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Chakroun-Walha O, Karray R, Jerbi M, Affes H, Nasri A, Salem I, Issaoui F, Ben Dhaou M, Rekik N. Catheterized chicken for training on ultrasound-guided vascular access: A simple, cost-effective, and effective model. Afr J Emerg Med 2024; 14:91-95. [PMID: 38660415 PMCID: PMC11039968 DOI: 10.1016/j.afjem.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/17/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
Ultrasound-guided vascular access is a medical procedure that is becoming increasingly common in daily practice and is recommended to avoid iatrogenic complications. One of the procedures with a high-risk rate of complications is the vascular puncture. However, training on this technique can be challenging due to the limited availability of simulation models. We propose a simple, cost-effective, and effective ultrasound-guided vascular access simulation model that utilizes chicken breast and a urine catheter to address this need.
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Affiliation(s)
- Olfa Chakroun-Walha
- Emergency department, Habib Bourguiba university hospital, Sfax Medical School Simulation Center, Faculty of Medicine, Sfax university, Tunisia
| | - Rim Karray
- Emergency Department, Habib Bourguiba University Hospital, Faculty of Medicine, Sfax University, Tunisia
| | - Mouna Jerbi
- Emergency Department, Habib Bourguiba University Hospital, Faculty of Medicine, Sfax University, Tunisia
| | - Houcem Affes
- Emergency Department, Habib Bourguiba University Hospital, Faculty of Medicine, Sfax University, Tunisia
| | - Abdennour Nasri
- Emergency Department, Habib Bourguiba University Hospital, Faculty of Medicine, Sfax University, Tunisia
| | - Imen Salem
- Emergency Department, Habib Bourguiba University Hospital, Faculty of Medicine, Sfax University, Tunisia
| | - Fadhila Issaoui
- Emergency Department, Habib Bourguiba University Hospital, Faculty of Medicine, Sfax University, Tunisia
| | - Mahdi Ben Dhaou
- Sfax Medical School Simulation Center, Faculty of Medicine, Sfax University, Tunisia
| | - Noureddine Rekik
- Emergency Department, Habib Bourguiba University Hospital, Faculty of Medicine, Sfax University, Tunisia
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Asghar A, Salim B, Khan MH. Dorsalis pedis cannulation: An overlooked option-A case report. SAGE Open Med Case Rep 2024; 12:2050313X241255014. [PMID: 38773988 PMCID: PMC11107308 DOI: 10.1177/2050313x241255014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/26/2024] [Indexed: 05/24/2024] Open
Abstract
Radial artery is mostly used for arterial cannulation because of its location, collateral circulation, and less complications. Dorsalis pedis artery can be an alternative for arterial cannulation in difficult radial or brachial arteries cannulation situations as it is mostly overlooked. We present a case of a 45-year-old female planned for supratentorial craniotomy for excision of meningioma. After induction of anesthesia, the invasive access couldn't be attained after multiple attempts under ultrasound guidance by five senior anesthesiologists. The surgery was abandoned, and the patient awakened. The case was rescheduled after 2 days. The new anesthesia team attained the arterial access in the right dorsalis pedis artery and the central venous access in the right internal jugular vein in the first attempt. No complications were noted post-operatively. The dorsalis pedis artery can be safely used for arterial cannulation when radial artery cannulation is not possible.
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Affiliation(s)
- Ali Asghar
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Bushra Salim
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
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Grechenig P, Hallmann B, Eibinger NR, Koutp A, Zajic P, Höfler G, Puchwein P. Percutaneous ultrasound-guided versus open cut-down access to femoral vessels for the placement of a REBOA catheter. Sci Rep 2024; 14:9111. [PMID: 38643229 PMCID: PMC11032382 DOI: 10.1038/s41598-024-59778-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/15/2024] [Indexed: 04/22/2024] Open
Abstract
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may be useful in treating exsanguinating trauma patients. This study seeks to compare rates of success, complications and time required for vascular access between ultrasound-guidance and surgical cut-down for femoral sheath insertion as a prospective observational case control study. Participating clinicians from either trauma surgery or anesthesiology were allocated to surgical cut-down or percutaneous ultrasound-guided puncture on a 1:1 ratio. Time spans to vessel identification, successful puncture, and balloon inflation were recorded. 80 study participants were recruited and allocated to 40 open cut-down approaches and 40 percutaneous ultrasound-guided approaches. REBOA catheter placement was successful in 18/40 cases (45%) using a percutaneous ultrasound guided technique and 33/40 times (83%) using the open cut-down approach (p < 0.001). Median times [in seconds] compared between percutaneous ultrasound-guided puncture and surgical cut-down were 36 (18-73) versus 117(56-213) for vessel visualization (p < 0.001), 136 (97-175) versus 183 (156-219) for vessel puncture (p < 0.001), and 375 (240-600) versus 288 (244-379) for balloon inflation (p = 0.08) overall. Access to femoral vessels for REBOA catheter placement is safer when performed by cut-down and direct visualization but can be performed faster by an ultrasound-guided technique when vessels can be identified clearly and rapidly.
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Affiliation(s)
- Peter Grechenig
- Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria
| | - Barbara Hallmann
- Department of Anaesthesiology and Intensive Care Medicine, Medical University Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Nicolas Rene Eibinger
- Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria
| | - Amir Koutp
- Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria
| | - Paul Zajic
- Department of Anaesthesiology and Intensive Care Medicine, Medical University Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Gerald Höfler
- Diagnostic and Research Institute of Pathology, Medical University Graz, Graz, Austria
| | - Paul Puchwein
- Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria
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Sun J, Lu B, Shan J, Pan Z, Sun J. Optimal insertion site for ultrasound-guided radial artery catheterization utilizing the dynamic needle tip positioning technique: A prospective randomized controlled study. J Vasc Access 2024:11297298241233713. [PMID: 38390724 DOI: 10.1177/11297298241233713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The dynamic needle tip positioning technique represents an advanced version of the short-axis out-of-plane ultrasound-guided approach employed for radial artery catheterization. The study aimed to explore the most effective insertion site capable of expeditiously and accurately executing the procedure in a clinical setting. METHODS A prospective randomized controlled study encompassed 246 elective surgery patients necessitating invasive arterial monitoring. Participants were randomly assigned to three distinct groups: Site 1 (targeting the radial styloid process), Site 2 (midway between Sites 1 and 3), and Site 3 (distal one-third of the forearm). The dynamic needle tip positioning technique was implemented across all groups. Crucial parameters, such as first-attempt success rate, time to success, overall success rate, total catheterization time, number of attempts, and complications, were meticulously documented and compared. RESULTS The Site 2 cohort presented a significantly heightened first-attempt success rate compared to Site 1 (97.5% vs 80%, p = 0.003) and Site 3 (97.5% vs 81.25%, p = 0.006). Moreover, Site 2 displayed a reduced time to success in contrast to Site 1 (31.5 vs 38, p = 0.003) and Site 3 (31.5 vs 40, p = 0.006). Total catheterization time was significantly shorter in Site 2 compared to Site 1 (32 vs 42.5, p < 0.001) and Site 3 (32 vs 43.5, p < 0.001). Site 2 necessitated fewer attempts than Site 1 (p = 0.02) and Site 3 (p = 0.03). Male gender and puncture at Site 2 were associated with expedited time to success. Adverse events manifested more frequently in the Site 3 group compared to the Site 1 group (15% vs 3.75%, p = 0.03) and the Site 2 group (15% vs 2.5%, p = 0.01). CONCLUSIONS The optimal insertion site for ultrasound-guided radial artery catheterization utilizing the dynamic needle tip positioning technique in adult patients is situated midway between the radial styloid process and the distal one-third of the forearm.
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Affiliation(s)
- Jiahui Sun
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Bo Lu
- Department of Anesthesiology, Ningbo No.2 Hospital, Ningbo, China
| | - Jianbo Shan
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Zhihao Pan
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Jianliang Sun
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Naddi L, Hübinette J, Kander T, Borgquist O, Adrian M. Operator gender differences in major mechanical complications after central line insertions: a subgroup analysis of a prospective multicentre cohort study. BMC Anesthesiol 2024; 24:68. [PMID: 38383304 PMCID: PMC10880374 DOI: 10.1186/s12871-024-02455-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND A previous study on mechanical complications after central venous catheterisation demonstrated differences in complication rates between male and female operators. The objective of this subgroup analysis was to further investigate these differences. The hypothesis was that differences in distribution of predefined variables between operator genders could be identified. METHODS This was a subgroup analysis of a prospective, multicentre, observational cohort study conducted between March 2019 and December 2020 including 8 586 patients ≥ 16 years receiving central venous catheters at four emergency care hospitals. The main outcome measure was major mechanical complications defined as major bleeding, severe cardiac arrhythmia, pneumothorax, arterial catheterisation, and persistent nerve injury. Independent t-test and χ2 test were used to investigate differences in distribution of major mechanical complications and predefined variables between male and female operators. Multivariable logistic regression analysis was used to determine association between operator gender and major mechanical complications. RESULTS Female operators had a lower rate of major mechanical complications than male operators (0.4% vs 0.8%, P = .02), were less experienced (P < .001), had more patients with invasive positive pressure ventilation (P < .001), more often chose the internal jugular vein (P < .001) and more frequently used ultrasound guidance (P < .001). Male operators more often chose the subclavian vein (P < .001) and inserted more catheters with bore size ≥ 9 Fr (P < .001). Multivariable logistic regression analysis showed that male operator gender was associated with major mechanical complication (OR 2.67 [95% CI: 1.26-5.64]) after correction for other relevant independent variables. CONCLUSIONS The hypothesis was confirmed as differences in distribution of predefined variables between operator genders were found. Despite being less experienced, female operators had a lower rate of major mechanical complications. Furthermore, male operator gender was independently associated with a higher risk of major mechanical complications. Future studies are needed to further investigate differences in risk behaviour between male and female operators. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03782324. Date of registration: 20/12/2018.
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Affiliation(s)
- Leila Naddi
- Anaesthesiology and Intensive Care, Department of Clinical Sciences, Lund University, Lund, Sweden.
- Department of Intensive and Perioperative Care, Skåne University Hospital, 221 85, Lund, Sweden.
| | | | - Thomas Kander
- Anaesthesiology and Intensive Care, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, 221 85, Lund, Sweden
| | - Ola Borgquist
- Anaesthesiology and Intensive Care, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Maria Adrian
- Anaesthesiology and Intensive Care, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
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Zhang M, Liu HL, Li WH, Li MZ. The value of transthoracic echocardiography and chest X-ray in locating the tip of central venous catheter in dialysis patients: a comparative study with computed tomography imaging. Ren Fail 2023; 45:2290179. [PMID: 38059492 PMCID: PMC11001318 DOI: 10.1080/0886022x.2023.2290179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023] Open
Abstract
To determine the tip position of the central venous catheter (CVC) in patients with dialysis, the guidelines recommend that it be determined using chest radiography (CXR) after catheterization, without fluoroscopy. However, some researchers have proposed that transthoracic echocardiography (TTE) can replace CXR, but this has not been widely adopted. This study aimed to determine which of the two aforementioned methods is more suitable for locating the tip position of the CVC. This prospective study included 160 patients who underwent hemodialysis at our hospital from March 2021 to December 2022. After inserting the CVC through the internal jugular vein, we used transthoracic echocardiography and CXR to determine the tip of the CVC and compared the results with those of computed tomography (CT). In the comparison between TTE and CXR for locating the CVC tip, we obtained three main findings. (1) TTE was associated with fewer misdiagnosed cases than CXR. (2) TTE provided higher sensitivity (similar sensitivity in position 2), specificity, positive/negative predictive values, and accuracy than CXR. (3) When comparing the receiver operating characteristic curves of TTE and CXR, the area under the curve (95% confidence interval) for the former was larger. Additionally, we made anatomical discoveries: the "hyperechoic triangle" recognized by TTE was equivalent to the entrance of the superior vena cava into the right atrium shown by transesophageal transthoracic echocardiography. TTE is more suitable than CXR as the first examination for CVC tip localization, as it improves diagnostic accuracy and reduces X-ray radiation damage.
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Affiliation(s)
- Meng Zhang
- Graduate School of Chengde Medical College, Hebei Province, China
| | - Hui-Ling Liu
- Headquarters Department of Ultrasound, Affiliated Hospital of Chengde Medical College, Hebei Province, China
| | - Wei-Hong Li
- Headquarters Department of Ultrasound, Affiliated Hospital of Chengde Medical College, Hebei Province, China
| | - Mu-Zi Li
- Physical Examination Department, Chengde Shuangluan District People’s Hospital, Hebei Province, China
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Baion DE, La Ferrara A, Maserin D, Caprioli S, Albano R, Malara F, Locascio F, Galluzzo E, Luison D, Lombardo M, Navarra R, Calzolari G, Tizzani M, Prisciandaro I, Morello F, Tuttolomondo P, Goffi A, Lupia E, Pivetta E. Mono- and bi-plane sonographic approach for difficult accesses in the emergency department - A randomized trial. Am J Emerg Med 2023; 74:49-56. [PMID: 37774550 DOI: 10.1016/j.ajem.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The insertion of peripheral intravenous (PIV) catheters is one of the most performed invasive procedures in acute healthcare settings. However, peripheral difficult vascular access (PDVA) is not uncommon and can lead to delays in administering essential medications. Ultrasound (US) has emerged as a valuable tool for facilitating PIV cannulation. Advancements in technology have introduced a technique known as bi-plane imaging, allowing the simultaneous display of both longitudinal and transverse views of vessels. We aimed to investigate whether the utilization of bi-plane imaging, as opposed to the single-plane approach, would yield superior results for PDVA in the emergency department (ED). METHODS This study was a single-center randomized controlled trial. We included adult patients admitted to the ED who required PIV cannulation. Patients were randomly assigned to undergo cannulation using either the mono-plane or bi-plane approach, both performed by skilled providers. The primary outcome of the study was to compare the first attempt success rates between the two techniques. RESULTS A total of 442 patients were enrolled, with 221 undergoing cannulation attempts using the mono-plane approach. Successful placement of a functioning PIV catheter was achieved in a single attempt for 313 out of 442 patients (70.8%). There was no significant difference in the success rates between the two study groups: 68.3% in the mono-plane group and 73.3% in the bi-plane group (p = 0.395). The median time required for a successful attempt differed between the groups, with 45 s (range 18-600) in the mono-plane group and 35 s (range 20-600) in the bi-plane group (p = 0.03). CONCLUSIONS Our study confirms that US is a highly effective tool for facilitating PIV cannulation in patients with PDVA presenting to the ED. However, our investigation into the use of bi-plane imaging did not reveal a significant improvement when compared to mono-plane imaging.
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Affiliation(s)
- Davide Enrici Baion
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Alberto La Ferrara
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Davide Maserin
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Stefania Caprioli
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Rosina Albano
- High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Francesco Malara
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Francesca Locascio
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Emanuela Galluzzo
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Deborah Luison
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Matteo Lombardo
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Roberta Navarra
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Gilberto Calzolari
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Maria Tizzani
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Isabella Prisciandaro
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Fulvio Morello
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; Department of Medical Sciences, University of Turin, 10126, Turin, Italy
| | - Pietro Tuttolomondo
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; Department of Healthcare Providers, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Alberto Goffi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Enrico Lupia
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; Department of Medical Sciences, University of Turin, 10126, Turin, Italy
| | - Emanuele Pivetta
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; Department of Medical Sciences, University of Turin, 10126, Turin, Italy.
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Villa A, Hermand V, Bonny V, Preda G, Urbina T, Gasperment M, Gabarre P, Missri L, Baudel JL, Zafimahazo D, Joffre J, Ait-Oufella H, Maury E. Improvement of central vein ultrasound-guided puncture success using a homemade needle guide-a simulation study. Crit Care 2023; 27:379. [PMID: 37777778 PMCID: PMC10543855 DOI: 10.1186/s13054-023-04661-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/26/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Out-of-plane (OOP) approach is frequently used for ultrasound-guided insertion of central venous catheter (CVC) owing to its simplicity but does not avoid mechanical complication. In-plane (IP) approach might improve safety of insertion; however, it is less easy to master. We assessed, a homemade needle guide device aimed to improve CVC insertion using IP approach. METHOD We evaluated in a randomized simulation trial, the impact of a homemade needle guide on internal jugular, subclavian and femoral vein puncture, using three approaches: out-of-plane free hand (OOP-FH), in-plane free hand (IP-FH), and in-plane needle guided (IP-NG). Success at first pass, the number of needle redirections and arterial punctures was recorded. Time elapsed (i) from skin contact to first skin puncture, (ii) from skin puncture to successful venous puncture and (iii) from skin contact to venous return were measured. RESULTS Thirty operators performed 270 punctures. IP-NG approach resulted in high success rate at first pass (jugular: 80%, subclavian: 95% and femoral: 100%) which was higher than success rate observed with OOP-FH and IP-FH regardless of the site (p = .01). Compared to IP-FH and OOP-FH, the IP-NG approach decreased the number of needle redirections at each site (p = .009) and arterial punctures (p = .001). Compared to IP-FH, the IP-NG approach decreased the total procedure duration for puncture at each site. CONCLUSION In this simulation study, IP approach using a homemade needle guide for ultrasound-guided central vein puncture improved success rate at first pass, reduced the number of punctures/redirections and shortened the procedure duration compared to OOP and IP free-hand approaches.
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Affiliation(s)
- Antoine Villa
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
| | | | - Vincent Bonny
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
- Faculty of Medicine, Sorbonne University, 75013, Paris, France
| | - Gabriel Preda
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
| | - Tomas Urbina
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
| | - Maxime Gasperment
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
| | - Paul Gabarre
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
- Faculty of Medicine, Sorbonne University, 75013, Paris, France
| | - Louai Missri
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
| | - Jean-Luc Baudel
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
| | - Daniel Zafimahazo
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
| | - Jérémie Joffre
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
- Faculty of Medicine, Sorbonne University, 75013, Paris, France
- INSERM UMR_S938, Centre de Recherche Saint-Antoine (CRSA), 75571, Paris Cedex 12, France
| | - Hafid Ait-Oufella
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
- Faculty of Medicine, Sorbonne University, 75013, Paris, France
- Paris Cardiovascular Research Center, INSERM U970, Paris University, Paris, France
| | - Eric Maury
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France.
- Faculty of Medicine, Sorbonne University, 75013, Paris, France.
- Pierre Louis Institute of Epidemiology and Public Health, INSERM U1136, Sorbonne University, Paris, France.
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Li YY, Liu YH, Yan L, Xiao J, Li XY, Ma J, Jia LG, Chen R, Zhang C, Yang Z, Zhang MB, Luo YK. Single-plane versus real-time biplane approaches for ultrasound-guided central venous catheterization in critical care patients: a randomized controlled trial. Crit Care 2023; 27:366. [PMID: 37742018 PMCID: PMC10517529 DOI: 10.1186/s13054-023-04635-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/04/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Critical care patients often require central venous cannulation (CVC). We hypothesized that real-time biplane ultrasound-guided CVC would improve first-puncture success rate and reduce mechanical complications. The purpose of this study was to compare the success rate and safety of single-plane and real-time biplane approaches for ultrasound-guided CVC. METHODS From October 2022 to March 2023, 256 participants with critical illness requiring CVC were randomized to either the single-plane (n = 128) or biplane (n = 128) ultrasound-guided cannulation groups. The success rate, number of punctures, procedure duration, incidence of catheterization-related complications, and confidence score of operators were documented. RESULTS The central vein was successfully cannulated in all 256 participants (163 [64%] man and 93 [36%] women; mean age 69 ± 19 [range 13-104 years]), including 182 and 74 who underwent internal jugular vein cannulation (IJVC) and femoral vein cannulation (FVC), respectively. The incidence of successful puncture on the first attempt was higher in the biplane group than that in the single-plane group (91.6% vs. 74.7%; relative risk (RR), 1.226; 95% confidence interval (CI), 1.069-1.405; P = 0.002 for the IJVC and 90.9% vs. 68.3%; RR, 1.331; 95% CI, 1.053-1.684; P = 0.019 for the FVC). The biplane group was also associated with a higher first-puncture single-pass catheterization success rate (87.4% vs. 69.0% and 90.9% vs. 68.3%), fewer undesired punctures (1[1-1(1-2)] vs. 1[1-2(1-4)] and 1[1-1(1-3)] vs. 1[1-2(1-4)]), shorter cannulation time (205 s [162-283 (66-1,526)] vs. 311 s [243-401 (136-1,223)] and 228 s [193-306 (66-1,669)] vs. 340 s [246-499 (130-944)]), and fewer immediate complications (10.5% vs. 28.7% and 9.1% vs. 34.1%) for both IJVC and FVC (all P < 0.05). CONCLUSION Real-time biplane imaging of ultrasound-guided CVCs offers advantages over the single-plane approach for critically ill patients. TRIAL REGISTRATION This prospective RCT was registered at Chinese Clinical Trial Registry (ChiCTR2200064843). Registered 19 October 2022.
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Affiliation(s)
- Ying-Ying Li
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing, 100853, China
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, 100853, China
| | - Yi-Hao Liu
- From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing, 100853, China
| | - Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, 100853, China
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, 100853, China
| | - Xin-Yang Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, 100853, China
| | - Jun Ma
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, 100853, China
| | - Li-Gang Jia
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, 100853, China
| | - Rui Chen
- Department of Ultrasound, People's Hospital of Torch Development Zone, Zhongshan, China
| | - Chao Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, 100853, China
| | - Zhen Yang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, 100853, China
| | - Ming-Bo Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, 100853, China.
| | - Yu-Kun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, 100853, China.
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10
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Ablordeppey EA, Keating SM, Brown KM, Theodoro DL, Griffey RT, James AS. Implementation of ultrasound after central venous catheter insertion: A qualitative study in early adopters. J Vasc Access 2023; 24:879-888. [PMID: 34763555 DOI: 10.1177/11297298211053447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The adoption rate of point of care ultrasound (POCUS) for the confirmation of central venous catheter (CVC) positioning and exclusion of post procedure pneumothorax is low despite advantages in workflow compared to traditional chest X-ray (CXR). To explore why, we convened focus groups to address barriers and facilitators of implementation for POCUS guided CVC confirmation and de-implementation of post-procedure CXR. METHODS We conducted focus groups with emergency medicine and critical care providers to discuss current practices in POCUS for CVC confirmation. The semi-structured focus group interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). We performed qualitative content analysis of the resulting transcripts using a consensual qualitative research approach (NVivo software), aiming to identify priority categories that describe the barriers and facilitators of POCUS guided CVC confirmation. RESULTS The coding dictionary of barriers and facilitators consisted of 21 codes from the focus group discussions. Our qualitative analysis revealed that 12 codes emerged spontaneously (inductively) within the focus group discussions and aligned directly to CFIR constructs. Common barriers included provider influences (e.g. knowledge and beliefs about POCUS for CVC confirmation), external network (e.g. societal guidelines, ancillary staff, and consultants), and inertia (habit or reflexive processes). Common facilitators included ultrasound protocol advantage and champions. Time and provider outcomes (cognitive offload, ownership, and independence) emerged as early barriers but late facilitators. CONCLUSION Our qualitative analysis demonstrates real and perceived barriers against implementation of POCUS for CVC position confirmation and pneumothorax exclusion. Our findings discovered organizational and personal constructs that will inform development of multifaceted strategies toward implementation of POCUS after CVC insertion.
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Affiliation(s)
- Enyo A Ablordeppey
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Shannon M Keating
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Katherine M Brown
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Daniel L Theodoro
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Richard T Griffey
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Aimee S James
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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11
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Boulet N, Bobbia X, Gavoille A, Louart B, Lefrant JY, Roger C, Muller L. Axillary vein catheterization using ultrasound guidance: A prospective randomized cross-over controlled simulation comparing standard ultrasound and new needle-pilot device. J Vasc Access 2023; 24:1042-1050. [PMID: 34965763 DOI: 10.1177/11297298211063705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Real-time ultrasound (US) guidance facilitates central venous catheterization in intensive care unit (ICU). New magnetic needle-pilot devices could improve efficiency and safety of central venous catheterization. This simulation trial was aimed at comparing venipuncture with a new needle-pilot device to conventional US technique. METHODS In a prospective, randomized, simulation trial, 51 ICU physicians and residents cannulated the right axillary vein of a human torso mannequin with standard US guidance and with a needle-pilot system, in a randomized order. The primary outcome was the time from skin puncture to successful venous cannulation. The secondary outcomes were the number of skin punctures, the number of posterior wall puncture of the axillary vein, the number of arterial punctures, the number of needle redirections, the failure rate, and the operator comfort. RESULTS Time to successful cannulation was shorter with needle-pilot US-guided technique (22 s (interquartile range (IQR) = 16-42) vs 25 s (IQR = 19-128); median of difference (MOD) = -9 s (95%-confidence interval (CI) -5, -22), p < 0.001). The rates of skin punctures, posterior wall puncture of axillary vein, and needle redirections were also lower (p < 0.01). Comfort was higher in needle-pilot US-guided group on a 11-points numeric scale (8 (IQR = 8-9) vs 6 (IQR = 6-8), p < 0.001). CONCLUSIONS In a simulation model, US-guided axillary vein catheterization with a needle-pilot device was associated with a shorter time of successful cannulation and a decrease in numbers of skin punctures and complications. The results plea for investigating clinical performance of this new device.
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Affiliation(s)
- Nicolas Boulet
- Intensive Care Unit, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Xavier Bobbia
- EA 2992 IMAGINE, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Antoine Gavoille
- Department of Biostatistics-Bioinformatic, Hospices Civils de Lyon, Lyon, France
| | - Benjamin Louart
- Intensive Care Unit, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Jean Yves Lefrant
- Intensive Care Unit, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Claire Roger
- Intensive Care Unit, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Laurent Muller
- Intensive Care Unit, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
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12
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Wu C, Zhang M, Gu W, Wang C, Zheng X, Zhang J, Zhang X, Lv S, He X, Shen X, Wei W, Wang G, Lu Y, Chen Q, Shan R, Wang L, Wu F, Shen T, Shao X, Cai J, Tao F, Cai H, Lu Q. Daily point-of-care ultrasound-assessment of central venous catheter-related thrombosis in critically ill patients: a prospective multicenter study. Intensive Care Med 2023; 49:401-410. [PMID: 36892598 DOI: 10.1007/s00134-023-07006-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/13/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Central venous catheter (CVC)-related thrombosis (CRT) is a known complication in critically ill patients. However, its clinical significance remains unclear. The objective of the study was to evaluate the occurrence and evolution of CRT from CVC insertion to removal. METHODS A prospective multicenter study was conducted in 28 intensive care units (ICUs). Duplex ultrasound was performed daily from CVC insertion until at least 3 days after CVC removal or before patient discharge from the ICU to detect CRT and to follow its progression. CRT diameter and length were measured and diameter > 7 mm was considered extensive. RESULTS The study included 1262 patients. The incidence of CRT was 16.9% (95% confidence interval 14.8-18.9%). CRT was most commonly found in the internal jugular vein. The median time from CVC insertion to CRT onset was 4 (2-7) days, and 12% of CRTs occurred on the first day and 82% within 7 days of CVC insertion. CRT diameters > 5 mm and > 7 mm were found in 48% and 30% of thromboses. Over a 7-day follow-up, CRT diameter remained stable when the CVC was in place, whereas it gradually decreased after CVC removal. The ICU length of stay was longer in patients with CRT than in those without CRT, and the mortality was not different. CONCLUSION CRT is a frequent complication. It can occur as soon as the CVC is placed and mostly during the first week following catheterization. Half of the thromboses are small but one-third are extensive. They are often non-progressive and may be resolved after CVC removal.
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Affiliation(s)
- Chunshuang Wu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
- Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
| | - Mao Zhang
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
- Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
| | - Wenjie Gu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
- Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
| | - Caimu Wang
- The First Hospital of Ninghai, Ningbo, China
| | | | | | | | - Shijin Lv
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Xuwei He
- Lishui People's Hospital, Lishui, China
| | - Xiaoyuan Shen
- The First People's Hospital of Xiaoshan District, Hangzhou, China
| | | | | | - Yingru Lu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Renfei Shan
- Taizhou Hospital of Zhejiang Province, Taizhou, China
| | - Lingcong Wang
- The First Affiliated Hospital of Zhejiang, Chinese Medical University, Hangzhou, China
| | - Feng Wu
- Zhejiang Quhua Hospital, Quzhou, China
| | - Ting Shen
- Yuyao People's Hospital of Zhejiang Province, Ningbo, China
| | - Xuebo Shao
- The First People's Hospital of Fuyang, Hangzhou, Hangzhou, China
| | - Jiming Cai
- The Second Hospital of Jiaxing, Jiaxing, China
| | - Fuzheng Tao
- Taizhou Integrated Chinese and Western Medicine Hospital, Taizhou, China
| | | | - Qin Lu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China.
- Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China.
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Incidence and short-term outcomes of central line-related bloodstream infection in patients admitted to the emergency department: a single-center retrospective study. Sci Rep 2023; 13:3867. [PMID: 36890192 PMCID: PMC9995448 DOI: 10.1038/s41598-023-31100-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/06/2023] [Indexed: 03/10/2023] Open
Abstract
Central line-related bloodstream infection (CRBSI) is a common complication during hospital admissions; however, there is insufficient data regarding CRBSI in the emergency department. Therefore, we evaluated the incidence and clinical impact of CRBSI using a single-center retrospective study to analyze medical data of 2189 adult patients (median age: 65 years, 58.8% males) who underwent central line insertion in ED from 2013 to 2015. CRBSI was defined if the same pathogens were identified at peripheral and catheter tips or the differential time to positivity was > 2 h. CRBSI-related in-hospital mortality and risk factors were evaluated. CRBSI occurred in 80 patients (3.7%), of which 51 survived and 29 died; those with CRBSI had higher incidence of subclavian vein insertion and retry rates. Staphylococcus epidermidis was the most common pathogen, followed by Staphylococcus aureus, Enterococcus faecium, and Escherichia coli. Using multivariate analysis, we found that CRBSI development was an independent risk factor for in-hospital mortality (adjusted odds ratio: 1.93, 95% confidence intervals: 1.19-3.14, p < 0.01). Our findings suggest that CRBSI after central line insertion in the emergency department is common and associated with poor outcomes. Infection prevention and management measures to reduce CRBSI incidence are essential to improve clinical outcomes.
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Ultrasound-Guided Infraclavicular Axillary Vein Versus Internal Jugular Vein Cannulation in Critically Ill Mechanically Ventilated Patients: A Randomized Trial. Crit Care Med 2023; 51:e37-e44. [PMID: 36476809 PMCID: PMC9847684 DOI: 10.1097/ccm.0000000000005740] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This clinical trial aimed to compare the ultrasound-guided in-plane infraclavicular cannulation of the axillary vein (AXV) and the ultrasound-guided out-of-plane cannulation of the internal jugular vein (IJV). DESIGN A prospective, single-blinded, open label, parallel-group, randomized trial. SETTING Two university-affiliated ICUs in Poland (Opole and Lublin). PATIENTS Mechanically ventilated intensive care patients with clinical indications for central venous line placement. INTERVENTIONS Patients were randomly assigned into two groups: the IJV group ( n = 304) and AXV group ( n = 306). The primary outcome was to compare the IJV group and AXV group through the venipuncture and catheterization success rates. Secondary outcomes were catheter tip malposition and early mechanical complication rates. All catheterizations were performed by advanced residents and consultants in anesthesiology and intensive care. MEASUREMENTS AND MAIN RESULTS The IJV puncture rate was 100%, and the AXV was 99.7% (chi-square, p = 0.19). The catheterization success rate in the IJV group was 98.7% and 96.7% in the AXV group (chi-square, p = 0.11). The catheter tip malposition rate was 9.9% in the IJV group and 10.1% in the AXV group (chi-square, p = 0.67). The early mechanical complication rate in the IJV group was 3% (common carotid artery puncture-4 cases, perivascular hematoma-2 cases, vertebral artery puncture-1 case, pneumothorax-1 case) and 2.6% in the AXV group (axillary artery puncture-4 cases, perivascular hematoma-4 cases) (chi-square, p = 0.79). CONCLUSIONS No difference was found between the real-time ultrasound-guided out-of-plane cannulation of the IJV and the infraclavicular real-time ultrasound-guided in-plane cannulation of the AXV. Both techniques are equally efficient and safe in mechanically ventilated critically ill patients.
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15
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Fournil C, Boulet N, Bastide S, Louart B, Ambert A, Boutin C, Lefrant JY, Muller L, Roger C. High success rates of ultrasound-guided distal internal jugular vein and axillary vein approaches for central venous catheterization: A randomized controlled open-label pilot trial. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:158-166. [PMID: 36385459 DOI: 10.1002/jcu.23383] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/27/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Ultrasound (US)-guided axillary vein (AV) catheterization has been considered as the preferred site of insertion to minimize catheter-related infections. Given its difficulty of realization, internal jugular vein (IJV) access remains, thus, the first choice of catheter insertion site. This descriptive study was aimed to assess the success and complication rates of in-plane short axis approach of IJV in the lower neck and the AV approach under US-guidance. METHODS In a prospective randomized controlled open-label pilot trial, all patients requiring central venous catheterization (CVC) in intensive care unit or operating room were randomly assigned to low IJV or AV groups. The primary objective was to estimate the overall success rate of both approaches. The secondary objectives were immediate complication rates, procedure durations, success rate after the first puncture, late complication rates (i.e., thrombosis, catheter colonization, and catheter-related infections), and nurse satisfaction regarding insertion site dressings. RESULTS One hundred and seventy-three out of two hundred and ten included patients were fully analyzed (90 and 83 in the IJV and AV approach groups, respectively). Overall success rates for IJV and AV sites were 96% (95% confidence interval (CI) [90-99]) and 89% (95% CI [81-94]) respectively. First puncture success rates were 90% and 80% respectively. The median overall procedure duration from US pre-procedural screening to guidewire insertion was 8 and 10 min in IJV and AV groups. Overall immediate complications rates for IJV and AV sites were 11.6% and 14.6%, respectively. Incidence of catheter colonization were 7.9% and 6.8% and catheter-related infection rate were 2.6% and 0%, respectively. CONCLUSION In this pilot study, US-guided low IJV and AV approaches are safe and efficient techniques for CVC insertion associated with high success and low complications rates. Duration for guidewire insertion seemed to be shorter in the short axis in-plane IJV approach. It provides the basis for a future randomized trial comparing these two approaches.
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Affiliation(s)
- Céline Fournil
- Department of Anesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Nicolas Boulet
- Department of Anesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Sophie Bastide
- Laboratoire de Biostatistique, Epidémiologie Clinique, Santé Publique Innovation et Méthodologie (BESPIM), Pôle Pharmacie, Santé Publique, Nîmes University Hospital, University of Montpellier, France
| | - Benjamin Louart
- Department of Anesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Audrey Ambert
- Department of Anesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Caroline Boutin
- Department of Anesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Jean-Yves Lefrant
- Department of Anesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Laurent Muller
- Department of Anesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Claire Roger
- Department of Anesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
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D'Arrigo S, Annetta MG, Pittiruti M. An ultrasound-based technique in the management of totally implantable venous access devices with persistent withdrawal occlusion. J Vasc Access 2023; 24:140-144. [PMID: 34096379 DOI: 10.1177/11297298211023275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Persistent withdrawal occlusion is a specific catheter malfunction characterized by inability to withdraw blood through the device while infusion is maintained. The main causes are fibroblastic sleeve and tip malposition (associated or not to venous thrombosis around the tip). All current guidelines recommend infusing vesicant/antiblastic drugs through a central venous port only after assessment of blood return. In PWO, blood return is impossible. We have recently started to assess the intravascular position of the tip and the delivery of the infusion in the proximity of the cavo-atrial junction utilizing transthoracic/subxiphoid ultrasound with the 'bubble test'. We found that this is an easy, real-time, accurate and safe method for verifying the possibility of using a port for chemotherapy even in the absence of blood return, as it occurs with persistent withdrawal occlusion.
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Affiliation(s)
- Sonia D'Arrigo
- Deptartment of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Giuseppina Annetta
- Deptartment of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Pittiruti
- Deptartment of Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Zhou J, Wu L, Zhang C, Wang J, Liu Y, Ping L. Ultrasound guided axillary vein catheterization versus subclavian vein cannulation with landmark technique: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31509. [PMID: 36316830 PMCID: PMC9622689 DOI: 10.1097/md.0000000000031509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although ultrasound (US) guided axillary vein (AV) catheterization has been well described, evidence for its efficacy and safety compared with conventional infraclavicular landmark guided subclavian vein (SCV) cannulation have not been comprehensively appraised. Thus, we conducted a systematic review and meta-analysis to determine whether US guided AV catheterization reduces catheterization failures and adverse events compared to SCV puncture based on landmark technique. METHODS We searched the PubMed, Embase, Cochrane Library, CINAHL, Web of Science, SCOPUS, China Biology Medicine, China National Knowledge Infrastructure, Wan Fang, and Wei Pu databases for randomized controlled trials (RCTs) studies published from inception to May 2021. Two investigators reviewed and extracted data on study design, number and type of inclusion criteria. Study quality was assessed using the Jadad scale. Outcomes included the puncture success rates and the incidence of adverse events. RESULTS Data of 1852 patients from five RCTs were included in this meta-analysis. The analysis showed that US guided AV catheterization increased the first (risk ratio (RR), confidence interval (CI)) (RR = 1.17, 95% CI = 1.13~1.22, P < .01) and overall (RR = 1.09, 95% CI = 1.04~1.15, P < .01) puncture success rate, and reduce the occurrence of adverse events, including the risk of arterial puncture (RR = 0.18, 95% CI = 0.06~0.55, P < .01), pneumo-and hemothorax (RR = 0.12, 95% CI = 0.02~0.64, P = .01). CONCLUSION This meta-analysis indicates that US guided AV catheterization reduces catheterization failures and mechanical complications compared with conventional landmark guided SCV puncture.
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Affiliation(s)
- Jinchuan Zhou
- The Emergency Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Lidong Wu
- The Emergency Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Chunquan Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Jiwei Wang
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Yanna Liu
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Luyi Ping
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
- *Correspondence: Luyi Ping, Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, Jiangxi, China (e-mail: )
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Adrian M, Borgquist O, Kröger T, Linné E, Bentzer P, Spångfors M, Åkeson J, Holmström A, Linnér R, Kander T. Mechanical complications after central venous catheterisation in the ultrasound-guided era: a prospective multicentre cohort study. Br J Anaesth 2022; 129:843-850. [DOI: 10.1016/j.bja.2022.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/15/2022] [Accepted: 08/31/2022] [Indexed: 11/02/2022] Open
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Morrow S, DeBoer E, Potter C, Gala S, Alsbrooks K. Vascular access teams: a global outlook on challenges, benefits, opportunities, and future perspectives. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S26-S35. [PMID: 35856587 DOI: 10.12968/bjon.2022.31.14.s26] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Specialized vascular access training for medical professionals organized into vascular access teams (VATs) was shown to improve patient outcomes, clinical efficiency, and cost savings. Professional perspectives on VAT benefits, organization, challenges, and opportunities on a global scale remain inadequately explored. Using detailed perspectives, in this study, we explored the global VAT landscape, including challenges faced, clinical and clinico-economic impacts of VATs, with emphasis on underresearched facets of VAT initiation, data dissemination, and metrics or benchmarks for VAT success. METHODS Semistructured in-depth interviews of 14 VAT professionals from 9 countries and 5 continents were used to elicit qualitative and quantitative information. RESULTS Catheter insertions (100%) and training (86%) were the most performed VAT functions. Based on a 1-7 scale evaluating observed impacts of VATs, patient satisfaction (6.5) and institutional costs (6.2) were ranked the highest. VAT co-initiatives, advanced technology utilization (6.6), and ongoing member training (6.3) distinctly impacted VAT endeavors. Most institutions (64%) did not have routine mechanisms for recording VAT-related data; however, all participants (100%) stated the importance of sharing data to demonstrate VAT impacts. Time constraints (57%) emerged as one of the major deterrents to data collection or dissemination. The majority (64%) experienced an increased demand or workload for VAT services during the COVID-19 pandemic. CONCLUSIONS Despite the global variances in VATs and gaps in VAT-related data, all participants unanimously endorsed the benefits of VAT programs. Evaluating the impact of VATs, disseminating VAT-related data, and forging specialized institutional partnerships for data sharing and training are potential strategies to tackle the hurdles surrounding VAT formation and sustenance.
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Affiliation(s)
- Shonda Morrow
- JD, MS, RN, CENP Rush University Medical Center, Chicago, IL
| | - Erica DeBoer
- RN, MA, CCRN-K, CNL, Sanford Health Corporate, Sioux Falls, SD
| | - Christopher Potter
- ODP, Southmead Hospital, Southmead Road Westbury-on-Trym, Bristol, United Kingdom
| | | | - Kimberly Alsbrooks
- BSN, RN, RT (R), VA-BC, Becton, Dickinson and Company (BD), Franklin Lakes, NJ
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20
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López-Álvarez JM, Pérez-Quevedo O, Naya-Esteban J, Ramirez-Lorenzo T, Falcón-González JC, Lorenzo-Villegas DL. Ultrasound-guided pediatric vascular cannulation by inexperienced operators: outcomes in a training model. J Ultrasound 2022; 25:199-205. [PMID: 33948886 PMCID: PMC9148336 DOI: 10.1007/s40477-021-00585-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To present the results of an ultrasound vascular cannulation (UGVC) training program for inexperienced operators using a training model. METHOD This was a descriptive observational study developed in the paediatric intensive care unit (PICU) of a third-level hospital. Operators received basic theoretical training in the USVC technique, followed by practical training with a model designed for USVC-inexperienced healthcare professionals. RESULTS The study included 25 healthcare professionals, who carried out a total of 300 ultrasound-guided cannulation procedures (12 per participant) at equidistant sites on the longitudinal axis/in-plane (LA/IP) and the transverse axis/out-of-plane (TA/OP). The mean depth of cannulated vessels was 0.90 (0.34) cm and their mean diameter was 0.41 (0.1) cm. In 41.7% of cases, complete view of the needle (CVN) was accomplished; in 49% of cases, repositioning of the needle/guidewire (RNG) was necessary for successful UGVC. The rate of successful UGVC in the training model was 79.7%. The mean time required for the procedure was 74.70 (73.72) seconds. The time to successful cannulation was 58.72 (56.87) seconds. The mean number of attempts needed until successful UGVC was 1.31 (0.72). Complications were: (a) 26.3% vessel perforation/wrong guidewire positioning (VP/WGP) and (b) 4.3% successful vessel puncture followed by failure to accomplish subsequent cannulation. CONCLUSIONS Through the present theoretical-practical training program for inexperienced operators using a training model: (a) high success rates and short procedural times were attained; (b) complete view of needle and need for repositioning the needle/guidewire occurred in half of the procedures; and (c) complications occurred in a third of the procedures.
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Affiliation(s)
- José Manuel López-Álvarez
- Pediatric Intensive Care Unit, Mother and Child University Hospital of the Canary Islands (Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias), Las Palmas de Gran Canaria, Spain.
- Department of Clinical Sciences, Fernando Pessoa Canarias University, Las Palmas de Gran Canaria, Spain.
| | - Olivia Pérez-Quevedo
- Pediatric Intensive Care Unit, Mother and Child University Hospital of the Canary Islands (Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias), Las Palmas de Gran Canaria, Spain
| | - Joaquín Naya-Esteban
- Interventive Radiology Unit, Mother and Child University Hospital of the Canary Islands (Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias), Las Palmas de Gran Canaria, Spain
- Department of Clinical Sciences, Fernando Pessoa Canarias University, Las Palmas de Gran Canaria, Spain
| | - Teresa Ramirez-Lorenzo
- Department of Biostatistics. Unit of de Support to Research, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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21
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Corradi F, Guarracino F, Santori G, Brusasco C, Tavazzi G, Via G, Mongodi S, Mojoli F, Biagini RUD, Isirdi A, Dazzi F, Robba C, Vetrugno L, Forfori F. Ultrasound localization of central vein catheter tip by contrast-enhanced transthoracic ultrasonography: a comparison study with trans-esophageal echocardiography. Crit Care 2022; 26:113. [PMID: 35449059 PMCID: PMC9027702 DOI: 10.1186/s13054-022-03985-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the usefulness of pre-operative contrast-enhanced transthoracic echocardiography (CE-TTE) and post-operative chest-x-ray (CXR) for evaluating central venous catheter (CVC) tip placements, with trans-esophageal echocardiography (TEE) as gold standard. METHODS A prospective single-center, observational study was performed in 111 patients requiring CVC positioning into the internal jugular vein for elective cardiac surgery. At the end of CVC insertion by landmark technique, a contrast-enhanced TTE was performed by both the apical four-chambers and epigastric bicaval acoustic view to assess catheter tip position; then, a TEE was performed and considered as a reference technique. A postoperative CXR was obtained for all patients. RESULTS As per TEE, 74 (67%) catheter tips were correctly placed and 37 (33%) misplaced. Considering intravascular and intracardiac misplacements together, they were detected in 8 patients by CE-TTE via apical four-chamber view, 36 patients by CE-TTE via epigastric bicaval acoustic view, and 12 patients by CXR. For the detection of catheter tip misplacement, CE-TTE via epigastric bicaval acoustic view was the most accurate method providing 97% sensitivity, 90% specificity, and 92% diagnostic accuracy if compared with either CE-TTE via apical four-chamber view or CXR. Concordance with TEE was 79% (p < 0.001) for CE-TTE via epigastric bicaval acoustic view. CONCLUSIONS The concordance between CE-TTE via epigastric bicaval acoustic view and TEE suggests the use of the former as a standard technique to ensure the correct positioning of catheter tip after central venous cannulation to optimize the use of hospital resources and minimize radiation exposure.
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Affiliation(s)
- Francesco Corradi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy. .,Azienda Ospedaliero Universitaria Pisana, Via Paradisa, 2, 56124, Pisa, PI, Italy.
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Claudia Brusasco
- Anesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Genoa, Italy
| | - Guido Tavazzi
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Anaesthesia, Intensive Care and Pain Therapy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Silvia Mongodi
- Anaesthesia, Intensive Care and Pain Therapy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Mojoli
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Anaesthesia, Intensive Care and Pain Therapy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Alessandro Isirdi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Federico Dazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Chiara Robba
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.,Anesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Francesco Forfori
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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22
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A delayed complication of a port-a-cath insertion via subclavian venous access: Case report of a "pinch-off syndrome". Int J Surg Case Rep 2022; 94:107039. [PMID: 35461178 PMCID: PMC9046788 DOI: 10.1016/j.ijscr.2022.107039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Port-a-caths are long-stay central catheters often used for chemotherapy or parenteral nutrition. The implantation of a port-a cath, despite being involved in routine procedures, is also associated with immediate and delayed complications. Complications are rare but must be known and managed by operators. Case report A delayed complication related to the presence of a port-a-cath, consisting in the fragmentation of the catheter, has been reported, in a 63-years-old female patient. The port was placed via subclavian venous access and affected by pinch-off syndrome, which resulted in catheter malfunction and then in fragmentation from compression by the subclavius-costoclavicular complex. The onset symptom was device malfunction. Discussion and conclusion The focus in the management of this rare but possible complication was the quick removal of the device and of the catheter fragment in the endovascular lumen with collaboration between different medical specialists. Port-a-cath implantation is an usual procedure in critically ill patients. There are rare but possible complications related to the port-a-cath implantation that it is necessary to know and know how to manage. a rare, delayed complication is the so-called "pynch-off syndrome", when the port catheter can be "pinched" to rupture and embolization between the clavicle and first rib. Patients should immediately report symptoms related to the malfunction of the port-a-cath (burning at the infusion, negative aspiration tests, etc.). It is essential to quickly manage the rupture and consequent embolization of a port-a-cath catheter, as the patient is exposed to serious complications. a collaboration between different specialists is the key for the rapid and complete resolution of a delayed complication of a port.
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23
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Nandy S, Borthakur MP, Yunus M, Karim HMR, Dey S, Bhattacharyya P. Ultrasound-Guided Right Internal Jugular Vein Cannulation by Operators of Different Experience: A Randomized, Pilot Study. Cureus 2022; 14:e24381. [PMID: 35611035 PMCID: PMC9124579 DOI: 10.7759/cureus.24381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND AIM Currently, ultrasound-guided (US-guided) internal jugular vein (IJV) cannulation is the recommended technique. However, it has a learning curve and might be unsafe in inexperienced hands. The present study aimed to compare the performance and complications with two levels of experience in performing US-guided right IJV cannulation. METHODS With informed consent, 108 procedures were performed after random allocation into two groups based on operator experience. An operator with experience in performing 30 or more ultrasound-guided IJV cannulation was considered an expert. The rate of successful cannulation, the time needed, number of attempts, and complication rate were measured. Quantitative continuous variables were compared using the unpaired student's t-test, and the chi-square test or Fisher's-exact test was used for the comparison of qualitative variables; P-value < 0.05 was considered significant. RESULTS The successful cannulation rates were 100% versus 94.44% in the expert and non-expert groups, respectively; (P=0.0803). The mean time for successful cannulation and the percentage of patients who required ≥ two attempts were significantly lower in the expert group (33.28 seconds and 12.96% versus 95.42 seconds and 61.12%). Although the incidence of carotid artery puncture and hematoma (7.4% and 5.56%) was higher in the non-expert group, it was not statistically different; (P=1.00). CONCLUSION US-guided right IJV cannulation has a learning curve, and procedures as many as 30 US-guided IJV cannulation need to be observed and performed under the guidance to achieve it.
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Affiliation(s)
- Sourav Nandy
- Anaesthesiology and Critical Care, Military Hospital Shillong, Shillong, IND
| | - Manas P Borthakur
- Anaesthesiology and Critical Care, Guwahati Neurological Research Centre (GNRC) Hospital Dispur, Guwahati, IND
| | - Mohd Yunus
- Emergency Medicine and Trauma, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Habib Md R Karim
- Anaesthesia/Critical Care/Emergency Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Samarjit Dey
- Anaesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Prithwis Bhattacharyya
- Anaesthesiology and Critical Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
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24
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Wang L, Li B, Hu B, Shen G, Zheng Y, Zheng Y. Failure mode effect and criticality analysis of ultrasound device by classification tracking. BMC Health Serv Res 2022; 22:429. [PMID: 35361206 PMCID: PMC8973517 DOI: 10.1186/s12913-022-07843-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 03/25/2022] [Indexed: 11/12/2022] Open
Abstract
Background Medical ultrasound device has been more and more widely used in the hospital and Its safety risk is significantly increased when failures occur. However, there is a lack of quantitative risk assessments of different types of failure modes for medical ultrasound device. This study utilizes a failure mode, effect and criticality analysis (FMECA) approach for quantitative risk evaluation of different failure modes for ultrasound devices. Methods The 4216 medical ultrasound device failure records at various hospitals were investigated. A failure mode and effect analysis method was developed for the quantitative evaluation of the risks of different failure modes. Visual correlation analysis was conducted for all categories to identify the causes of various failure modes. Based on the severity, occurrence and detectability of the failure causes determined, the risk priority number (RPN) for each failure mode was back-calculated through the obtained tracking diagram. Results The failure modes of unclear images, unable to power on and dark shadows on an image had the highest RPNs. One failure mode could be caused by various factors, and the failure location was not necessarily related to the cause of the failure. Conclusions This quantitative approach more accurately evaluated the risks of different failure modes, and the results of the corresponding analysis of failure modes and causes could support the rapid determination of the causes of failures in clinical practice.
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Affiliation(s)
- Longchen Wang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Bin Li
- Department of Biomedical Engineering, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Guofeng Shen
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Yunxin Zheng
- Department of Biomedical Engineering, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Yuanyi Zheng
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
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25
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Tian Y, Bai B, Zhang Y, Che L, Wang J, Wang Y, Yu C, Huang Y. The Improved Catheterization Is Associated With the Deeper Radial Arteries in Ultrasound-Guided Dynamic Needle Tip Positioning Technique. Front Med (Lausanne) 2022; 9:803124. [PMID: 35242780 PMCID: PMC8885597 DOI: 10.3389/fmed.2022.803124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/07/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to determine the associations between the first-attempt success and arterial depth in ultrasound-guided radial artery catheterization (RAC) with dynamic needle tip positioning (DNTP) technique. This study also aimed to further explore the cut-off depth correlated to improved first-attempt success catheterization in less time. Methods The cases undertaken by RAC within the DNTP technique between March 2019 and July 2020 were extracted from our institutional cohort database. Relevant variables were collected, including patients' demographics and catheterized information. Univariable and multivariable logistic regression analyses were performed to determine the association. The receiver operating characteristic (ROC) curve and the Youden index were used to explore the cut-off values of the arterial depth. Categorized cases according to the cut-off values, the Kaplan-Meier analysis, and the log-rank test were used to determine the difference of first-attempt success with limited catheterized time between groups. Results In this study, 119 patients were enrolled and 98 achieved first-attempt success. The first-attempt success catheterization was observed to be correlated to arterial depth (p < 0.01, odds ratio 6.47). An optimal cut-off depth of 2.25 mm was found using the Youden index (0.53) by ROC curve (area under curve 0.77). Arterial depth of more than 2.25 mm was correlated to improved first-attempt success catheterization in less time (log-rank p < 0.01). Conclusion To achieve first-attempt success catheterization using the DNTP technique, an arterial depth of more than 2.25 mm was associated with less catheterized time.
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Affiliation(s)
- Yuan Tian
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bing Bai
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Che
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Wang
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Wang
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunhua Yu
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuguang Huang
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Adrian RJ, Choi A, Lamba S, Ostrovsky I, Ramdin C, Traba C, Chen S, Sudyn A, Alerhand S. Teaching Module on Ultrasound-Guided Venous Access Using a Homemade Gel Model for Fourth-Year Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11222. [PMID: 35136837 PMCID: PMC8807663 DOI: 10.15766/mep_2374-8265.11222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/20/2021] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Evidence supports an ultrasound-guided approach in patients with difficult vascular access. Prior research on teaching ultrasound-guided intravenous access has included only small groups of first- and second-year medical students. METHODS We enrolled fourth-year medical students in our teaching module. The module featured a 6-minute prelearning narrated lecture and 5-minute orientation, followed by ultrasound-guided IV placement on homemade gel models. Facilitators were emergency medicine (EM) residents with a prespecified level of procedural ultrasound skills according to EM milestones. Students completed pre- and postmodule surveys. Facilitators completed the Directly Observed Procedural Skills Evaluation. Primary outcomes included global rating, proficiency on six procedural skills, and perceived learning. RESULTS Our module was completed by 150 fourth-year medical students (94% of the class); 84% cannulated the vein in one attempt. We used a global rating scale to describe the students' cannulation abilities; 59% were trusted to perform this procedure with direct supervision and coaching, 29% with indirect supervision, and 8% without supervision. There was no association between a student's order of attempting IV access within the group and global rating (p = .41). Students reported increased understanding of indications, antecubital anatomy, sonographic anatomy, and procedural comfort (12%, 29%, 38%, and 65% improvement pre- vs. postmodule, respectively; p < .001). DISCUSSION Our module enabled more than one-third of fourth-year medical students to achieve an indirect supervision or better level of proficiency in ultrasound-guided IV access, with significant improvements in perceived knowledge. This module may be useful for other educators facilitating the transition to residency.
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Affiliation(s)
- Robert James Adrian
- Fourth-Year Resident, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - April Choi
- Fourth-Year Resident, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - Sangeeta Lamba
- Professor, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - Ilya Ostrovsky
- Assistant Professor, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - Christine Ramdin
- Research Associate, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - Christin Traba
- Assistant Professor, Department of Pediatrics, Rutgers New Jersey Medical School
| | - Sophia Chen
- Assistant Professor, Department of Emergency Medicine, Rutgers New Jersey Medical School
| | - Alexander Sudyn
- Fourth-Year Medical Student, Rutgers New Jersey Medical School
| | - Stephen Alerhand
- Assistant Professor, Department of Emergency Medicine, Rutgers New Jersey Medical School
- Corresponding author:
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Shehata I, Diab S, Kweon J, Farrag O. The role of ultrasonography in anesthesia for bariatric surgery. Saudi J Anaesth 2022; 16:347-354. [PMID: 35898531 PMCID: PMC9311175 DOI: 10.4103/sja.sja_80_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 11/30/2022] Open
Abstract
Bariatric surgeries are effective long-term management for morbid obesity with its adverse sequelae. Anesthesia of bariatric surgeries poses unique challenges for the anesthesiologist in every step starting with vascular access till tracheal extubation. The usage of ultrasound in anesthesia is becoming more prevalent with a variety of benefits, especially in the obese population. Ultrasound is successfully used for obtaining vascular access, with more than 15 million catheters placed in the United States alone. Ultrasound can also be used to predict difficult intubation, as it can confirm the tracheal intubation and assess the gastric content to prevent pulmonary aspiration. Ultrasound is also used in the management of mechanically ventilated patients to monitor lung aeration and to identify respiratory complications during positive pressure ventilation. Moreover, intraoperative echocardiography helps to discover the pulmonary embolism and guides the fluid therapy. Finally, ultrasound can be used to perform neuraxial and fascial plane block with a less overall time of the procedures and minimal complications. The wide use of ultrasound in bariatric anesthesia reflects the learning curve of the anesthesiologists and their mounting efforts to provide safe anesthesia utilizing the updated technology. In this review, we highlight the role of ultrasonography in anesthesia of bariatric surgery and discuss the recent guidelines.
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Basic ultrasound head-to-toe skills for intensivists in the general and neuro intensive care unit population: consensus and expert recommendations of the European Society of Intensive Care Medicine. Intensive Care Med 2021; 47:1347-1367. [PMID: 34787687 PMCID: PMC8596353 DOI: 10.1007/s00134-021-06486-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/16/2021] [Indexed: 01/21/2023]
Abstract
Purpose To provide consensus, and a list of experts’ recommendations regarding the basic skills for head-to-toe ultrasonography in the intensive care setting. Methods The Executive Committee of the European Society of Intensive Care (ESICM) commissioned the project and supervised the methodology and structure of the consensus. We selected an international panel of 19 expert clinicians–researchers in intensive care unit (ICU) with expertise in critical care ultrasonography (US), plus a non-voting methodologist. The panel was divided into five subgroups (brain, lung, heart, abdomen and vascular ultrasound) which identified the domains and generated a list of questions to be addressed by the panel. A Delphi process based on an iterative approach was used to obtain the final consensus statements. Statements were classified as a strong recommendation (84% of agreement), weak recommendation (74% of agreement), and no recommendation (less than 74%), in favor or against. Results This consensus produced a total of 74 statements (7 for brain, 20 for lung, 20 for heart, 20 for abdomen, 7 for vascular Ultrasound). We obtained strong agreement in favor for 49 statements (66.2%), 8 weak in favor (10.8%), 3 weak against (4.1%), and no consensus in 14 cases (19.9%). In most cases when consensus was not obtained, it was felt that the skills were considered as too advanced. A research agenda and discussion on training programs were implemented from the results of the consensus. Conclusions This consensus provides guidance for the basic use of critical care US and paves the way for the development of training and research projects. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06486-z.
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Ablordeppey EA, Powell B, McKay V, Keating S, James A, Carpenter C, Kollef M, Griffey R. Protocol for DRAUP: a deimplementation programme to decrease routine chest radiographs after central venous catheter insertion. BMJ Open Qual 2021; 10:bmjoq-2020-001222. [PMID: 34663588 PMCID: PMC8524291 DOI: 10.1136/bmjoq-2020-001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/02/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Avoiding low value medical practices is an important focus in current healthcare utilisation. Despite advantages of point-of-care ultrasound (POCUS) over chest X-ray including improved workflow and timeliness of results, POCUS-guided central venous catheter (CVC) position confirmation has slow rate of adoption. This demonstrates a gap that is ripe for the development of an intervention. Methods The intervention is a deimplementation programme called DRAUP (deimplementation of routine chest radiographs after adoption of ultrasound-guided insertion and confirmation of central venous catheter protocol) that will be created to address one unnecessary imaging modality in the acute care environment. We propose a three-phase approach to changing low-value practices. In phase 1, we will be guided by the Consolidated Framework for Implementation Research framework to explore barriers and facilitators of POCUS for CVC confirmation in a single centre, large tertiary, academic hospital via focus groups. The qualitative methods will inform the development and adaptation of strategies that address identified determinants of change. In phase 2, the multifaceted strategies will be conceptualised using Morgan’s framework for understanding and reducing medical overuse. In phase 3, we will locally implement these strategies and assess them using Proctor’s outcomes (adoption, deadoption, fidelity and penetration) in an observational study to demonstrate proof of concept, gaining valuable insights on the programme. Secondary outcomes will include POCUS-guided CVC confirmation efficacy measured by time and effectiveness measured by sensitivity and specificity of POCUS confirmation after CVC insertion. With limited data available to inform interventions that use concurrent implementation and deimplementation strategies to substitute chest X-ray for POCUS using the DRAUP programme, we propose that this primary implementation and secondary effectiveness pilot study will provide novel data that will expand the knowledge of implementation approaches to replacing low value or unnecessary care in acute care environments. Ethics and dissemination Approval of the study by the Human Research Protection Office has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means. Trial registration number ClinicalTrials.gov Identifier, NCT04324762, registered on 27 March 2020.
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Affiliation(s)
- Enyo A Ablordeppey
- Department of Anesthesiology and Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Byron Powell
- Brown School at Washington University in St Louis, St Louis, Missouri, USA
| | - Virginia McKay
- Brown School at Washington University in St Louis, St Louis, Missouri, USA
| | - Shannon Keating
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Aimee James
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Christopher Carpenter
- Department of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Marin Kollef
- Department of Internal Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Richard Griffey
- Department of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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30
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Biplane Imaging Versus Standard Transverse Single-Plane Imaging for Ultrasound-Guided Peripheral Intravenous Access: A Prospective Controlled Crossover Trial. Crit Care Explor 2021; 3:e545. [PMID: 34651134 PMCID: PMC8505338 DOI: 10.1097/cce.0000000000000545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Obtaining peripheral IV access in critically ill patients is often challenging especially for novice providers. The availability of biplane imaging for ultrasound guided peripheral access has the potential to improve successful venous cannulation compared with standard plane imaging.
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31
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Kojima Y, Sendo R. A novel technique for stellate ganglion block using biplane imaging technology. PAIN MEDICINE 2021; 23:596-608. [PMID: 34480574 DOI: 10.1093/pm/pnab268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yuki Kojima
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ryozo Sendo
- Department of Anesthesiology, Imakiire General Hospital, Kagoshima, Japan.,Department of Dentistry and Oral Surgery, Imakiire General Hospital, Kagoshima, Japan
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32
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McMenamin L, Brown FE, Arora M, Barnard J, Smith LE, Stockell DJ, Tung P, Wakefield RJ, Weerasinghe A, Wolstenhulme S. Twelve tips for integrating ultrasound guided peripheral intravenous access clinical skills teaching into undergraduate medical education. MEDICAL TEACHER 2021; 43:1010-1018. [PMID: 33161823 DOI: 10.1080/0142159x.2020.1841127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Peripheral Intravenous access (PIV) is a procedure undertaken by Medical Practitioners and Non-Medical Practitioners. Traditional PIV uses a visual and tactile technique to locate blood vessels close to the surface of the skin. Chronic medical conditions, dehydration, obesity and recurrent intravenous access can make PIV challenging. Ultrasound (US) guided PIV is recommended to aid the identification of the arm arteries and veins and improve the success rate of needle placement in difficult cases. Medical and non-medical schools, and hospital organisations, are recognising the importance of US guided PIV education for undergraduate and postgraduate Medical and Non-Medical Practitioners. This to promote independence, efficiency and to improve patient safety. The aim of this 12 tips article is to highlight the considerations and practicalities of integrating and delivering, a practical based skills (PBS) session, on the use of US guided practice as an adjunct in difficult PIV, into the undergraduate medical education curricula.
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Affiliation(s)
- Luke McMenamin
- Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | - Fiona E Brown
- James Cook University Teaching Hospital, South Tees Hospitals NHS Foundation Trust Middlesbrough, UK
| | - Mohit Arora
- Department of Emergency Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James Barnard
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | - Laura E Smith
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | - David J Stockell
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Patrick Tung
- Department of Emergency Medicine, Dewsbury and District Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Richard J Wakefield
- Department of Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Asoka Weerasinghe
- Department of Emergency Medicine, Dewsbury and District Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
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33
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Kalagara H, Coker B, Gerstein NS, Kukreja P, Deriy L, Pierce A, Townsley MM. Point-of-Care Ultrasound (POCUS) for the Cardiothoracic Anesthesiologist. J Cardiothorac Vasc Anesth 2021; 36:1132-1147. [PMID: 33563532 DOI: 10.1053/j.jvca.2021.01.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/06/2021] [Accepted: 01/09/2021] [Indexed: 12/21/2022]
Abstract
Point-of-Care Ultrasound (POCUS) is a valuable bedside diagnostic tool for a variety of expeditious clinical assessments or as guidance for a multitude of acute care procedures. Varying aspects of nearly all organ systems can be evaluated using POCUS and, with the increasing availability of affordable ultrasound systems over the past decade, many now refer to POCUS as the 21st-century stethoscope. With the current available and growing evidence for the clinical value of POCUS, its utility across the perioperative arena adds enormous benefit to clinical decision-making. Cardiothoracic anesthesiologists routinely have used portable ultrasound systems for nearly as long as the technology has been available, making POCUS applications a natural extension of existing cardiothoracic anesthesia practice. This narrative review presents a broad discussion of the utility of POCUS for the cardiothoracic anesthesiologist in varying perioperative contexts, including the preoperative clinic, the operating room (OR), intensive care unit (ICU), and others. Furthermore, POCUS-related education, competence, and certification are addressed.
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Affiliation(s)
- Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Bradley Coker
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Promil Kukreja
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Lev Deriy
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Albert Pierce
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL.
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Convissar D, Bittner EA, Chang MG. Biplane Imaging Using Portable Ultrasound Devices for Vascular Access. Cureus 2021; 13:e12561. [PMID: 33437560 PMCID: PMC7793334 DOI: 10.7759/cureus.12561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The use of ultrasound guidance for the placement of difficult IVs, arterial lines, and central venous access has become the standard of care. While imaging quality has improved over the last two decades, the lack of affordability, availability, and training have been major limitations in its routine clinical use. We detail the first reported use of biplane imaging using a portable ultrasound probe for difficult vascular access to increase first past success, efficiency, safety, and sterility during the coronavirus disease 2019 (COVID-19) pandemic.
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Affiliation(s)
- David Convissar
- Anesthesiology and Critical Care, Massachusetts General Hospital, Boston, USA
| | - Edward A Bittner
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
| | - Marvin G Chang
- Anesthesiology and Critical Care, Massachusetts General Hospital, Boston, USA
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35
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Gold AK, Al-Ghofaily L, Wenger IE, Augoustides JG. Arterial Access-Choosing In-Plane or Out-of-Plane Imaging for Vessel Cannulation. J Cardiothorac Vasc Anesth 2020; 35:89-90. [PMID: 33139162 DOI: 10.1053/j.jvca.2020.09.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew K Gold
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lourdes Al-Ghofaily
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Isaac E Wenger
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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36
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Rosa RG, Teixeira C, Sjoding M. Novel approaches to facilitate the implementation of guidelines in the ICU. J Crit Care 2020; 60:1-5. [PMID: 32731099 DOI: 10.1016/j.jcrc.2020.07.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 12/12/2022]
Abstract
The effective implementation of evidence-based recommendations in routine intensive care unit (ICU) practice is challenging. Barriers related to the proposed recommendations, local contexts and processes can make the adoption of evidence-based practices difficult, contributing to healthcare inefficiency and worse patient and family outcomes. This review discusses the common barriers to guideline implementation in critical care settings, explores how implementation science provides an important framework for guiding implementation interventions, and discusses some specific and proven implementation strategies to improve adherence to evidence-based practices in the ICU.
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Affiliation(s)
- Regis Goulart Rosa
- Intensive Care Unit,Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil.
| | - Cassiano Teixeira
- Intensive Care Unit, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil
| | - Michael Sjoding
- Department of Internal Medicine, Pulmonary and Critical Care Medicine and Institute for Healthcare Policy & Innovation, Michigan Center for Integrated Research in Critical Care, University of Michigan, Ann Arbor, MI, USA
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37
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Barksdale AN, Goede M, Madden S, Campos A, High R. Obesity is not associated with increased difficulty placing peripheral IVs in trauma activation patients. Am J Emerg Med 2020; 38:2228-2229. [PMID: 32641265 DOI: 10.1016/j.ajem.2020.06.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Aaron Nathan Barksdale
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America.
| | - Matthew Goede
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States of America.
| | - Scott Madden
- Department of Emergency Medicine, University of Nebraska Medical Center (Bellevue Campus), Bellevue, NE, United States of America.
| | - Abraham Campos
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America.
| | - Robin High
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States of America.
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38
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Su Y, Hou JY, Ma GG, Hao GW, Luo JC, Yu SJ, Liu K, Zheng JL, Xue Y, Luo Z, Tu GW. Comparison of the proximal and distal approaches for axillary vein catheterization under ultrasound guidance (PANDA) in cardiac surgery patients susceptible to bleeding: a randomized controlled trial. Ann Intensive Care 2020; 10:90. [PMID: 32643012 PMCID: PMC7343682 DOI: 10.1186/s13613-020-00703-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 06/26/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The present study aimed at comparing the success rate and safety of proximal versus distal approach for ultrasound (US)-guided axillary vein catheterization (AVC) in cardiac surgery patients susceptible to bleeding. METHODS In this single-center randomized controlled trial, cardiac surgery patients susceptible to bleeding and requiring AVC were randomized to either the proximal or distal approach group for US-guided AVC. Patients susceptible to bleeding were defined as those who received oral antiplatelet drugs or anticoagulants for at least 3 days. Success rate, catheterization time, number of attempts, and mechanical complications within 24 h were recorded for each procedure. RESULTS A total of 198 patients underwent randomization: 99 patients each to the proximal and distal groups. The proximal group had the higher first puncture success rate (75.8% vs. 51.5%, p < 0.001) and site success rate (93.9% vs. 83.8%, p = 0.04) than the distal group. However, the overall success rates between the two groups were similar (99.0% vs. 99.0%; p = 1.00). Moreover, the proximal group had fewer average number of attempts (p < 0.01), less access time (p < 0.001), and less successful cannulation time (p < 0.001). There was no significant difference in complications between the two groups, such as major bleeding, minor bleeding, arterial puncture, pneumothorax, nerve injuries, and catheter misplacements. CONCLUSIONS For cardiac surgery patients susceptible to bleeding, both proximal and distal approaches for US-guided AVC can be considered as feasible and safe methods of central venous cannulation. In terms of the first puncture success rate and cannulation time, the proximal approach is superior to the distal approach. Trial registration Clinicaltrials.gov, NCT03395691. Registered January 10, 2018, https://clinicaltrials.gov/ct2/show/NCT03395691?cond=NCT03395691&draw=1&rank=1 .
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Affiliation(s)
- Ying Su
- grid.8547.e0000 0001 0125 2443Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032 China
| | - Jun-yi Hou
- grid.8547.e0000 0001 0125 2443Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032 China
| | - Guo-guang Ma
- grid.8547.e0000 0001 0125 2443Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032 China
| | - Guang-wei Hao
- grid.8547.e0000 0001 0125 2443Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032 China
| | - Jing-chao Luo
- grid.8547.e0000 0001 0125 2443Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032 China
| | - Shen-ji Yu
- grid.8547.e0000 0001 0125 2443Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032 China
| | - Kai Liu
- grid.8547.e0000 0001 0125 2443Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032 China
| | - Ji-li Zheng
- grid.413087.90000 0004 1755 3939Department of Nursing, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032 China
| | - Yan Xue
- grid.413087.90000 0004 1755 3939Department of Nursing, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032 China
| | - Zhe Luo
- grid.8547.e0000 0001 0125 2443Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032 China
- grid.8547.e0000 0001 0125 2443Department of Critical Care Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, No. 668 Jinghu Road, Huli District, Xiamen, 361015 China
| | - Guo-wei Tu
- grid.8547.e0000 0001 0125 2443Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032 China
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Sanchez C, Baroutjian A, McKenney M, Elkbuli A. Obesity is not associated with increased difficulty placing peripheral IVs in trauma activation patients. Am J Emerg Med 2020; 38:2226-2227. [PMID: 33008705 DOI: 10.1016/j.ajem.2020.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/22/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Carol Sanchez
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Amanda Baroutjian
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; University of South Florida, Tampa, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.
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Bala N, Pathak V, Goyal S, Kothari N. Popliteal artery cannulation as a saviour during prone positioning. BMJ Case Rep 2020; 13:13/6/e234370. [PMID: 32513762 DOI: 10.1136/bcr-2020-234370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The cannulation of the peripheral artery is a prerequisite for invasive blood pressure monitoring and repeated arterial blood gas sampling. Radial artery is commonly used site for inserting an arterial cannula. Many times, either during the change of posture or during prone ventilation, the arterial cannula gets displaced, and it is challenging to reinsert the arterial cannula in the lateral or prone position. In such circumstances, an alternative site of arterial cannulation needs to be looked into; we report a case in which the popliteal artery was used for arterial cannulation while the patient was in a prone position.
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Affiliation(s)
- Narayan Bala
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vinay Pathak
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shilpa Goyal
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Nikhil Kothari
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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[Ultrasound visualization of the guidewire and positioning of the central venous catheter : A prospective observational study]. Anaesthesist 2020; 69:489-496. [PMID: 32409857 DOI: 10.1007/s00101-020-00794-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/08/2020] [Accepted: 04/21/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND After insertion of a central venous catheter (CVC) the catheter position must be controlled and a pneumothorax ruled out. OBJECTIVE The aim was to examine whether the use of two standard acoustic windows known from emergency sonography examination techniques is feasible to 1) verify the correct intravenous localization and direction of the guidewire before final CVC insertion and 2) correctly predict the required CVC length for positioning of the catheter tip in the lower third of the superior vena cava. MATERIAL AND METHODS This single center prospective observational study included adult patients (age ≥18 years) with an indication for CVC insertion after institutional ethics approval was obtained. Puncture sites were restricted to bilateral internal jugular and subclavian veins and except for duplicate examinations no further exclusion criteria were defined. After vessel puncture and insertion of the guidewire, the vena cava was displayed by an additional ultrasound examiner (sector scanner 1.5-3.6 MHz) using the transhepatic or subcostal acoustic window to localize the guidewire. For positioning of the CVC tip, the required catheter length in relation to the cavoatrial junction was measured using the guidewire marks during slow retraction and consecutive disappearance of the J‑shaped guidewire tip from each acoustic window. From the resulting insertion length of the guidewire 4 cm was subtracted for the transhepatic and 2 cm for the subcostal window under the assumption that this length correlates to the distance from the cavoatrial junction. The CVC was finally inserted and a chest radiograph was performed for radiological verification of the CVC position. RESULTS Of 100 included patients, 94 could finally be analyzed. The guidewire could be identified in the vena cava in 91 patients (97%) within a time period of 2.2 ± 1.9 min. In three patients, the wire could not be visualized, although two catheters had the correct position, while one catheter was incorrectly positioned in the opposite axillary vein. In the second study part, positioning of the CVC was evaluated in 44 of the 94 patients. In 5 of these 44 patients, the correct direction and disappearance of the guidewire from the acoustic window could also be reliably visualized; however, with the left subclavian vein as the puncture site, the respective catheters were up to 6 cm too short for correct positioning. Thus, these 5 patients were excluded from this analysis. In the remaining 39 patients, the position of the CVC tip was optimally located in the lower third of the superior vena cava according to the chest radiograph in 20 patients (51%), while it was relatively too high in 5 patients (13%) and too low (entrance of the right atrium) in 9 patients. In the other 5 patients, disappearance of the guidewire from the acoustic window was not definitely detectable. CONCLUSION The presented intraprocedural ultrasound-based method using two standard acoustic windows is reliable for verification of the correct intravenous location and direction of the guidewire even before dilatation of the vessel puncture site for insertion of the catheter. Furthermore, the method allows the clinically acceptable measurement of the required length for catheter positioning. A chest radiograph can be waived provided the ultrasound examination (identification of the guidewire and exclusion of puncture-related complications such as pneumothorax) is unambiguous.
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Abstract
More than 5 million central lines are placed in the United States each year. Advanced practice providers place central lines and must understand the importance of ultrasound guidance technology. The use of anatomic landmarks to place central lines has been employed in the past and in some instances is still used. This method may make accessing the target vessel difficult in the patient with anomalous anatomy or in the obese patient. These characteristics decrease successful placement and increase complications. Different organizations have agreed that the use of ultrasound during central venous access has decreased rates of complication and cost. In addition to cannulating and accessing a central vein, ultrasound can be used to rapidly confirm placement and to rule out complications such as pneumothorax. Utilizing ultrasound to assist in performance of procedures, and in assessment of patients, is a skill that should be optimized by nurse practitioners.
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Volpicelli G, Mayo P, Rovida S. Focus on ultrasound in intensive care. Intensive Care Med 2020; 46:1258-1260. [PMID: 32236645 DOI: 10.1007/s00134-020-06027-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Turin, Italy.
| | - Paul Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, Hempstead, NY, USA
| | - Serena Rovida
- Department of Emergency Medicine, Linköping University Hospital, Linköping, Sweden
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Iacobone E, Elisei D, Gattari D, Carbone L, Capozzoli G. Transthoracic echocardiography as bedside technique to verify tip location of central venous catheters in patients with atrial arrhythmia. J Vasc Access 2020; 21:861-867. [DOI: 10.1177/1129729820905200] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Transthoracic echocardiography with bubble test is an accurate, reproducible, and safe technique to verify the location of the tip of the central venous catheter. The aim of this study is to confirm the effectiveness of this method for tip location in patients with atrial arrhythmia. Methods: Transthoracic echocardiography with bubble test was adopted as a method of tip location in patients with atrial arrhythmia requiring central venous catheter. If bubbles were evident in the right atrium in less than 2 s after simple saline injection, tip placement was assumed as correct. In cases of uncertain visualization of the bubble effect, the test was repeated injecting a saline–air mixture. Tip location was also assessed by post-procedural chest X-ray. Results: In 42 patients with no evident P-wave at the electrocardiography, we placed 34 centrally inserted central catheters and 8 peripherally inserted central catheters. Transthoracic echocardiography with bubble test detected two centrally inserted central catheter malpositions. In four patients with peripherally inserted central catheter, transthoracic echocardiography with bubble test was positive only when repeated with the saline–air mixture. When the transthoracic echocardiography was positive, the mean (±standard deviation) time for onset of the bubble effect was 0.89 ± 0.33 s in patients with centrally inserted central catheter and 1.1 ± 0.20 s in those with peripherally inserted central catheter; such time difference was not statistically significant (p > 0.05). Conclusion: Tip location of central venous catheter by transthoracic echocardiography with bubble test is feasible, safe, and accurate in patients with atrial arrhythmia. This method can also be applied in peripherally inserted central catheters; however, further studies may be needed to confirm its use in this type of catheters.
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Affiliation(s)
- Emanuele Iacobone
- Department of Intensive Care and Anesthesia, Central Hospital of Macerata, Macerata, Italy
| | - Daniele Elisei
- Department of Intensive Care and Anesthesia, Central Hospital of Macerata, Macerata, Italy
| | - Diego Gattari
- Department of Intensive Care and Anesthesia, Central Hospital of Macerata, Macerata, Italy
| | - Luigi Carbone
- Department of Intensive Care and Anesthesia, Central Hospital of Macerata, Macerata, Italy
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Sidoti A, Brogi E, Biancofiore G, Casagli S, Guarracino F, Malacarne P, Tollapi L, Borselli M, Santori G, Corradi F, Forfori F. Ultrasound- versus landmark-guided subclavian vein catheterization: a prospective observational study from a tertiary referral hospital. Sci Rep 2019; 9:12248. [PMID: 31439913 PMCID: PMC6706444 DOI: 10.1038/s41598-019-48766-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/06/2019] [Indexed: 01/10/2023] Open
Abstract
This was a single-center, observational, prospective study designed to compare the effectiveness of a real-time, ultrasound- with landmark-guided technique for subclavian vein cannulation. Two groups of 74 consecutive patients each underwent subclavian vein catheterization. One group included patients from intensive care unit, studied by using an ultrasound-guided technique. The other group included patients from surgery or emergency units, studied by using a landmark technique. The primary outcome for comparison between techniques was the success rate of catheterization. Secondary outcomes were the number of attempts, cannulation failure, and mechanical complications. Although there was no difference in total success rate between ultrasound-guided and landmark groups (71 vs. 68, p = 0.464), the ultrasound-guided technique was more frequently successful at first attempt (64 vs. 30, p < 0.001) and required less attempts (1 to 2 vs. 1 to 6, p < 0.001) than landmark technique. Moreover, the ultrasound-guided technique was associated with less complications (2 vs. 13, p < 0.001), interruptions of mechanical ventilation (1 vs. 57, p < 0.001), and post-procedure chest X-ray (43 vs. 62, p = 0.001). In comparison with landmark-guided technique, the use of an ultrasound-guided technique for subclavian catheterization offers advantages in terms of reduced number of attempts and complications.
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Affiliation(s)
- Anna Sidoti
- Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Etrusca Brogi
- Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy.
| | | | | | | | | | - Lara Tollapi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Matteo Borselli
- Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Francesco Corradi
- Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy.,Department of Anesthesia and Intensive Care, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Francesco Forfori
- Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy
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Shin HJ, Na HS, Koh WU, Ro YJ, Lee JM, Choi YJ, Park S, Kim JH. Complications in internal jugular vs subclavian ultrasound-guided central venous catheterization: a comparative randomized trial. Intensive Care Med 2019; 45:968-976. [DOI: 10.1007/s00134-019-05651-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/18/2019] [Indexed: 01/09/2023]
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