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Kim YJ, Jung CW, Choi S, Kim Y, Seo JH. Laser guidance for ultrasound-guided radial artery catheterization using smart glasses: a randomized trial. Can J Anaesth 2023; 70:1635-1642. [PMID: 37505419 DOI: 10.1007/s12630-023-02532-0] [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: 11/03/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE The use of smart glasses during ultrasound-guided needle procedures may reduce operators' head movements but has not been shown to improve procedural performance. Laser guidance has been shown to decrease the time required for ultrasound-guided procedures in phantom models but has not been tested clinically. We hypothesized that adding laser guidance to the use of smart glasses for ultrasound-guided radial artery catheterization using the long axis approach would improve performance by relatively inexperienced users unfamilar with these techniques. METHODS In an unblinded controlled trial, we enrolled 52 patients requiring radial artery catheterization under anesthesia, randomized into two groups: smart glasses only (SO) (control; N = 26) or smart glasses with laser guidance group (SL) (N = 26). We assessed catheterization time (primary outcome), the number of needle redirections, first-pass success rate, and operator satisfaction (100 = most satisfactory; 0 = unsatisfactory). RESULTS Comparing the SL with the SO group, catheterization time was shorter (median [interquartile range], 13 [9-20] sec vs 24 [18-46] sec, P < 0.001) and the number of needle redirections was lower (0 [0-1] vs 3 [1-3], P < 0.001) while the first-pass success rate (50% vs 12%, P = 0.007) and operator satisfaction score (85 [76-95] vs 52 [44-74], P < 0.001) were higher. CONCLUSION Laser guidance improved the performance of ultrasound-guided radial artery catheterization using smart glasses in users inexperienced in the long axis in-plane approach. Nevertheless, it is unclear whether these findings are clinically significant. STUDY REGISTRATION DATE CRIS.nih.go.kr (KCT0007168); registered 8 April 2022.
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Affiliation(s)
- Yoon Jung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chul-Woo Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seungeun Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Youngwon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jeoung-Hwa Seo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Tsumura R, Gao S, Tang Y, Zhang HK. Concentric-ring arrays for forward-viewing ultrasound imaging. J Med Imaging (Bellingham) 2022; 9:065002. [PMID: 36444284 PMCID: PMC9683378 DOI: 10.1117/1.jmi.9.6.065002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2023] Open
Abstract
Purpose Current ultrasound (US)-image-guided needle insertions often require an expertized technique for clinicians because the performance of tasks in a three-dimensional space using two-dimensional images requires operators to cognitively maintain the spatial relationships between the US probe, the needle, and the lesion. This work presents forward-viewing US imaging with a ring array configuration to enable needle interventions without requiring the registration between tools and targets. Approach The center-open ring array configuration allows the needle to be inserted from the center of the visualized US image, providing simple and intuitive guidance. To establish the feasibility of the ring array configuration, the design parameters causing the image quality, including the radius of the center hole and the number of ring layers and transducer elements, were investigated. Results Experimental results showed successful visualization, even with a hole in the transducer elements, and the target visibility was improved by increasing the number of ring layers and the number of transducer elements in each ring layer. Reducing the hole radius improved the region's image quality at a shallow depth. Conclusions Forward-viewing US imaging with a ring array configuration has the potential to be a viable alternative to conventional US image-guided needle insertion methods.
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Affiliation(s)
- Ryosuke Tsumura
- Worcester Polytechnic Institute, Department of Biomedical Engineering, Worcester, Massachusetts, United States
- National Institute of Advanced Industrial Science and Technology, Health and Medical Research Institute, Tsukuba, Japan
| | - Shang Gao
- Worcester Polytechnic Institute, Department of Robotics Engineering, Worcester, Massachusetts, United States
| | - Yichuan Tang
- Worcester Polytechnic Institute, Department of Robotics Engineering, Worcester, Massachusetts, United States
| | - Haichong K. Zhang
- Worcester Polytechnic Institute, Department of Biomedical Engineering, Worcester, Massachusetts, United States
- Worcester Polytechnic Institute, Department of Robotics Engineering, Worcester, Massachusetts, United States
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Effect of Transradial Artery Catheterization on Shock Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:8746066. [PMID: 36212956 PMCID: PMC9534606 DOI: 10.1155/2022/8746066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/13/2022] [Accepted: 09/17/2022] [Indexed: 11/18/2022]
Abstract
Objective. This study aimed to investigate the clinical effect of ultrasound-guided transradial catheterization (TRC) for ICU patients with shock. Methods. 120 shock patients registered in the ICU of our hospital from January 2019 to June 2022 were selected for prospective study. The control group (60 patients) were treated with palpation-guided TRC. The observation group was treated with ultrasound-guided TRC and was divided into the internal puncture group (internal TRC) and external puncture group (external TRC), with 30 cases in each. The first attempt success rate, total success rate, operation duration, complication, measurement of radial artery, and VAS scores were compared in these groups. Results. The success rate was higher in the observation group than in the control group (
), and higher in the internal puncture group than in the external puncture group (
). The first attempt success rate was significantly higher in the observation group than in the control group (
), with no significant difference in between (
). The number of attempts and operation duration were lower in the observation group than in the control group (
), with significantly more operation duration in the internal puncture group than in the external puncture group (
) and no significant difference in the number of attempts (both
). The complication rate was significantly lower in the observation group than in the control group (
) and there was no significant difference in between (
). The radial artery diameter, cross-sectional area, and depth from the skin in the observation group were larger than those in the control group (
) and there was no significant difference in between (
). At 1, 6, 24, and 48 h after the surgery, the observation group showed lower VAS scores than the control group (
). Conclusion. The ultrasound-guided TRC reduced the number of attempts, the complication rates, and the operation duration. For patients with shock, if Doppler ultrasound cannot detect blood flow, the success rate in the observation group was higher than that in the control group, and its advantage is worthy of promotion in severe patients.
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Vydyanathan A, Agrawal P, Shetty N, Nair S, Shilian N, Shaparin N. The Use of a New Device-Assisted Needle Guidance versus Conventional Approach to Perform Ultrasound Guided Brachial Plexus Blockade: A Randomized Controlled Study. Local Reg Anesth 2022; 15:61-69. [PMID: 35915616 PMCID: PMC9338390 DOI: 10.2147/lra.s363563] [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: 03/04/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Ultrasound guidance during nerve blockade poses the challenge of maintaining in-plane alignment of the needle tip. The needle guidance device maintains needle alignment and assists with in-plane needle visualization. The purpose of this study is to evaluate the utility of this device by comparing procedure performance during brachial plexus blockade with the conventional approach. Methods After the Institutional Review Board approval and obtaining informed consent, 70 patients receiving either interscalene or supraclavicular nerve blocks were randomly assigned into 2 groups, a conventional approach versus utilizing the needle guidance device. An independent observer recorded: total procedure time; needle insertion time; number of unplanned redirections; and number of reinsertions. Additionally, physician satisfaction and ease of needle visualization were assessed. Results Data from seventy patients were analyzed. The median [25th percentile-75th percentile] time to complete the block by the device assisted needle guidance group was 3 (2–3.75) minutes and 4 (3–6) minutes in the conventional approach group (p < 0.001). Additionally, subgroup analyses were performed in the supraclavicular block and interscalene block. Supraclavicular blockade, needle insertion time (median [25th percentile-75th percentile] in seconds) (106 [92–162] vs 197 [140–278]), total procedure time (3 [2–3] vs 4.5 [4–6] in minutes) and unplanned needle redirections (2 [1–5] vs 5.5 [3–9]) were significantly lower in needle guidance group (p < 0.001). With interscalene blockade, needle insertion time (86 [76–146] vs 126 [94–295]) and unplanned needle redirections (2 [1–3] vs 4 [2–8.5]) were significantly lower with needle guidance (p < 0.001), but total procedure time was similar. All the physicians reported that they would use the needle guidance again, and 90% would prefer it for in-plane blocks. Conclusion Performing regional blocks using the needle guidance device reduces needle insertion time and unplanned needle redirections in brachial plexus blockade. Moreover, physician satisfaction also improved compared to the use of the conventional technique.
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Affiliation(s)
- Amaresh Vydyanathan
- Department of Anesthesiology and Pain Management, Montefiore Medical Center, Bronx, NY, USA
| | | | - Naveen Shetty
- Department of Anesthesiology, New York University, New York, NY, USA
| | - Singh Nair
- Department of Anesthesiology and Pain Management, Montefiore Medical Center, Bronx, NY, USA
| | - Nancy Shilian
- Department of Family Medicine, Mount Sinai South Nassau Hospital, Oceanside, NY, USA
| | - Naum Shaparin
- Department of Anesthesiology and Pain Management, Montefiore Medical Center, Bronx, NY, USA
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A new method for facilitating ultrasound-guided in-plane cannulation of the subclavian vein: a randomized clinical trial. Sci Rep 2021; 11:9605. [PMID: 33953213 PMCID: PMC8099870 DOI: 10.1038/s41598-021-88798-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 04/16/2021] [Indexed: 11/11/2022] Open
Abstract
The objective of this study was to propose a new method for facilitating needle-beam alignment ultrasound-guided in-plane catheterization of the subclavian vein (SCV). Three hundred patients were recruited, and ultrasound examination of the SCV was performed. Then, the patients were divided into two groups and SCV catheterization was performed: ultrasound-guided catheterization with the aiming method (group A) and ultrasound-guided catheterization with needle guide (group NG). The success rate, insertion time, number of skin breaks, number of needle redirections, needle visibility and rate of mechanical complications were documented and compared for each procedure. To depict the optimum long-axis view of the SCV, there was a 30° ± 7.3° angle (rotation) between the long axis of the ultrasound probe and the clavicle, while there was a 39° ± 7.4° angle (tilt) between the ultrasound beam plane and the right chest wall. The aiming method was associated with fewer skin breaks [(mean (IQR): 1 (1–1) times vs 1 (1–2) times, P = 0.009], a shorter time to cannulation [(mean (IQR): 39 (32–48.5) s vs 48 (44–54.8) s, P = 0.000] and more needle redirections [(mean (IQR): 0 (0–1) vs 0 (0–0), P = 0.000]. There were no differences between group A and group NG in the overall success rate, first puncture success rate, needle visibility or mechanical complication rate. In conclusion, during ultrasound-guided in-plane catheterization of the SCV, the aiming method provides comparable needle-beam alignment with a lower cannulation time than the needle guide technique.
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Nakame K, Kaji T, Onishi S, Murakami M, Nagano A, Matsui M, Nagai T, Yano K, Harumatsu T, Yamada K, Yamada W, Masuya R, Muto M, Ieiri S. A retrospective analysis of the real-time ultrasound-guided supraclavicular approach for the insertion of a tunneled central venous catheter in pediatric patients. J Vasc Access 2021; 23:698-705. [PMID: 33827294 DOI: 10.1177/11297298211008084] [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: 11/15/2022] Open
Abstract
PURPOSE Tunneled central venous catheter (tCVC) placement plays an important role in the management of pediatric patients. We adopted a real-time ultrasound (US)-guided supraclavicular approach to brachiocephalic vein cannulation. We evaluated the outcomes of tCVC placement via a US-guided supraclavicular approach. METHODS A retrospective study was performed for patients who underwent US-guided central venous catheterization of the internal jugular vein (IJV group) and brachiocephalic vein (BCV group) in our institution. The background information and outcomes were reviewed using medical records. RESULTS We evaluated 85 tCVC placements (IJV group: n = 59, BCV group: n = 26). Postoperative complications were recognized in 19 patients in the IJV group (catheter-related bloodstream infection (CRBSI), n = 14 (1.53 per 1000 catheter days); occlusion, n = 1 (1.7%, 1.09 per 1000 catheter days); accidental removal, n = 3 (5.2%, 0.33 per 1000 catheter days); and other, n = 1 (1.7%, 1.09 per 1000 catheter days)) and five patients in the BCV group (CRBSI, n = 2 (0.33 per 1000 catheter days); catheter damage, n = 1 (3.8%, 1.67 per 1000 catheter days); and accidental removal, n = 2 (7.7%, 0.33 per 1000 catheter days)). In the BCV group, despite that, the incidence of postoperative complications was lower (p = 0.205) and the period of placement was significantly longer in comparison to the IJV group (p = 0.024). CONCLUSION US-guided placement of tunneled CVC though the BCV results in a low rate of postoperative complications despite longer CVC indwelling times compared to IJV insertion. Our results suggest that BCV insertion of tunneled CVC in children may offer advantages in terms of device performance and patient safety.
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Affiliation(s)
- Kazuhiko Nakame
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.,Department of Surgery, Division of the Gastrointestinal, Endocrine and Pediatric Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Masakazu Murakami
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Ayaka Nagano
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Mayu Matsui
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Taichiro Nagai
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Keisuke Yano
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Toshio Harumatsu
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Ryuta Masuya
- Department of Surgery, Division of the Gastrointestinal, Endocrine and Pediatric Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Mitsuru Muto
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
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Raft J, Dupanloup D, Clerc-Urmès I, Baumann C, Richebé P, Bouaziz H. Training novice in ultrasound-guided venipuncture: A randomized controlled trial comparing out-of-plane needle-guided versus free-hand ultrasound techniques on a simulator. J Vasc Access 2021; 22:898-904. [PMID: 33663253 DOI: 10.1177/1129729820962916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Peripheral intravenous access is a common medical procedure, however, it can be difficult to perform in some patients. Success rates have proved greater with ultrasound guidance. Peripheral intravenous access using ultrasound requires specific training, especially for new ultrasound users. To overcome these difficulties, guidance devices on ultrasound probes are able to control the angle of penetration into tissues. We hypothesized that, and particularly for new ultrasound users, the use of a needle guide (NG) paired with the out-of-plane approach would facilitate puncture of a simulation model of vessel more effectively than similar free hand (FH) techniques. METHODS A prospective controlled randomized study was conducted of new ultrasound users using a guide wire introducer needle on gelatine phantom. After a 30-min lecture, one group performed the FH technique and the other group performed the NG technique both in an out-of-plane approach. The main criterion was the number of attempts before success of catheterization of this model of vessel. RESULTS Thirty-four nurse anesthetist students participated in the study. The number of attempts before success using the NG technique was significantly lower: 3.7 (±0.9) in the NG group versus 6.7 (±3.3) in the FH group (p = 0.01). In the NG group, 100% of the participants achieved success after the sixth attempt. In the FH group, only 81.25% (n = 13/16) reached success. CONCLUSION NG technique has been proved to have a steeper learning curve compared with the FH technique. A study on a learning curve in clinical practice is needed to confirm these results.
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Affiliation(s)
- Julien Raft
- Department of Anesthesiology, Cancer Institute of Lorraine, Vandoeuvre-les-Nancy, France.,INSERM UMR-S 1116 Equipe 2 University of Lorraine, Vandoeuvre-les-Nancy, France
| | - Danièle Dupanloup
- School of Nurse Anesthetist, University Hospital of Nancy, Vandœuvre-lès-Nancy, France
| | - Isabelle Clerc-Urmès
- Methodological, Promotion and Investigation Department, UMDS, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Cédric Baumann
- Methodological, Promotion and Investigation Department, UMDS, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, University of Montreal, Maisonneuve-Rosemont Hospital and CEMTL, Montréal, QC, Canada
| | - Hervé Bouaziz
- Department of Anesthesiology and Intensive Care, University Hospital of Nancy, Nancy, France
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Watanabe K, Tokumine J, Lefor AK, Yorozu T. Shallow-angle needle guide for ultrasound-guided internal jugular venous catheterization: A randomized controlled crossover simulation study (CONSORT). PLoS One 2020; 15:e0235519. [PMID: 32603357 PMCID: PMC7326219 DOI: 10.1371/journal.pone.0235519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/16/2020] [Indexed: 02/05/2023] Open
Abstract
Background Needle guides for ultrasound-guided internal jugular venous catheterization facilitate successful cannulation. The ability of a needle guide to prevent a posterior vein wall injury which may secondarily induce lethal complications, is unknown. Previous studies showed that a shallow angle of approach may reduce the incidence of posterior wall injuries. We developed a novel needle guide with a shallow angle of approach for ultrasound-guided venous catheterization and examined whether this needle guide reduces the incidence of posterior wall injuries compared to a conventional needle guide and free-hand placement in a simulated vein. Methods This study was a randomized crossover-controlled trial. The primary outcome was the rate of posterior vein wall injuries. Participants had a didactic lecture about three ultrasound-guided techniques using the short-axis out-of-plane approach, including free-hand (P-free), a commercial needle guide (P-com), and a novel needle guide (P-sha). The view inside a simulated vein was recorded during venipuncture. Results Thirty-five residents participated in this study. Posterior vein wall injuries occurred in 66% using P-free, 60% using P-com, and 0% using P-sha (p< 0.01). There was no significant difference in the incidence of posterior vein wall injuries between P-free and P-com. Conclusions Use of a shallow angle of approach needle guide resulted in a lower rate of posterior vein injuries during venipuncture of a simulated vein compared with other techniques using a steeper angle techniques.
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Affiliation(s)
- Kunitaro Watanabe
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
- * E-mail:
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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Wang J, Lai Z, Weng X, Lin Y, Wu G, Su J, Huang Q, Zeng J, Liu J, Zhao Z, Yan T, Zhang L, Zhou L. Modified long-axis in-plane ultrasound technique versus conventional palpation technique for radial arterial cannulation: A prospective randomized controlled trial. Medicine (Baltimore) 2020; 99:e18747. [PMID: 31914094 PMCID: PMC6959944 DOI: 10.1097/md.0000000000018747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A low first-pass success rate of radial artery cannulation was obtained when using the conventional palpation technique (C-PT) or conventional ultrasound-guided techniques, we; therefore, evaluate the effect of a modified long-axis in-plane ultrasound technique (M-LAINUT) in guiding radial artery cannulation in adults. METHODS We conducted a prospective, randomized and controlled clinical trial of 288 patients undergoing radial artery cannulation. Patients were randomized 1:1 to M-LAINUT or C-PT group at Fujian Medical University Union Hospital between 2017 and 2018. Radial artery cannulation was performed by 3 anesthesiologists with different experience. The outcome was the first and total radial artery cannulation success rates, the number of attempts and the cannulation time, and incidence of complications. RESULTS Two hundred eighty-five patients were statistically analyzed. The success rate of first attempt was 91.6% in the M-LAINUT group (n = 143) and 57.7% in the C-PT group (n = 142; P < .001) (odds ratio, 7.9; 95% confidence interval, 4.0-15.7). The total success rate (≤5 minutes and ≤3 attempts) in the M-LAINUT group was 97.9%, compared to 84.5% in the palpation group (P < .001) (odds ratio, 8.5; 95% confidence interval, 2.5-29.2). The total cannulation time was shorter and the number of attempts was fewer in the M-LAINUT group than that in the C-PT group (P < .05). The incidence of hematoma in the C-PT group was 19.7%, which was significantly higher than the 2.8% in the M-LAINUT group (P < .001). CONCLUSIONS Modified long-axis in-plane ultrasound-guided radial artery cannulation can increase the first and total radial artery cannulation success rates, reduce the number of attempts, and shorten the total cannulation time in adults.
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Affiliation(s)
| | | | | | - Yong Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital
| | | | | | | | | | | | | | | | | | - Linying Zhou
- Public Technology Service Center of Fujian Medical University, Fujian Medical University, Fuzhou, Fujian Province, China
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10
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England JR, Fischbeck T, Tchelepi H. The Value of Needle-Guidance Technology in Ultrasound-Guided Percutaneous Procedures Performed by Radiology Residents: A Comparison of Freehand, In-Plane, Fixed-Angle, and Electromagnetic Needle Tracking Techniques. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:399-405. [PMID: 30027597 DOI: 10.1002/jum.14701] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Radiology residents typically learn ultrasound-guided procedures by performing supervised procedures on patients who may experience longer procedure times and higher complication rates. The purpose of this study was to determine if existing technologies, such as in-plane, fixed-angle guidance (IPFA) and electromagnetic needle tracking (ENT), can improve resident procedure time and accuracy. METHODS Radiology residents (18 total) were randomized to 1 of 3 ultrasound-guidance technique groups-freehand, IPFA, or ENT-and instructed to place a needle into 4 liver lesions in a humanoid phantom, each increasing in difficulty. For each lesion, residents were timed from skin puncture to needle placement, and the number of times the needle was pulled back and redirected (pullbacks) was recorded. Primary outcomes were total time and total number of pullbacks for all 4 lesions. Secondary outcomes were individual time and number of pullbacks for each lesion. RESULTS Compared to the freehand group, the IPFA and ENT groups demonstrated lower procedural time and number of pullbacks both in total and for each individual lesion. Differences in total time and total number of pullbacks were significant (P < .001), as were differences for lesion 3 (P = .002-.02) and lesion 4 (P < .001). Differences for lesions 1 and 2 were not statistically significant. CONCLUSIONS Radiology resident procedure time and procedure accuracy (as judged by number of pullbacks) are significantly improved by the use IPFA and ENT guidance technologies.
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Affiliation(s)
- Joseph R England
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, California USA
| | - Tucker Fischbeck
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, California USA
| | - Hisham Tchelepi
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, California USA
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11
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Kwon SY, Kim JW, Cho MJ, Al-Sinan AH, Han YJ, Kim YH. The efficacy of cervical spine phantoms for improving resident proficiency in performing ultrasound-guided cervical medial branch block: A prospective, randomized, comparative study. Medicine (Baltimore) 2018; 97:e13765. [PMID: 30572526 PMCID: PMC6320022 DOI: 10.1097/md.0000000000013765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Few studies have been conducted on the utility of cervical spine phantoms for practicing cervical procedures. Here, we describe a simple method for creating a cervical spine phantom and investigate whether the use of a gelatin-based phantom is associated with improved proficiency in performing ultrasound-guided cervical medial branch block. METHODS A cervical spine phantom was prepared using a cervical spine model immersed in a mixture of gelatin and psyllium husk. In total, 27 participants, inexperienced in spinal ultrasonography, were enrolled and allocated to 1 of 2 groups (training group, n = 18; control group, n = 9). All participants were tested (test-1) following an introductory course of basic ultrasonography. Participants in the control group were tested again after 1 week (test-2). Those in the training group received a further individual 3-hour training session, and were tested again after 1 week (test-2). RESULTS The mean performance score in test-1 was 62.5 ± 10.1 points in the training group and 62.3 ± 4.1 points in the control group [95% confidence interval (95% CI) -5.5 to 5.8; P = .954]. In test-2, the mean score was 86.8 ± 6.5 points and 59.9 ± 4.4 points in the training and control groups, respectively (95% CI 21.9-31.8; P < .001). The mean time required to complete test-1 was 84.6 ± 26.6 seconds in training group and 90.7 ± 43.9 seconds in the control group (95% CI -34.0 to 21.7; P = .653); in test-2, the time required was 56.6 ± 27.9 and 91.2 ± 43.8 seconds (95% CI -63.0 to -6.2; P = .019), respectively. Interobserver reliability showed excellent agreement based on the intraclass correlation coefficient, and moderate to almost perfect agreement by kappa statistics. CONCLUSION Training using a gelatin-based cervical spine phantom helps novices acquire the skills necessary to perform ultrasound-guided cervical medial branch blocks.
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Affiliation(s)
- So Young Kwon
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon
| | - Jong-Woan Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Ji Cho
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Abdullah Hussain Al-Sinan
- Department of Anesthesiology and Pain Medicine, Ministry of Health, Qatif Central Hospital, Alawjam, Saudi Arabia
| | - Yun-Joung Han
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Hoon Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Meek ME(M, Meek JC, Hollowoa B, Li R, Deloney LA, Phelan KD. Lightly Embalmed Cadavers as a Training Tool for Ultrasound-Guided Procedures Commonly Used in Interventional Radiology. Acad Radiol 2018; 25:1503-1509. [PMID: 30017501 DOI: 10.1016/j.acra.2018.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES Competency in ultrasound (US) imaging and US-guided procedures is often difficult for medical students and residents to master. The use of simulation training has been strongly encouraged but the quality of phantom models available for US-guided procedures is limited. As a feasible alternative, we describe the innovative use of a lightly embalmed cadaver for realistic practice of common interventional radiology (IR) procedures prior to direct patient care. MATERIALS AND METHODS Lightly embalmed cadavers were positioned as patients would be in the IR suite: supine, prone, and erect seated position. Lidocaine was injected and visualized under standard percutaneous techniques and sonographic guidance was used to simulate common US-guided procedures performed in IR including liver biopsy, kidney biopsy, thoracentesis, and vascular access. RESULTS The ability to position cadavers was a key factor that allowed entire procedures to be simulated. Medical students with very limited exposure to US imaging and diagnostic radiology residents with minimal exposure to US imaging successfully completed common US-guided procedures. Arterial and venous vascular access was obtained. Wires were passed and catheters easily placed via both access sites. The texture of the tissue layers provided realistic feedback for the trainees as they advanced the needle or dilated the tissues. Images from each simulated procedure resembled images expected in a living patient. CONCLUSION Lightly embalmed cadavers are an innovative and feasible tool to simulate common IR US-guided procedures in a realistic fashion for deliberate practice in advance of first-attempt encounters with patients.
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Li Y, Li Z, Ammanuel S, Gillan D, Shah V. Efficacy of using a 3D printed lumbosacral spine phantom in improving trainee proficiency and confidence in CT-guided spine procedures. 3D Print Med 2018; 4:7. [PMID: 30649653 PMCID: PMC6179970 DOI: 10.1186/s41205-018-0031-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/25/2018] [Indexed: 11/24/2022] Open
Abstract
Background Minimally-invasive spine procedures provide targeted, individualized diagnosis and pain management for patients. Competence in these procedures is acquired through experience and training. We created a 3D printed model of a degenerative lumbosacral spine with scoliosis and spondylosis, using materials that mimic bone and soft tissue density under CT. In this study, we evaluate the efficacy of using such a spine model to improve novice trainee confidence and proficiency in performing CT-guided facet joint injections. Results Thirteen medical students with no prior exposure to CT-guided spine procedures were divided into two groups. Both groups received an introductory didactic lecture, as well as identical pre- and post- test assessments. The Training group (7 students) received two separate training sessions using the simulation model. The Control group (6 students) received only one training session. The Training group demonstrated significantly fewer needle readjustments during the second simulation session, compared with the first session (p = 0.005). Both groups demonstrated significant increase in confidence in ability to perform CT-guided spine procedures on the post-test (p = 0.004 for the Control group and p = 0.00001 for the Training group). Conclusion A 3D printed lumbosacral spine phantom with realistic spondylosis can be made to facilitate novice training in minimally-invasive spine procedures. Training using a realistic lumbosacral spine model helps novices acquire the skills and confidence to perform CT-guided spine procedures.
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Affiliation(s)
- Yi Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143-0628, USA.
| | - Zhixi Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143-0628, USA
| | - Simon Ammanuel
- School of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Derrick Gillan
- Lucile Packard Children's Hospital, Stanford University, 725 Welch Road, Palo Alto, CA, 94304, USA
| | - Vinil Shah
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143-0628, USA
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Miao S, Wang X, Zou L, Zhao Y, Wang G, Liu Y, Liu S. Safety and efficacy of the oblique-axis plane in ultrasound-guided internal jugular vein puncture: A meta-analysis. J Int Med Res 2018; 46:2587-2594. [PMID: 29619861 PMCID: PMC6124295 DOI: 10.1177/0300060518765344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This meta-analysis was performed to evaluate the safety and efficacy of the oblique-axis plane in ultrasound-guided internal jugular vein puncture. Methods We searched Embase, PubMed, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure for relevant randomized clinical trials comparing the oblique axis with the short axis in ultrasound-guided internal jugular vein puncture. Results Five randomized clinical trials were included in this meta-analysis. The pooled meta-analysis showed that the incidence of arterial puncture in the oblique-axis group was significantly lower than that in the short-axis group. No significant difference was found in the first-pass success rate between the oblique-axis group and short-axis group. Additionally, there were no significant differences in the puncture success rate or number of attempts required between the two groups. Conclusion Ultrasound-guided internal jugular vein puncture using the oblique-axis plane reduced the risk of arterial puncture, but no difference was found in the first-pass success rate, puncture success rate, or number of attempts required.
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Affiliation(s)
- Shuai Miao
- 1 Department of Anesthesiology, The Affiliated Hospital of XuZhou Medical University, XuZhou, Jiangsu, China
| | - Xiuli Wang
- 1 Department of Anesthesiology, The Affiliated Hospital of XuZhou Medical University, XuZhou, Jiangsu, China
| | - Lan Zou
- 1 Department of Anesthesiology, The Affiliated Hospital of XuZhou Medical University, XuZhou, Jiangsu, China
| | - Ye Zhao
- 1 Department of Anesthesiology, The Affiliated Hospital of XuZhou Medical University, XuZhou, Jiangsu, China
| | - Guanglei Wang
- 1 Department of Anesthesiology, The Affiliated Hospital of XuZhou Medical University, XuZhou, Jiangsu, China
| | - Yuepeng Liu
- 2 Center Of Clinical Research and Translational Medicine, Lianyungang Oriental Hospital, Lianyungang, Jiangsu, China
| | - Su Liu
- 1 Department of Anesthesiology, The Affiliated Hospital of XuZhou Medical University, XuZhou, Jiangsu, China
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Ultrasound for central vascular access. A safety concept that is renewed day by day. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2018. [DOI: 10.1097/cj9.0000000000000043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Neice AE, Forton C. Evaluation of a Novel Out-of-Plane Needle Guide. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:543-549. [PMID: 28850749 DOI: 10.1002/jum.14361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 05/23/2017] [Accepted: 05/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Most ultrasound-guided regional procedures use an in-plane approach. Out-of-plane approaches may be desirable in some situations but can be difficult because of an inability to visualize the needle until it intersects the plane of the ultrasonic beam. Here we present a novel out-of-plane needle guide, using a retreating depth stop, and compare its performance with unguided in-plane and out-of-plane techniques. METHODS First- and third-year medical students with no or minimal ultrasound experience were recruited for the study. After a brief training session on in-plane and out-of-plane needling techniques, as well as use of the retreating-stop needle guide, they attempted to place a needle as close as possible to a target embedded in porcine tissue. The total time to complete the procedure was measured. Accuracy was measured by a skilled sonographer, who identified the needle tip and measured the distance to the target. The data were tested for significance using an analysis of variance. RESULTS The mean total time spent differed significantly between groups (novel needle guide, 34 seconds; in-plane, 120 seconds; out-of-plane, 113 seconds; P = .021). Needle proximity was on average more accurate with the needle guide, although this difference was not statistically significant (novel needle guide, 8 mm; in-plane, 15 mm; out-of-plane, 14 mm; P = .289). CONCLUSIONS In relatively inexperienced sonographers, the retreating-stop needle guide reduced the procedure time compared with in-plane and out-of-plane techniques. No significant changes in needling accuracy were observed.
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Affiliation(s)
- Andrew E Neice
- Department of Anesthesia and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Camelia Forton
- Department of School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
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Kim JH, Park JH, Cho J, Kong TY, Lee JH, Beom JH, Joo YS, Ko DR, Chung HS. Simulated internal jugular vein cannulation using a needle-guiding device. Am J Emerg Med 2018; 36:1931-1936. [PMID: 29467087 DOI: 10.1016/j.ajem.2018.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 02/10/2018] [Accepted: 02/11/2018] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Using a two-dimensional ultrasound-guided approach does not guarantee success during the first attempt at internal jugular vein cannulation. Our randomized, parallel simulation study examined whether a new disposable device could improve the success rate of the first attempt at ultrasound-guided internal jugular vein cannulation of a simulated internal jugular vein. METHODS Eighty-eight participants were randomized to perform needle insertion for internal jugular vein cannulation of a phantom using the ultrasound-guided approach with (case group) or without (control group) this new device. The primary outcome was the success rate of the first attempt. The secondary outcome was the frequency of mechanical complications such as arterial puncture and posterior wall puncture, procedure time, and level of difficulty. RESULTS Among 44 participants using the device, 33 (75.0%) achieved successful cannulation on the first attempt. However, only 12 (27.3%) of the 44 participants not using the device recorded success during the first attempt (risk difference, 0.477; 95% confidence interval [CI] 0.294-0.661; P<0.001). The number of attempts was significantly lower (risk difference, -3.955; 95% CI, -5.014 to -3.712; P<0.001) when participants performed cannulation with the device (1.63±1.71) than without the device (5.59±5.78). Our study also showed that participants were comfortable when performing the ultrasound-guided approach with the new device (risk difference, -1.955; 95% CI, -2.016 to -1.493; P<0.0001). CONCLUSIONS The new disposable device was effective for successful first attempts at needle insertion during ultrasound-guided internal jugular vein cannulation. Future clinical trials are needed to assess the effectiveness of this device.
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Affiliation(s)
- Ji Hoon Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Jin Ha Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemoon-gu, Seoul 03722, Republic of Korea
| | - Junho Cho
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Tae Young Kong
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Ji Hwan Lee
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Jin Ho Beom
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Young Seon Joo
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Dong Ryul Ko
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
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Fürst RVDC, Polimanti AC, Galego SJ, Bicudo MC, Montagna E, Corrêa JA. Ultrasound-Guided Vascular Access Simulator for Medical Training: Proposal of a Simple, Economic and Effective Model. World J Surg 2017; 41:681-686. [PMID: 27766394 DOI: 10.1007/s00268-016-3757-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To present a simple and affordable model able to properly simulate an ultrasound-guided venous access. DESIGN The simulation was made using a latex balloon tube filled with water and dye solution implanted in a thawed chicken breast with bones. RESULTS The presented model allows the simulation of all implant stages of a central catheter. The obtained echogenicity is similar to that observed in human tissue, and the ultrasound identification of the tissues, balloon, needle, wire guide and catheter is feasible and reproducible. CONCLUSION The proposed model is simple, economical, easy to manufacture and capable of realistically and effectively simulating an ultrasound-guided venous access.
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Affiliation(s)
| | - Afonso César Polimanti
- Department of Angiology and Vascular Surgery, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Sidnei José Galego
- Department of Angiology and Vascular Surgery, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Maria Claudia Bicudo
- Department of Angiology and Vascular Surgery, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Erik Montagna
- Laboratory of Research in Health Sciences Teaching, Faculdade de Medicina do ABC, Av Principe de Gales, 821, Santo André, SP, CEP 09060-650, Brazil.
| | - João Antônio Corrêa
- Department of Angiology and Vascular Surgery, Faculdade de Medicina do ABC, Santo André, SP, Brazil
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Saugel B, Scheeren TWL, Teboul JL. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:225. [PMID: 28844205 PMCID: PMC5572160 DOI: 10.1186/s13054-017-1814-y] [Citation(s) in RCA: 217] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The use of ultrasound (US) has been proposed to reduce the number of complications and to increase the safety and quality of central venous catheter (CVC) placement. In this review, we describe the rationale for the use of US during CVC placement, the basic principles of this technique, and the current evidence and existing guidelines for its use. In addition, we recommend a structured approach for US-guided central venous access for clinical practice. Static and real-time US can be used to visualize the anatomy and patency of the target vein in a short-axis and a long-axis view. US-guided needle advancement can be performed in an "out-of-plane" and an "in-plane" technique. There is clear evidence that US offers gains in safety and quality during CVC placement in the internal jugular vein. For the subclavian and femoral veins, US offers small gains in safety and quality. Based on the available evidence from clinical studies, several guidelines from medical societies strongly recommend the use of US for CVC placement in the internal jugular vein. Data from survey studies show that there is still a gap between the existing evidence and guidelines and the use of US in clinical practice. For clinical practice, we recommend a six-step systematic approach for US-guided central venous access that includes assessing the target vein (anatomy and vessel localization, vessel patency), using real-time US guidance for puncture of the vein, and confirming the correct needle, wire, and catheter position in the vein. To achieve the best skill level for CVC placement the knowledge from anatomic landmark techniques and the knowledge from US-guided CVC placement need to be combined and integrated.
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Affiliation(s)
- Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Thomas W L Scheeren
- Department of Anesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jean-Louis Teboul
- Service de Réanimation Médicale Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, AP-HP, Le Kremlin-Bicêtre, France
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Htet N, Vaughn J, Adigopula S, Hennessey E, Mihm F. Needle-guided ultrasound technique for axillary artery catheter placement in critically ill patients: A case series and technique description. J Crit Care 2017; 41:194-197. [PMID: 28577475 DOI: 10.1016/j.jcrc.2017.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/09/2017] [Accepted: 05/23/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Axillary arterial cannulation for blood pressure monitoring has been reported in adults since 1973. Reported failure rates using palpation landmarks are high. This report describes a needle-guided ultrasound technique for axillary arterial line placement in critically ill patients. METHODS A retrospective review of all patients requiring axillary arterial cannulation attempts with ultrasound-assisted needle guidance for hemodynamic monitoring was performed from July 2010 to June 2016 at a single institution. RESULTS One hundred fifty nine (159) cannulation attempts were performed in 155 patients. The overall success rate was 97%, with a first pass success rate of 84%. Inexperienced operators performed 49% of procedures under direct faculty supervision, and had a 99% success rate, which was not different from experienced operators. Almost 20% of patients had moderate-to-severe coagulopathy (platelets<50k/uL, INR>2.0 or PTT>60s). Complications reported included the following: nonfunctioning of catheter (6%) and hematoma (6%). Ischemia was noted in 2 patients (1%), but only one was attributed to the arterial catheter. CONCLUSIONS Use of the needle-guided ultrasound assisted approach for axillary arterial line placement is easily teachable and can be used to promote safe and successful placement of axillary arterial lines for novice learners.
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Affiliation(s)
- Natalie Htet
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, United States
| | - Jessica Vaughn
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, United States
| | - Sasikanth Adigopula
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, United States
| | - Erin Hennessey
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, United States
| | - Frederick Mihm
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, United States.
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Ikhsan M, Tan KK, Putra AS. Assistive technology for ultrasound-guided central venous catheter placement. J Med Ultrason (2001) 2017; 45:41-57. [DOI: 10.1007/s10396-017-0789-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 03/30/2017] [Indexed: 11/28/2022]
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Takashima M, Ray-Barruel G, Ullman A, Keogh S, Rickard CM. Randomized controlled trials in central vascular access devices: A scoping review. PLoS One 2017; 12:e0174164. [PMID: 28323880 PMCID: PMC5360326 DOI: 10.1371/journal.pone.0174164] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/03/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Randomized controlled trials evaluate the effectiveness of interventions for central venous access devices, however, high complication rates remain. Scoping reviews map the available evidence and demonstrate evidence deficiencies to focus ongoing research priorities. METHOD A scoping review (January 2006-December 2015) of randomized controlled trials evaluating the effectiveness of interventions to improve central venous access device outcomes; including peripherally inserted central catheters, non-tunneled, tunneled and totally implanted venous access catheters. MeSH terms were used to undertake a systematic search with data extracted by two independent researchers, using a standardized data extraction form. RESULTS In total, 178 trials were included (78 non-tunneled [44%]; 40 peripherally inserted central catheters [22%]; 20 totally implanted [11%]; 12 tunneled [6%]; 6 non-specified [3%]; and 22 combined device trials [12%]). There were 119 trials (68%) involving adult participants only, with 18 (9%) pediatric and 20 (11%) neonatal trials. Insertion-related themes existed in 38% of trials (67 RCTs), 35 RCTs (20%) related to post-insertion patency, with fewer trials on infection prevention (15 RCTs, 8%), education (14RCTs, 8%), and dressing and securement (12 RCTs, 7%). There were 46 different study outcomes reported, with the most common being infection outcomes (161 outcomes; 37%), with divergent definitions used for catheter-related bloodstream and other infections. CONCLUSION More high quality randomized trials across central venous access device management are necessary, especially in dressing and securement and patency. These can be encouraged by having more studies with multidisciplinary team involvement and consumer engagement. Additionally, there were extensive gaps within population sub-groups, particularly in tunneled devices, and in pediatrics and neonates. Finally, outcome definitions need to be unified for results to be meaningful and comparable across studies.
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Affiliation(s)
- Mari Takashima
- Alliance for Vascular Access Teaching and Research (AVATAR) group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research (AVATAR) group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Amanda Ullman
- Alliance for Vascular Access Teaching and Research (AVATAR) group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Samantha Keogh
- School of Nursing & Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia
| | - Claire M. Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR) group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
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Novel needle guide reduces time to perform ultrasound-guided femoral nerve catheter placement. Eur J Anaesthesiol 2017; 34:135-140. [DOI: 10.1097/eja.0000000000000584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Li X, Fang G, Yang D, Wang L, Zheng C, Ruan L, Wang L. Ultrasonic Technology Improves Radial Artery Puncture and Cannulation in Intensive Care Unit (ICU) Shock Patients. Med Sci Monit 2016; 22:2409-16. [PMID: 27397118 PMCID: PMC4954160 DOI: 10.12659/msm.896805] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background This study observed the efficacy of ultrasonic technique with out-of-plane orientation and in-plane guidance in radial artery puncture and cannulation in intensive care unit (ICU) shock patients to elucidate the effect of this technique on the security of cannulation. Material/Methods A total of 88 ICU shock patients, randomized into a palpation (control) group and an ultrasound (experimental) group, received continuous intravenous sedation and analgesia. The palpation group patients underwent radial artery cannulation using the traditional palpation pulsation approach, and the ultrasound group patients underwent radial artery cannulation under out-of-plane orientation and in-plane guidance using an ultrasonic apparatus. Data were recorded and compared between the 2 groups. Results (1) The success rate of the first puncture in the ultrasound group and the palpation group was 80% and 42%, respectively (P<0.05). (2) The cannulation duration in the ultrasound group and the palpation group was 8.77±6.33 s and 28.7±26.33 s, respectively (P<0.01). (3) Incidence of hematoma and staxis around stoma in the ultrasound group was 2.5% and 5%, respectively, which was significantly lower than that in the palpation group, which was 20% and 32.5%, respectively (P<0.05). (4) Time to achieve the early goal-directed therapy in the ultrasound group and the palpation group was 306.73±39.98 min and 356.75±40.97 min, respectively (P<0.01). Conclusions Compared with the traditional method, radial artery cannulation with out-of-plane orientation and in-plane guidance is a quick and secure cannulation method and is appropriate for use in clinics.
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Affiliation(s)
- Xiuyan Li
- Department of Intensive Care Unit (ICU), The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (mainland)
| | - Guizhen Fang
- Department of Nursing, The First Affiliated Hospital Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (mainland)
| | - Danhua Yang
- Department of Cardiology, The First Affiliated Hospital Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (mainland)
| | - Lanfang Wang
- Department of Intensive Care Unit (ICU), The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (mainland)
| | - Chunmei Zheng
- Department of Intensive Care Unit (ICU), The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (mainland)
| | - Longjuan Ruan
- Department of Intensive Care Unit (ICU), The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (mainland)
| | - Lingcong Wang
- Department of Intensive Care Unit (ICU), The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (mainland)
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Cho T, Komasawa N, Haba M, Fujiwara S, Mihara R, Minami T. Needle guides for venous catheter insertion during chest compressions: a crossover simulation trial. Am J Emerg Med 2016; 34:989-92. [DOI: 10.1016/j.ajem.2016.02.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/12/2016] [Indexed: 11/16/2022] Open
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Batllori M, Urra M, Uriarte E, Romero C, Pueyo J, López-Olaondo L, Cambra K, Ibáñez B. Randomized comparison of three transducer orientation approaches for ultrasound guided internal jugular venous cannulation. Br J Anaesth 2016; 116:370-6. [DOI: 10.1093/bja/aev399] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 11/13/2022] Open
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The Requisites of Needle-to-Nerve Proximity for Ultrasound-Guided Regional Anesthesia. Reg Anesth Pain Med 2016; 41:221-8. [DOI: 10.1097/aap.0000000000000201] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kwon SY, Hong SH, Kim ES, Park HJ, You Y, Kim YH. The Efficacy of Lumbosacral Spine Phantom to Improve Resident Proficiency in Performing Ultrasound-Guided Spinal Procedure. PAIN MEDICINE 2015; 16:2284-91. [DOI: 10.1111/pme.12870] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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A randomized crossover study comparing a novel needle guidance technology for simulated internal jugular vein cannulation. Anesthesiology 2015; 123:535-41. [PMID: 26154184 DOI: 10.1097/aln.0000000000000759] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite ultrasound guidance for central line placement, complications persist, as exact needle location is often difficult to confirm with standard two-dimension ultrasound. A novel real-time needle guidance technology has recently become available (eZono, Germany) that tracks the needle during insertion. This randomized, blinded, crossover study examined whether this needle guidance technology improved cannulation of a simulated internal jugular (IJ) vein in an ultrasound phantom. METHODS One hundred physicians were randomized to place a standard needle in an ultrasound neck phantom with or without the needle guidance system. Video cameras were placed externally and within the lumens of the vessels to record needle location in real time. The primary outcome measured was the rate of posterior wall puncture. Secondary outcomes included number of carotid artery punctures, number of needle passes, final needle position, time to cannulation, and comfort level with this new technology. RESULTS The incidence of posterior vessel wall puncture without and with needle guidance was 49 and 13%, respectively (P < 0.001, odds ratio [OR] = 7.33 [3.44 to 15.61]). The rate of carotid artery puncture was higher without needle navigation technology than with needle navigation 21 versus 2%, respectively (P = 0.001, OR = 12.97 [2.89 to 58.18]). Final needle tip position being located within the lumen of the IJ was 97% accurate with the navigation technology and 76% accurate with standard ultrasound (P < 0.001, OR = 10.42 [2.76 to 40.0]). Average time for successful vessel cannulation was 1.37 times longer without guidance technology. CONCLUSION This real-time needle guidance technology (eZono) shows significant improvement in needle accuracy and cannulation time during simulated IJ vein puncture.
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Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients—Part I. Crit Care Med 2015; 43:2479-502. [DOI: 10.1097/ccm.0000000000001216] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Jaffer U, Normahani P, Singh P, Aslam M, Standfield NJ. Randomized study of teaching ultrasound-guided vascular cannulation using a phantom and the freehand versus needle guide-assisted puncture techniques. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:469-477. [PMID: 25704049 DOI: 10.1002/jcu.22263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 09/15/2014] [Accepted: 11/16/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE The task of ultrasound-guided vessel cannulation can be technically difficult. Needle guides have been designed to facilitate vessel puncture. We aimed to identify and compare the learning curves of participants performing vessel puncture with conventional freehand (FH) and needle guide-assisted (NG) techniques. METHODS Thirty-six participants were randomly allocated to either the FH or the NG group. They were asked to consecutively perform as many as 30 vessel punctures on a simulated phantom model. Quantitative metrics (time taken and number of skin and posterior-wall punctures) were recorded and compared between the two groups. The cumulative sum and moving F-test statistical methods were used to delineate the learning curves. RESULTS There was a significantly lower rate of posterior-wall punctures in the NG group than in the FH group (15% versus 26%; p < 0.0001). Participants in the NG group also performed significantly fewer skin punctures than did those in the FH group (mean, 405 versus 515; p < 0.0001). Cumulative sum statistical method analysis showed that participants in the NG group surmounted the learning curve earlier (13 attempts; interquartile range, 10.3-17.0) than did those in the FH group (19 attempts; interquartile range, 15.0-27.5). The number of attempts to surmount the learning curve was significantly less for the FH group (7.2 versus 16 attempts; p = 0.007) when using the moving F-test. CONCLUSIONS The NG puncture allows a greater number of trainees to cross the learning threshold and offers the advantages of fewer posterior-wall punctures and skin punctures. The use of NG puncture may result in a shorter path to proficiency, allowing trainees to attempt needle puncture earlier and with a greater degree of safety.
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Affiliation(s)
- Usman Jaffer
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Pasha Normahani
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Prashant Singh
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Mohammed Aslam
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Nigel J Standfield
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
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Maecken T, Heite L, Wolf B, Zahn PK, Litz RJ. Ultrasound-guided catheterisation of the subclavian vein: freehand vs needle-guided technique. Anaesthesia 2015; 70:1242-9. [PMID: 26316098 DOI: 10.1111/anae.13187] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2015] [Indexed: 11/30/2022]
Abstract
The objective of this prospective, randomised study was to examine the impact of a multi-angle needle guide for ultrasound-guided, in-plane, central venous catheter placement in the subclavian vein. One hundred and sixty patients were randomly allocated to two groups, freehand or needle-guided, and then 159 catheterisations were analysed. Cannulation of the first examined access site was successful in 96.9% of cases with no significant difference between groups. There were three arterial punctures and no other severe injuries. Catheter misplacements did not differ between the groups. Higher success rates within the first and second attempts in the needle-guided group were observed (p = 0.041 and p = 0.019, respectively). Use of the needle guide reduced the access time from a median (IQR [range]) of 30 (18-76 [6-1409]) s to 16 (10-30 [4-295]) s; p = 0.0001, and increased needle visibility from 31.8% (9.7%-52.2% [0-96.67]) to 86.2% (62.5%-100% [0-100]); p < 0.0001. A multi-angle needle guide significantly improved aligning the needle and ultrasound plane compared with the freehand technique when cannulating the subclavian vein. Use of the guide resulted in faster access times and increased success at the first and second attempts.
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Affiliation(s)
- T Maecken
- Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil, Bochum, Germany
| | - L Heite
- Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil, Bochum, Germany
| | - B Wolf
- Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil, Bochum, Germany
| | - P K Zahn
- Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil, Bochum, Germany
| | - R J Litz
- Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil, Bochum, Germany
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Zhong X, Hamill M, Collier B, Bradburn E, Ferrara J. Dynamic Multiplanar Real Time Ultrasound Guided Infraclavicular Subclavian Vein Catheterization. Am Surg 2015. [DOI: 10.1177/000313481508100628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ultrasound guided vascular access has been well-characterized as a safe and effective technique for internal jugular and femoral vein catheterization. However, there is limited experience with the use of ultrasound to access the infraclavicular subclavian vein. Multiple ultrasound techniques do exist to identify the subclavian vein, but real time access is limited by vessel identification in a single planar view. To overcome this limitation, a novel technique of ultrasound guided infraclavicular subclavian vein catheterization using a real time multiplanar approach has been developed. The initial experience with this approach is described. A single surgeon used combined oblique, transverse, and longitudinal views along with Doppler color flow images to both define the infraclavicular anatomy and to obtain subclavian vein access in 42 adult patients (20 M/22 F and 22 L/20 R) with a mean body mass index of 29.2 (range = 18.9–55.4). Chest x-ray was obtained to confirm position and to rule out pneumothorax. Subclavian vein cannulation was achieved in 100 per cent of patients; subsequent catheterization was successful in 92.9 per cent. The number of attempts required for cannulation averaged 1.3 (range = 1–5), and decreased after a five patient learning curve. No patient developed a pneumothorax, hematoma, or cannula malposition. Ultrasound guided multiplanar infraclavicular subclavian vein access appears to be a safe and effective adjunct for central line placement.
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Affiliation(s)
- Xin Zhong
- Virginia Tech—Carilion School of Medicine, Roanoke VA
| | - Mark Hamill
- Virginia Tech—Carilion School of Medicine, Roanoke VA
| | - Bryan Collier
- Virginia Tech—Carilion School of Medicine, Roanoke VA
| | - Eric Bradburn
- Virginia Tech—Carilion School of Medicine, Roanoke VA
| | - John Ferrara
- Virginia Tech—Carilion School of Medicine, Roanoke VA
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Ultrasound-guided central venous access: what’s new? Intensive Care Med 2015; 41:705-7. [DOI: 10.1007/s00134-014-3628-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/18/2014] [Indexed: 01/21/2023]
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Gadsden J, Latmore M, Levine DM. Evaluation of the eZono 4000 with eZGuide for ultrasound-guided procedures. Expert Rev Med Devices 2014; 12:251-61. [PMID: 25543816 DOI: 10.1586/17434440.2015.995095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ultrasound-guided procedures are increasingly common in a variety of acute care settings, such as the operating room, critical care unit and emergency room. However, accurate judgment of needle tip position using traditional ultrasound technology is frequently difficult, and serious injury can result from inadvertently advancing beyond or through the target. Needle navigation is a recent innovation that allows the clinician to visualize the needle position and trajectory in real time as it approaches the target. A novel ultrasound machine has recently been introduced that is portable and designed for procedural guidance. The eZono 4000™ features an innovative needle navigation technology that is simple to use and permits the use of a wide range of commercially available needles, avoiding the inconvenience and cost of proprietary equipment. This article discusses this new ultrasound machine in the context of other currently available ultrasound machines featuring needle navigation.
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Affiliation(s)
- Jeff Gadsden
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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Wiesmann T, Steinfeldt T, Volk T, Schwemmer U, Kessler P, Wulf H. [Seeing more : Technical innovations in regional anesthesia]. Anaesthesist 2014; 63:875-82. [PMID: 25398422 DOI: 10.1007/s00101-014-2381-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Visualization and verification are key factors since the implementation of ultrasound-guided regional anesthesia. This article reviews and discusses newer technical innovations in regional anesthesia with regard to optimization of needle guidance, improvements in needle visibility, technical improvements in ultrasound techniques and innovative technologies in regional anesthesia. Clinically available applications are presented as well as experimental tools and techniques with a potential for clinical implementation in the future. Mechanical needle guides are used to improve alignment of needle axis and ultrasound beam axis. Compound imaging technology improves needle visibility in steep needle insertion angles and is already implemented in daily clinical practice. Sonoelastography improves tissue discrimination and detection of small amounts of fluids. Benefits of 3D and 4D ultrasound in regional anesthesia are discussed as well as experimental tools for tissue discrimination, such as optical reflection spectrophotometry.
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Affiliation(s)
- T Wiesmann
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität, Baldinger Str., 35033, Marburg, Deutschland,
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Richard C, Argaud L, Blet A, Boulain T, Contentin L, Dechartres A, Dejode JM, Donetti L, Fartoukh M, Fletcher D, Kuteifan K, Lasocki S, Liet JM, Lukaszewicz AC, Mal H, Maury E, Osman D, Outin H, Richard JC, Schneider F, Tamion F. [Extracorporeal life support for patients with acute respiratory distress syndrome (adult and paediatric). Consensus conference organized by the French Intensive Care Society]. Rev Mal Respir 2014; 31:779-95. [PMID: 25391514 DOI: 10.1016/j.rmr.2014.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/24/2014] [Indexed: 01/19/2023]
Affiliation(s)
- C Richard
- Service de réanimation médicale, EA 4533, université Paris-Sud, hôpitaux universitaires Paris-Sud, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - L Argaud
- Service de réanimation médicale, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France
| | - A Blet
- Département d'anesthésie-réanimation, centre de traitement des brulés, hôpitaux universitaires Saint-Louis, Lariboisière, Fernand-Widal, hôpital Saint Louis, AP-HP, 75010 Paris, France
| | - T Boulain
- Service de réanimation polyvalente, hôpital de La Source, centre hospitalier régional Orléans, 45067 Orléans, France
| | - L Contentin
- Service de réanimation polyvalente, hôpital Bretonneau, CHRU de Tours, 37000 Tours, France
| | - A Dechartres
- Inserm U1153, équipe « méthodes en évaluation thérapeutique des maladies chroniques », centre de recherche épidémiologie et biostatistique, centre Cochrane français, Hôtel-Dieu, 75004 Paris, France
| | - J-M Dejode
- Réanimation pédiatrique, hôpital Mère-Enfant, CHU de Nantes, 40000 Nantes, France
| | - L Donetti
- Service de réanimation, centre hospitalier Le Raincy-Montfermeil, 93370 Montfermeil, France
| | - M Fartoukh
- Unité de réanimation médicochirurgicale, hôpitaux universitaire Est Parisien, hôpital Tenon, AP-HP, 75020 Paris, France
| | - D Fletcher
- Département d'anesthésie, hôpitaux universitaires Paris Île-de-France Ouest, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - K Kuteifan
- Service de réanimation médicale, hôpital Émile-Muller, 68070 Mulhouse, France
| | - S Lasocki
- Pôle d'anesthésie réanimation, LUNAM université, université d'Angers, CHU d'Angers, 49000 Angers, France
| | - J-M Liet
- Réanimation pédiatrique, hôpital Mère-Enfant, CHU de Nantes, 40000 Nantes, France
| | - A-C Lukaszewicz
- Département d'anesthésie réanimation - réanimation chirurgicale et postopératoire, groupe hospitalier Saint-Louis-Lariboisière-Fernand-Widal, hôpital Lariboisière, AP-HP, 75010 Paris, France
| | - H Mal
- Service de pneumologie, hôpitaux universitaires Paris Nord Val-de-Seine, hôpital Bichat, AP-HP, 75018 Paris, France
| | - E Maury
- Service de réanimation médicale, hôpitaux universitaire Est Parisien, hôpital Saint-Antoine, AP-HP, 75020 Paris, France
| | - D Osman
- Service de réanimation médicale, EA 4533, université Paris-Sud, hôpitaux universitaires Paris-Sud, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - H Outin
- Service de réanimation médicochirurgicale, centre hospitalier intercommunal de Poissy-Saint-Germain-en-Laye, 78300 Poissy, France
| | - J-C Richard
- Service de réanimation médicale, hospices civils de Lyon, hôpital de la Croix-Rousse, 69004 Lyon, France
| | - F Schneider
- Service de réanimation médicale, faculté de médecine, université de Strasbourg, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, Hautepierre, France
| | - F Tamion
- Inserm U1096, IRIB, service de réanimation médicale, université de Rouen, CHU Charles-Nicolle, 76031 Rouen, France
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Intensive care ultrasound: II. Central vascular access and venous diagnostic ultrasound. Ann Am Thorac Soc 2014; 10:549-56. [PMID: 24161065 DOI: 10.1513/annalsats.201306-148ot] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Extracorporeal life support for patients with acute respiratory distress syndrome: report of a Consensus Conference. Ann Intensive Care 2014; 4:15. [PMID: 24936342 PMCID: PMC4046033 DOI: 10.1186/2110-5820-4-15] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/28/2014] [Indexed: 12/15/2022] Open
Abstract
The influenza H1N1 epidemics in 2009 led a substantial number of people to develop severe acute respiratory distress syndrome and refractory hypoxemia. In these patients, extracorporeal membrane oxygenation was used as rescue oxygenation therapy. Several randomized clinical trials and observational studies suggested that extracorporeal membrane oxygenation associated with protective mechanical ventilation could improve outcome, but its efficacy remains uncertain. Organized by the Société de Réanimation de Langue Française (SRLF) in conjunction with the Société Française d’Anesthésie et de Réanimation (SFAR), the Société de Pneumologie de Langue Française (SPLF), the Groupe Francophone de Réanimation et d’Urgences Pédiatriques (GFRUP), the Société Française de Perfusion (SOFRAPERF), the Société Française de Chirurgie Thoracique et Cardiovasculaire (SFCTV) et the Sociedad Española de Medecina Intensiva Critica y Unidades Coronarias (SEMICYUC), a Consensus Conference was held in December 2013 and a jury of 13 members wrote 65 recommendations to answer the five following questions regarding the place of extracorporeal life support for patients with acute respiratory distress syndrome: 1) What are the available techniques?; 2) Which patients could benefit from extracorporeal life support?; 3) How to perform extracorporeal life support?; 4) How and when to stop extracorporeal life support?; 5) Which organization should be recommended? To write the recommendations, evidence-based medicine (GRADE method), expert panel opinions, and shared decisions taken by all the thirteen members of the jury of the Consensus Conference were taken into account.
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Ultrasound-guided supraclavicular access to the innominate vein for central venous cannulation. J Trauma Acute Care Surg 2014; 76:1328-31. [DOI: 10.1097/ta.0000000000000209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Richard C, Argaud L, Blet A, Boulain T, Contentin L, Dechartres A, Dejode JM, Donetti L, Fartoukh M, Fletcher D, Kuteifan K, Lasocki S, Liet JM, Lukaszewicz AC, Mal H, Maury E, Osman D, Outin H, Richard JC, Schneider F, Tamion F. Assistance extracorporelle au cours du syndrome de détresse respiratoire aiguë (chez l’adulte et l’enfant, à l’exclusion du nouveau-né). Conférence de consensus organisée par la Société de réanimation de langue française. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s13546-014-0858-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
There has been a recent explosion of education and training in echocardiography in the specialties of anesthesiology and critical care. These devices, by their impact on clinical management, are changing the way surgery is performed and critical care is delivered. A number of international bodies have made recommendations for training and developed examinations and accreditations.The challenge to medical educators in this area is to deliver the training needed to achieve competence into already over-stretched curricula.The authors found an apparent increase in the use of simulators, with proven efficacy in improving technical skills and knowledge. There is still an absence of evidence on how it should be included in training programs and in the accreditation of certain levels.There is a conviction that this form of simulation can enhance and accelerate the understanding and practice of echocardiography by the anesthesiologist and intensivists, particularly at the beginning of the learning curve.
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A New Biplane Ultrasound Probe for Real-Time Visualization and Cannulation of the Internal Jugular Vein. Case Rep Anesthesiol 2014; 2014:349797. [PMID: 24715987 PMCID: PMC3970077 DOI: 10.1155/2014/349797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/08/2014] [Indexed: 11/17/2022] Open
Abstract
Ultrasound guidance is recommended for cannulation of the internal jugular vein. Use of ultrasound allows you to identify relevant anatomy and possible anatomical anomalies. The most common approach is performed while visualizing the vein transversely and inserting the needle out of plane to the probe. With this approach needle tip visualization may be difficult. We report the use of a new biplane ultrasound probe which allows the user to simultaneously view the internal jugular vein in transverse and longitudinal views in real time. Use of this probe enhances needle visualization during venous cannulation.
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Techniques d’assistance respiratoire veinoveineuses et alternatives au cours du syndrome de détresse respiratoire aiguë. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-014-0873-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gupta RK, Lane J, Allen B, Shi Y, Schildcrout JS. Improving Needle Visualization by Novice Residents During an In-Plane Ultrasound Nerve Block Simulation Using an In-Plane Multiangle Needle Guide. PAIN MEDICINE 2013; 14:1600-7. [DOI: 10.1111/pme.12160] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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46
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Collins GB, Fanou EM, Young J, Bhogal P. A comparison of free-hand vs laser-guided long-axis ultrasound techniques in novice users. Br J Radiol 2013; 86:20130026. [PMID: 23873905 DOI: 10.1259/bjr.20130026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The increasing use of point-of-care ultrasonography for targeted procedures justifies a device that helps both novices in training and experts perform the long-axis needle approach. The initial success of traditional needle guidance devices in reducing the time of target procedures is not universal and they can be cumbersome. We aim to investigate whether the less bulky and previously untested laser guide can succeed in reducing procedure time in novice ultrasonographers. METHODS 82 medical students with no ultrasound experience volunteered. Random allocation determined whether, during a targeted procedure in a turkey breast and olive phantom, participants were assisted by the laser guide or not. The time taken to pierce the target was recorded at 1-cm depth. RESULTS The mean procedure time in the laser-assisted (LA) group was 25.1 s (14.0 s; 18.0-25.0 s). The mean procedure time in the free-hand group was 45.5 s (23.0 s; 7.0-55.0 s). The procedure time in the LA group was significantly reduced (p<0.01). CONCLUSION The laser guide significantly improved procedure times. It is felt that the cheaper, smaller, easy to integrate, sterile and more user-friendly laser guidance unit may be a better alternative to the needle guide in improving procedure times for the novice ultrasonographer or to assist the expert, during training for, or performance of, ultrasound-guided targeted procedures. ADVANCES IN KNOWLEDGE Following from the prototype paper, this is the first study to investigate the effectiveness of attaching a laser-guidance device to an ultrasound probe. The device succeeded in reducing the procedure times of targeted procedures.
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Affiliation(s)
- G B Collins
- University College London Medical School, University College London, London, UK.
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Schepers M, Vercauteren M, De Bock D, Rodrigus I, Vanderplanken D, Camerlinck M. Inadvertent Intrathecal Placement of a Pulmonary Artery Catheter Introducer. Anesth Analg 2013; 117:119-22. [DOI: 10.1213/ane.0b013e318269cd55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Whittaker S, Lethbridge G, Kim C, Keon Cohen Z, Ng I. An ultrasound needle insertion guide in a porcine phantom model. Anaesthesia 2013; 68:826-9. [DOI: 10.1111/anae.12262] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/27/2022]
Affiliation(s)
- S. Whittaker
- Anaesthetic Department; Royal Melbourne Hospital; Melbourne; Vic.; Australia
| | - G. Lethbridge
- Anaesthetic Department; Royal Melbourne Hospital; Melbourne; Vic.; Australia
| | - C. Kim
- Anaesthetic Department; Royal Melbourne Hospital; Melbourne; Vic.; Australia
| | - Z. Keon Cohen
- Anaesthetic Department; Alfred Hospital; Melbourne; Vic.; Australia
| | - I. Ng
- Anaesthetic Department; Royal Melbourne Hospital; Melbourne; Vic.; Australia
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Levigoureux E, Charbonnel JF, Latour JF, Rosay H. [The PICC line, a new approach for venous access]. ANNALES PHARMACEUTIQUES FRANÇAISES 2013; 71:75-83. [PMID: 23537408 DOI: 10.1016/j.pharma.2013.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/17/2013] [Accepted: 01/22/2013] [Indexed: 12/01/2022]
Abstract
Peripheral Inserted Central Catheter (PICC) line is a peripherally inserted central catheter. This implantable medical device is placed into a peripheral vein of the arm in order to obtain an intravenous central access. This device can find its use in various applications like intravenous delivery of parenteral nutrition, anticancer agents and antibiotics, as well as for blood sampling. PICC line is not widely used in medical practice because it remains largely unknown. The aim of this review is thus to introduce PICC line to the medical and scientific community. First, we will approach its insertion and maintenance of the dressing. We will then detail the benefits and drawbacks associated with its use, and finally discuss its position with regards to the other central venous access available.
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Affiliation(s)
- E Levigoureux
- Département de pharmacie, centre régional de lutte contre le cancer Léon-Bérard, 28, boulevard Laennec, 69008 Lyon, France.
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Current world literature. Curr Opin Anaesthesiol 2012; 25:629-38. [PMID: 22955173 DOI: 10.1097/aco.0b013e328358c68a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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