03-05-12

Mark, Grant Part of ASA Task Force on Central Venous Access Release Guidelines

The journal Anesthesiology has published “Practice Guidelines for Central Venous Access” A Report by the American Society of Anesthesiologists Task Force on Central Venous Access in which Drs. Jonathan Mark and Stuart Grant are members.

PRACTICE Guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints, and are not intended to replace local institutional

policies. In addition, Practice Guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome. Practice Guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data.

Mark J, Grant S, Members of the ASA Task Force on Central Venous Access. Practice guidelines for central venous access: a report by the american society of anesthesiologists task force on central venous access. Anesthesiology. 2012 Mar;116(3):539-73.

A Model PatientBy Neil Offen, [email protected]; 419-6646

DURHAM — Lamont lay on a hospital bed in the Durham VA Medical Center, his mouth agape, a tray of crackers, broccoli and cucumbers in front of him.

His blue eyes blinked.

Jonathan Mark, the chief of anesthesiology, pulled up Lamont’s blue T-shirt to check his pale chest. It imperceptibly rose and descended, rose and descended.

“Yup, he’s breathing,” Mark said.

Lamont seemed at ease under his Magnum P.I. ball cap. “And he’s also

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Department of Anesthesiology Research ConferenceMonday, March 12, 2012 | 5-6 pm | 5685-HAFS

Intraoperative AwarenessGeorge A. Mashour, M.D., Ph.D.Director, Division of NeuroanesthesiologyAssistant Professor of Anesthesiology and Neurosurgery

quite friendly and useful,” Atilio Barbeito, an anesthesiologist and director of the VA Center’s new simulation center, said with a smile. “But bad things keep happening to him.”

And they will continue happening to him.

Lamont is a medical dummy, the centerpiece of the simulation center, which officially opened Wednesday. The warren of rooms on the third floor is the first comprehensive simulation center in a VA facility in the state.

A kind of robot, he will be used as a teaching tool, to help train staff.

“We believe that simulation can be a transformative tool in helping us improve the quality of care we deliver to our veterans,” said Alberto Bonifacio, the program manager for the simulation center.

“Being able to simulate real medical procedures is far superior to learning on patients until you obtain a level of proficiency.”

With the simulator, staff can practice, for instance, inserting IV lines, intubation and many more complex procedures.

“And you can work on it until you get it right,” Bonifacio said. “The great thing is, we can recreate just about any event — and everything is on wheels, so if we want, we can re-create a cardiac emergency in the parking lot.”

The simulation center — or SimQUEST, for Simulation for Quality, Education, Safety & Teamwork — also features teleconferencing platforms, audio-visual capture and playback systems, and virtual reality computer stations.

At the computer terminals in an adjoining room, staffers can create their own avatars and direct them to solve medical problems.

“They can move around, like in a video game,” said Mary Holtschneider, one of the leaders of the simulation center. “Look, if you want to check the patient’s pupils, you just click here.”

Different avatars can work together in the center, just like different health care providers can do.

NewsMonday, March 5, 2012 • Volume 14, Issue 10

Mary Holtschneider, left, one of the leaders of the Durham VA Medical Center’s new simulation center, demonstrates how to take the pulse of Lamont, the resuscitation dummy, to VA staffer Nan Lowe-Huggins.

THIS MonTH In THe DePARTMenT oF AneSTHeSIoloGy


March 2012MonDAy TUeSDAy WeDneSDAy THURSDAy FRIDAy5 6 7 8 9

7:15-8:00 am, RM203-Pain ClinicMRC Pain Conference

2:30-3:30 pm, VAMCVA EchocardiographyConference

6-7:30 pm, 5685-HAFSExecutive Team Meeting

5-6 pm, 5685-HAFSCT Conference

5-6 pm, 2001DNCA-1 Resident Lectures: “Acid-base analysis I - the traditional approach” - Richard Moon, MD

5-6 pm, 6686-HAFSGVTCCM Conference: “Selective Digestive Decontamination” - Eugene Moretti, MD

IRB Deadline

7:00 am, 2001DNGrand Rounds: “Maestro Care: One Patient; One Record; One System” - Jeffrey Ferranti, MD

4:30 pm, 5685-HAFSAdvanced Resident Lecture: “Antibiotic Selection in the Critically Ill” - Michelle Sharpe, PharmD

7:15-8:00 am, RM203-PainClinicMRC Pain Journal Club

12-1 pm, 2003DNCritical Care Grand Rounds: NICU M&M - “Pregnancy in critical care”- Dr. Jessica McFarlin

4-5 pm, 5680A-HAFSPediatric Conference: “Meeting Reivew - What we did at the SPA” - Allison Ross, MD

5-6 pm, 7683-HAFSResident Education Sessions: “Trauma Management for the Anesthesiologist” - Mark Shapiro, MD

12 13 14 15 16



5:30 pm, 5680A-HAFSPerioperative Leadership Group Meeting

5-6 pm, 5685-HAFSDepartment Research Conference: “Intraoperative Awareness” - George A. Mashour, MD, PhD


5-6 pm, 2001DNCA-1 Resident Lectures: “Acid-base analysis II - the Stewart approach”- Richard Moon, MD

5-6 pm, 6686-HAFSGVTCCM Conference: “Heparin Induced Thrombocytopenia” - Brian Barrett, MD

IRB Deadline

7:00 am, 2001DNGrand Rounds: “Neurally Adjusted Ventilatory Support: Perioperative Indications?” - Manuel Fontes, MD

4:30 pm, 5685-HAFSAdvanced Resident Lecture: “Man-agement of the Burn Patient” - Mark Shapiro, MD


12-1 pm, 2003DNCritical Care Grand Rounds

4-5 pm, 5680A-HAFSPediatric Conference

19 20 21 22 23



5-6:30 pm, 5685-HAFSExecutive Team Meeting


5-6 pm, 2001DNCA-1 Resident Lectures: “Thyroid and Adrenal Function, Emergencies and Anesthesia” - Timothy Miller, MB

5-6 pm, 6686-HAFSGVTCCM Conference: “TBA” - Evelyn Lockhart, MD

7:00 am, 2001DNGrand Rounds: “Clinical Case Confer-ence” - Raquel Bartz, MD

4:30 pm, 5685-HAFSAdvanced Resident Lecture: “Induced Hypothermia: Indications and Tech-niques” - David McDonagh, MD




5-6 pm, 7683-HAFSResident Education Sessions: “M&M” Ashraf Habib, MD

26 27 28 29 30




5-6 pm, 2001DNCA-1 Resident Lectures: ” Physiologi-cal and Clinical Aspects of aging”- Kenneth Schmader, MD

5-6 pm, 6686-HAFSGVTCCM Conference: “Direct Throm-bin Inhibitors and Neuraxial Anesthe-sia” - Cory Maxwell, MD

IRB Deadline

7:00 am, 2001DNGrand Rounds: “Adult Congenital Car-diac Disease” - Jessica Meyers, MD

4:30 pm, 5685-HAFSAdvanced Resident Lecture: “Critical Care Review for the Anesthesia Board Exam” - Ryan Fink, MD




Upcoming:2012 Office Professional Day: Wednesday, April 25, 2012 | 11:30am - 1pm | 5685-HAFSDuke Anesthesiology 40th Anniversary Gala: June 1-3, 2012 | Washington Duke Inn, Durham, NC2012 Academic evening: Friday, June 1, 2012 | Washington Duke Inn, Durham, NC2012 Duke Anesthesiology Alumni Reception: Sunday, October 14, 2012 | Washington, DC2012 ASA: October 13-17, 2012 | Washington, DC


AneSTHeSIoloGy neWS

“Typically, health care providers have been trained in silos,” said Barbeito. “Nurses learned with nurses, anesthesiologists learned with anesthesiologists. In training, they never mixed. But that’s not how we actually deliver health care. This is a way to bring all of them together.”

It’s also a place, he said, where medical personnel can feel safe to make errors.“It’s a blame-free environment,” Barbeito explained. “We come here, we mess up, we look at the video of what we did, then we reflect. And then we practice it again, until we get it right. It’s not exactly rocket science.”

While the center had been using simulation for about two years, it hadn’t had a dedicated space — and Lamont — until now.

Lamont, in addition to blinking and breathing, also makes heart and lung sounds, cries, sweats, bleeds and his tongue can even swell, if needed.

“He is kind of a creepy guy,” Bonifacio acknowledged. “He’s a dead plastic dude, but he’s very helpful.”

And why is named Lamont?

“Remember the old TV show ‘Sanford and Son’?” Bonifacio asked. “The father, Fred, always used to call his son Lamont, ‘you big dummy.’ Well now, we’ve got a big dummy, too, that we can play with.”

Reprinted with permission by the Durham Herald Sun where it first appeared.

Duke DReAM Campaign Grateful Patient CardsWhat these cards are for: These cards were designed to serve as a quick and easy way for you to make contact with grateful patients you encounter who express a desire to give back to the department.

How to use them:When you identify a grateful patient, simply give them this card along with your business card in the slots as seen in the example below. Ask the patient if it would be okay if one of our development staff followed up with them. If they agree, contact Elizabeth Perez ([email protected]) or Lauren Marcilliat ([email protected]).

Where you can find them:• The Anesthetizing Station in the PACU• The Center for Hyperbaric Medicine and Environmental Physiology• Dr. Billy Huh at the Morreene Road Pain Clinic• Luanne Latta at the Ambulatory Surgical Center• Julie Rosato at the VAMC• Bridget White (HAFS, 6th floor) • Melinda Macalino, Chris Keith, Katherine Siler, Angela Rogers, and

Myra Stein Duke North (HAFS, 5th floor)

new Research PublicationKwatra SG, Kiely AE, Kwatra MM. Prehypertension: To Treat or Not To Treat Should No Longer Be the Question. Hypertension. 2012 Feb 27. [Epub ahead of print]

“Model Patient” Continued from page 1 Tips for the Clinical Researcher “Where to Place the Signed Informed Consent”Bonnie Funk

For protocols with prospective enrollment, after the patient (or Legally Authorized Representative if applicable and IRB approved) and the person obtaining consent have both signed and dated the informed consent, two copies should be made. The original is to be maintained in the study file. One copy is to be given to the subject. One copy is to be placed on the subject’s medical chart or delivered to Health Information Management (HIM). HIM is located in Duke South, red zone basement, room 04255.

March Medical education Grand RoundsMarch’s Medical Education Grand Rounds session - “Making Presentations Even More Impactful” with Dr. Jonathan Mark, Chief of Anesthesia, VA Medical Center - will be held today, Monday, March 5th - 7am – 8am (DN2001).

If you would like to attend this session and have not yet registered, please do so by clicking the following link - https://www.surveymonkey.com/s/MedEdGrandRoundsReg2012

Announcing new Anesthesiology Residency Program CoordinatorCatherine Kuhn, MD

Please welcome Irene Kontje to our department. Irene is our new Residency Program Coordinator, and will be starting today, March 5, 2012. We appreciate Cheryl Jacobs’ service and wish her well as she is pursuing other opportunities in adult education.

Dream Campaign Fiscal year 2012 GoalThe DREAM Innovation Grant (DIG) sup-ports innovative high-risk, and potentially high-reward investigations to acceler-ate anesthesia and pain management research. Our goal is to raise $90,000, which will allow us to fund three $30K DIG recipients in 2013. The winners of this grant will be announced in October 2012. Total raised to date: $49,901.00.

To make a gift, please visit: http://blueprint.duhs.duke.edu/

Comings and GoingsPlease welcome Seongtae Jeong, PhD to the department. Dr. Jeong is a new Visiting Research Scholar working in the Neuroanesthesiology Division. Dr. Jeong started on March 1, 2012.

Leaving the department soon? Let’s keep in touch! Please contact Lauren Marcilliat at [email protected] with your new mailing and email address prior to your departure so that we can add you to our database!

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Upcoming CMe Activities

5th Annual emerging Technologies in the oR and Great Fluid DebateJune 11-15, 2012 | Disney’s Grand Floridian Resort and Spa lake Buena Vista, FlFor more information, email Katherine Siler: [email protected].

15th Annual Cardiothoracic Update and Tee Board ReviewJuly 5-8, 2012 | The Westin Hilton Head Island Resort and Spa Hilton Head Island, SCFor more information, contact Jaime C. Cooke: [email protected].

7th Annual Winter Anesthesia and Critical Care ReviewMarch 3-8, 2013 | Canyons Resort | Park City, UTFor more information, email Katherine Siler: [email protected].

Preceptorships

Ultrasound Guided Regional Anesthesia Preceptorship Course2011 Dates Available | Duke University Medical Center, Durham, nCFor more information, email Katherine Siler: [email protected] in the Duke Preceptorship will spend three days in the regional block area, operating rooms and on the floor with post surgery patients observing ultra-sound guided single shot nerve blocks and catheter techniques in a wide variety of clinical scenarios.

Visiting Preceptorship in Intraoperative Transesophageal echocardiography2011-2012 Dates Available | Duke University Medical Center, Durham, nCFor more information, email Jaime C. Cooke: [email protected] in the Duke Intraoperative TEE Preceptorship spend one three-day session in the cardiac operating suites, observing techniques of intraoperative TEE and interpretation of images.

For more information and to register, visit http://anesthesiology.duke.edu

ClassifiedsHoUSe FoR RenT: 210 Knightwood Drive, Durham NC 27703, $1295.00. 4 bedroom/2.5 bathrooms, garage, 2298 square feet. Patio w/view of the woods and no home behind you. Bonus area and one car garage. Lawn Maintenance and W/D included. Contact Mark Heizer at 919-604-0093/Para espanol: 919-604-7987 or email [email protected].

For more information and tour at: http://hcoproperties.com/virtualRealtor/?action=showProperty&agent=10811&property=res171787

MeRCHAnDISe: I have new, never used low end white appliances for sale: Whirlpool dishwasher, gas stove, microwave, 2 toilets, and a pedes-tal sink. These would be great to put in a rental property. Will sell sepa-rately but prefer to sell as a bundle. You need to transport from Cary off of Davis Drive. $1000 takes all, Cash only. Email me at [email protected] if you are interested and/or want pictures. Thanks!

Anesthesiology on Facebook and TwitterDo you have exciting news or information pertinent to the academic community that you want to share through the department’s social media sites? The department has facebook and twitter accounts for Duke

Anesthesiology, Duke Anesthesiology Alumni, and the DREAM Campaign. Send your announcements to Lauren Marcilliat ([email protected]) to be posed on the department’s social media sites. Remember to keep announcements to 140 characters in length so that they are twitter compatible (about the size of this sentence). Including a link to another online source for more information is highly recommended.

03-05-12

Documents

practice guidelines

asa task force

jonathan mark

durham va medical center

mark j

chief of anesthesiology

medical dummy

durham lamont