clear communication to colleagues who may see the patient during the inpatient stay or on a subsequent ED visit (see Figure 3).
FIGURE 3: Our UGNB template has
been built for the ED clinician. Documentation allows for proper data transfer to other clinicians
as well as billing.
Conclusion
USGNBs are becoming more common in the practice of emergency medicine. Along with being an excellent part of a multimodal pain regimen in an acutely injured ED patient, USGNBs may be an ideal alternative to time consuming procedural sedation. Like various procedural skills that have been adopted from other specialties (e.g., laryngoscopy, transesophageal echocardiogram, etc.), there are multiple challenges to integrating USGBNs into clinical care. We recommend that each department find a clinical USGNB champion who can acquire procedural skills as well as teach their EM colleagues a few commonly needed blocks. Also, working in collaboration with other hospital service lines will allow you to build patient centered protocols that address timely pain control. Finally, leveraging user based design principles by having all supplies required for USGNBs in one mobile location will reduce barriers to performing blocks.
Dr. Nagdev is emergency ultrasound director at Highland Hospital/Alameda Health System.
Dr. Howell is ultrasound fellow at Highland Hospital/Alameda Health System.
Dr. Desai is ultrasound fellow at Highland Hospital/Alameda Health System.
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