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Iwamoto Y, Onishi S, Sugita K, Nakame K, Kaji T, Yano K, Ogata M, Takada L, Kedoin C, Nagano A, Murakami M, Harumatsu T, Yamada K, Yamada W, Masuya R, Kawano T, Muto M, Ieiri S. An ultrasound-guided supraclavicular approach for tunneled central venous catheter insertion can be safely performed by junior residents. Pediatr Surg Int 2024; 40:207. [PMID: 39039236 DOI: 10.1007/s00383-024-05773-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE Ultrasound-guided supraclavicular catheterization (UGSC) of the brachiocephalic vein (BCV) for long-term tunneled central venous catheter (tCVC) insertion may be safer than the internal jugular vein approach due to its superior field of view. We examined the clinical outcomes of tCVC insertions performed by junior residents through UGSC of the BCV. PATIENTS AND METHODS From January 2018 to December 2023, we assessed clinical outcomes and compared the experience levels of surgeons conducting tCVC insertions. Surgeons were categorized into three groups: junior residency (JR), senior residency (SR), and board-certified pediatric surgeons (BCPS). RESULTS 177 tCVC insertions were done on 146 patients. Intraoperative complications included 6 cases of arterial puncture, 1 case of pneumothorax, 1 case of over insertion of catheter tip, and 1 case of suspected hemothorax. Distribution across groups was as follows: 28 cases (15.8%) in JR group, 92 (52.0%) in SR group, and 57 (32.2%) in BCPS group. Although the JR group exhibited longer operation times than the BCPS group, no significant differences in intraoperative complications were noted. CONCLUSION Junior residents can safely perform UGSC for tCVC insertion. However, careful consideration of complications such as arterial or thoracic puncture is essential and case selection should be based on experience.
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Affiliation(s)
- Yumiko Iwamoto
- 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.
| | - Koshiro Sugita
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Kazuhiko Nakame
- Division of the Gastrointestinal, Endocrine and Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, 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
| | - Masato Ogata
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Lynne Takada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Chihiro Kedoin
- 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
| | - 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
| | - 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
- Division of the Gastrointestinal, Endocrine and Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, 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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Baidya M, Sinha M, Kumar M, Agrawal N, Ramchandani S, Sandeep G, Vijapurkar S. A Randomized Study Comparing Ultrasound-Guided Internal Jugular Vein Cannulation Using Two Techniques: Short-Axis Out-of-Plane With Dynamic Needle Tip Positioning Versus Long-Axis In-Plane. Cureus 2024; 16:e63004. [PMID: 39050343 PMCID: PMC11267105 DOI: 10.7759/cureus.63004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Internal jugular vein (IJV) cannulation is a routine procedure in operating rooms, critical care units, and perioperative settings. Ultrasound guidance has notably increased the success rates of IJV cannulation. A modified ultrasound technique known as the short-axis out-of-plane method with dynamic needle tip positioning (DNTP) allows for continuous visualization of the needle tip throughout the procedure. This study aims to compare the first-pass success rate of IJV cannulation using the DNTP and long-axis in-plane (LAIP) approaches. Methods One hundred patients between 18 and 70 years undergoing elective surgery requiring IJV cannulation were recruited. Patients were assigned randomly to the DNTP group (n = 50) or the LAIP group (n = 50). We recorded the first-pass success rate, time to achieve successful cannulation, number of skin punctures, overall success rate within five minutes, and potential complications such as pneumothorax and hematoma. Results The first pass success rate was higher in the DNTP group (48/50, 96%) as compared to the LAIP group (38/50, 76%, relative risk, 1.67; 95% confidence interval, 0.039-0.707; p = 0.008). The cannulation time was shorter in DNTP (116.98 ± 22.90 seconds) versus the LAIP group (213.04 ± 52.08 seconds; p < 0.001). No complications like pneumothorax or hematoma were noted in both groups. Conclusion We conclude that the ultrasound-guided DNTP technique for IJV cannulation, as compared with the LAIP technique, may significantly improve the first attempt cannulation, number of attempts, and cannulation time.
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Affiliation(s)
- Mainak Baidya
- Anesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Mamta Sinha
- Anesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Mayank Kumar
- Anesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Nandkishore Agrawal
- Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Sarita Ramchandani
- Anesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Gade Sandeep
- Cardiac Anesthesia, All India Institute of Medical Sciences, Raipur, Raipur, IND
- Anesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Swati Vijapurkar
- Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Watanabe H, Fukuda H, Ezawa Y, Matsuyama E, Kondo Y, Hayashi N, Ogura T, Shimosegawa M. Automated angular measurement for puncture angle using a computer-aided method in ultrasound-guided peripheral insertion. Phys Eng Sci Med 2024; 47:679-689. [PMID: 38358620 DOI: 10.1007/s13246-024-01397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/28/2024] [Indexed: 02/16/2024]
Abstract
Ultrasound guidance has become the gold standard for obtaining vascular access. Angle information, which indicates the entry angle of the needle into the vein, is required to ensure puncture success. Although various image processing-based methods, such as deep learning, have recently been applied to improve needle visibility, these methods have limitations, in that the puncture angle to the target organ is not measured. We aim to detect the target vessel and puncture needle and to derive the puncture angle by combining deep learning and conventional image processing methods such as the Hough transform. Median cubital vein US images were obtained from 20 healthy volunteers, and images of simulated blood vessels and needles were obtained during the puncture of a simulated blood vessel in four phantoms. The U-Net architecture was used to segment images of blood vessels and needles, and various image processing methods were employed to automatically measure angles. The experimental results indicated that the mean dice coefficients of median cubital veins, simulated blood vessels, and needles were 0.826, 0.931, and 0.773, respectively. The quantitative results of angular measurement showed good agreement between the expert and automatic measurements of the puncture angle with 0.847 correlations. Our findings indicate that the proposed method achieves extremely high segmentation accuracy and automated angular measurements. The proposed method reduces the variability and time required in manual angle measurements and presents the possibility where the operator can concentrate on delicate techniques related to the direction of the needle.
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Affiliation(s)
- Haruyuki Watanabe
- School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan.
| | - Hironori Fukuda
- Department of Radiology, Cardiovascular Hospital of Central Japan, Shibukawa, Japan
| | - Yuina Ezawa
- School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | - Eri Matsuyama
- Faculty of Informatics, The University of Fukuchiyama, Fukuchiyama, Japan
| | - Yohan Kondo
- Graduate School of Health Sciences, Niigata University, Niigata, Japan
| | - Norio Hayashi
- School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | - Toshihiro Ogura
- School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | - Masayuki Shimosegawa
- School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
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Nakazawa H, Tokumine J, Lefor AK, Yamamoto K, Karasawa H, Shimazu K, Yorozu T. Use of a photoacoustic needle improves needle tip recognition in a video recording of simulated ultrasound-guided vascular access: A pilot study. J Vasc Access 2024; 25:922-927. [PMID: 36519739 PMCID: PMC11075403 DOI: 10.1177/11297298221122137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/29/2022] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND We developed a novel photoacoustic needle, which emits ultrasound produced by the photoacoustic effect. This study focused on the most common "pitfall" associated with placement during ultrasound-guided vascular access, which is misidentification of the needle tip. METHODS The study was conducted as a prospective cohort study using a questionnaire. The authors intentionally created two successful and one failed ultrasound-guided central venous catheterization videos using the photoacoustic needle on a simulator. Each of these three videos was then split into two movies for viewing, one with standard ultrasound images only and the second including the images from the photoacoustic needle, for a total of six movies. RESULTS Participants who were 18 anesthesiologists, 12 residents, and 10 medical students, watched each of the six movies and completed a survey whether the puncture was successful or not. In the results, there was a significant difference in the percentage of correct answers whether the movie depicted successful or failed puncture with and without the photoacoustic ultrasound (p = 0.0001). CONCLUSION The novel photoacoustic needle improved the ability to identify the needle tip on recorded videos. It may have efficacy to prevent serious mechanical complication during the ultrasound-guided vascular access in clinical practice.
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Affiliation(s)
- Harumasa Nakazawa
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - 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
| | - Katsuya Yamamoto
- Medical System Research & Development Center, FUJIFILM Corporation, Kanagawa, Japan
| | - Hiroyuki Karasawa
- Medical System Research & Development Center, FUJIFILM Corporation, Kanagawa, Japan
| | - Keisuke Shimazu
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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Sugiki D, Matsushima H, Asao T, Tokumine J, Lefor AK, Kamisasanuki T, Suzuki M, Gomei S. A web-based self-learning system for ultrasound-guided vascular access. Medicine (Baltimore) 2022; 101:e31292. [PMID: 36316890 PMCID: PMC9622633 DOI: 10.1097/md.0000000000031292] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Ultrasound-guided vascular access is practiced widely. Optimal educational methods have not yet been established. We hypothesized that a step-by-step web-based learning system is effective for self-learning. In this study, we examined the potential of this system as a self-learning tool. This was an observational study at a single institution. Participants included residents, who were self-educated through the web-based system. Skill proficiency was measured after self-learning. The primary outcome was the extent to which self-learning enabled residents to acquire proficiency in the basic skills of ultrasound-guided vascular access: needle visualization, hand-eye coordination, and avoiding posterior wall penetration. A secondary outcome was the time required to achieve proficiency. Thirty-nine residents were enrolled in this study. Eleven residents (28%) passed the first skill assessment test. There was no significant difference in the number of days that the web-based system was accessed, the total number of screen views, or the total learning time between participants who passed and those who failed the first test. Skill assessment scores between those who passed and those who failed the first test were different, especially the score for hand-eye coordination, and the number of posterior wall penetrations. Self-learning with a web-based system enabled 28% of residents to pass the first skill assessment test. The remaining 72% failed the first skill assessment test but continued to learn using the web-based system and eventually passed the test. Hence, the web-based system needed formative testing to function as a self-learning system. Simulation education for vascular access is expected to increase in educational content and methods. Self-learning through a web-based learning system is a leading candidate for this growth.
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Affiliation(s)
- Daisuke Sugiki
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Hisao Matsushima
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Takayuki Asao
- Gunma University Center for Mathematics and Data Science, Gunma, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
- *Correspondence: Joho Tokumine, Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Sinkawa, Mitaka, Tokyo, Japan (e-mail: )
| | | | - Toshirou Kamisasanuki
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Mitsuhiro Suzuki
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Sayaka Gomei
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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Utsu Y, Masuda S, Watanabe R, Arai H, Nakamura A, Matsui S, Izumi S, Aotsuka N. Changes in Central Venous Catheter Use in the Hematology Unit with the Introduction of Ultrasound Guidance and a Peripherally Inserted Central Venous Catheter. Intern Med 2021; 60:2765-2770. [PMID: 34470985 PMCID: PMC8479208 DOI: 10.2169/internalmedicine.7119-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective A central venous catheter (CVC) is often needed to treat hematologic diseases, but it is accompanied by many complications. Ultrasound guidance (USG) or a peripherally inserted central venous catheter (PICC) can reduce such complications. Meterials We collected data of patients with attempted CVC placement in our hematology unit in 2012 (before introduction of USG and PICC) and 2018 (after introduction) and compared both periods. Results In total, 187 CVC insertions were attempted in 2018 and 198 in 2012. USG was used 154 times (82%) in 2018 and 4 times (2%) in 2012 (p<0.001). The success rates of insertion were 95% in 2018 and 89% in 2012 (p=0.063). The incidence of acute complications was 4.3% in 2018 and 9.1% in 2012 (p=0.069). The incidence of CVC removal owing to delayed complications was 26% in 2018 and 21% in 2012 (p=0.327). The sites of approach in 2018 and 2012 were the internal jugular in 42 (22%) and 54 (27%), subclavian in 52 (28%) and 128 (65%), brachial (PICC) in 89 (48%) and 14 (7%), and femoral in 4 (2%) and 2 (1%), respectively (p<0.001). Conclusion USG has become commonplace since its introduction. The landmark-based subclavian approach was largely replaced by PICC with USG in 2018. USG and PICC can help improve success rates and safety profiles.
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Affiliation(s)
- Yoshikazu Utsu
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Shinichi Masuda
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Reiko Watanabe
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Hironori Arai
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Ayako Nakamura
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Shinichirou Matsui
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Shintarou Izumi
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Nobuyuki Aotsuka
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
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Soundappan SSV, Lam L, Cass DT, Karpelowsky J. Open Versus Ultrasound Guided Tunneled Central Venous Access in children: A Randomized Controlled Study. J Surg Res 2020; 260:284-292. [PMID: 33360753 DOI: 10.1016/j.jss.2020.11.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/03/2020] [Accepted: 11/15/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND The purpose of this study was to compare open insertion to ultrasound guided percutaneous insertion of central access catheters performed in a tertiary pediatric hospital in terms of its safety and complication rates. METHODS This was an ethics approved prospective randomized trial of children under 16 y of age. Procedure was performed by surgeons with varying experience with percutaneous and open insertion. Primary outcome studied was complications-immediate and late. Secondary outcomes were time taken to complete procedure, conversion rates, duration of line use. RESULTS A total of 108 patients were analyzed. Sixty-four were male. Right internal jugular vein was accessed in 97. Eighty-one lines were double lumen, 23 implantable access devices, and the rest were single lumen catheters. More than one needle puncture was needed in 22% of the cases but there were no conversions in the ultrasound group. Twelve patients needed more than one insertion to achieve optimal position of the tip. Eleven patients had immediate and late complications. Percutaneous lines lasted 45 d longer though this was not statistically significant. Operating time was 20.6% shorter with percutaneous access. Post-removal measurement of vein size by ultrasound demonstrated significant decrease in size in the open group. CONCLUSIONS Ultrasound guided percutaneous insertion was safe. The study also demonstrated a decrease in operating times, preservation of vein size, and no increase in complication rates in the US group when performed by operators of varying expertise.
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Affiliation(s)
- Soundappan S V Soundappan
- Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Division of Child and Adolescent health, Sydney Medical School, University of Sydney, NSW, Australia.
| | | | - Daniel T Cass
- Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Division of Child and Adolescent health, Sydney Medical School, University of Sydney, NSW, Australia
| | - Jonathan Karpelowsky
- Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Division of Child and Adolescent health, Sydney Medical School, University of Sydney, NSW, Australia
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Lee S, Chang JE, Oh Y, Yang HJ, Bae J, Cho YJ, Jeon Y, Nam K, Kim TK. Comparison of dynamic needle tip positioning versus conventional long-axis in-plane techniques for ultrasound-guided internal jugular venous catheterization: a randomized controlled trial. Minerva Anestesiol 2020; 87:294-301. [PMID: 33319947 DOI: 10.23736/s0375-9393.20.14734-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Continuous visualization of the needle tip is essential for successful ultrasound-guided central venous catheterization, and the dynamic needle tip positioning (DNTP) technique enables it. The aim of this randomized, dual-center trial was to compare the first-attempt success rate of ultrasound-guided internal jugular catheterization between the DNTP and conventional long-axis in-plane (LAX-IP) techniques. METHODS Patients undergoing cardiac surgery at two tertiary teaching hospitals were randomly allocated to either the DNTP or LAX-IP group. Internal jugular venous catheterization was performed by four anesthesiologists. The primary outcome was the first-attempt success rate of central venous catheterization. Procedural time and complications related to catheterization were compared as secondary outcomes. RESULTS In total, 142 patients were analysed. The first-attempt success rate was significantly higher in the DNTP group (59/72, 81.9%) than in the LAX-IP group (46/70, 65.7%; odds ratio, 2.37; 95% confidence interval 1.09-5.15; P=0.028). In addition, the needle was redirected less frequently in the DNTP group than the LAX-IP group (P=0.026). Procedural time was comparable between the groups. No significant differences were observed in complications related to catheterization, including posterior wall puncture, carotid artery puncture, or hematoma. CONCLUSIONS The DNTP technique resulted in a significantly higher success rate on the first attempt at internal jugular venous catheterization and required less frequent redirection of the needle during the procedure than the conventional LAX-IP technique.
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Affiliation(s)
- Seohee Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jee-Eun Chang
- Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Yoomin Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyo-Jun Yang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Jinyoung Bae
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Youn-Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Yunseok Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Karam Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Tae-Kyong Kim
- Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea -
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Long-Axis In-Plane Approach Versus Short-Axis Out-of-Plane Approach for Ultrasound-Guided Central Venous Catheterization in Pediatric Patients: A Randomized Controlled Trial. Pediatr Crit Care Med 2020; 21:e996-e1001. [PMID: 32590831 DOI: 10.1097/pcc.0000000000002476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to compare the occurrence of posterior wall puncture between the long-axis in-plane and the short-axis out-of-plane approaches in a randomized controlled trial of pediatric patients who underwent cardiovascular surgery under general anesthesia. DESIGN Prospective randomized controlled trial. SETTING Operating room of Osaka Women's and Children's Hospital. PATIENTS Pediatric patients less than 5 years old who underwent cardiovascular surgery. INTERVENTIONS Ultrasound-guided central venous catheterization using the long-axis in-plane approach and short-axis out-of-plane approach. MEASUREMENTS AND MAIN RESULTS The occurrence of posterior wall puncture was compared between the long-axis in-plane and short-axis out-of-plane approaches for ultrasound-guided central venous catheterization. Patients were randomly allocated to a long-axis group or a short-axis group and underwent ultrasound-guided central venous catheterization in the internal jugular vein using either the long-axis in-plane approach (long-axis group) or the short-axis out-of-plane approach (short-axis group). After exclusion, 97 patients were allocated to the long-axis (n = 49) or short-axis (n = 48) groups. Posterior wall puncture rates were 8.2% (4/49) and 39.6% (19/48) in the long-axis and short-axis groups, respectively (relative risk, 0.21; 95% CI, 0.076-0.56; p = 0.0003). First attempt success rates were 67.3% (33/49) and 64.6% (31/48) in the long-axis and short-axis groups, respectively (relative risk, 1.04; 95% CI, 0.78-1.39; p = 0.77). Overall success rates within 20 minutes were 93.9% (46/49) and 93.8% (45/48) in the long-axis and short-axis groups, respectively (relative risk, 0.99; 95% CI, 0.90-1.11; p = 0.98). CONCLUSIONS The long-axis in-plane approach for ultrasound-guided central venous catheterization is a useful technique for avoiding posterior wall puncture in pediatric patients, compared with the short-axis out-of-plane approach.
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Ultrasound-guided peripheral vascular catheterization in pediatric patients: a narrative review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:592. [PMID: 32998762 PMCID: PMC7526377 DOI: 10.1186/s13054-020-03305-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
Peripheral vascular catheterization (PVC) in pediatric patients is technically challenging. Ultrasound guidance has gained the most interest in perioperative and intensive care fields because it visualizes the exact location of small target vessels and is less invasive than other techniques. There have been a growing number of studies related to ultrasound guidance for PVC with or without difficult access in pediatric patients, and most findings have demonstrated its superiority to other techniques. There are various ultrasound guidance approaches, and a comprehensive understanding of the basics, operator experience, and selection of appropriate techniques is required for the successful utilization of this technique. This narrative review summarizes the literature regarding ultrasound-guided PVC principles, approaches, and pitfalls to improve its clinical performance in pediatric settings.
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Practical guide for safe central venous catheterization and management 2017. J Anesth 2019; 34:167-186. [PMID: 31786676 PMCID: PMC7223734 DOI: 10.1007/s00540-019-02702-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 10/15/2019] [Indexed: 12/19/2022]
Abstract
Central venous catheterization is a basic skill applicable in various medical fields. However, because it may occasionally cause lethal complications, we developed this practical guide that will help a novice operator successfully perform central venous catheterization using ultrasound guidance. The focus of this practical guide is patient safety. It details the fundamental knowledge and techniques that are indispensable for performing ultrasound-guided internal jugular vein catheterization (other choices of indwelling catheters, subclavian, axillary, and femoral venous catheter, or peripherally inserted central venous catheter are also described in alternatives).
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12
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Takeshita J, Nishiyama K, Fukumoto A, Shime N. Combined Approach Versus 2 Conventional Approaches in Ultrasound-Guided Central Venous Catheterization: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2019; 33:2979-2984. [DOI: 10.1053/j.jvca.2019.03.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/18/2019] [Accepted: 03/23/2019] [Indexed: 11/11/2022]
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Asao T, Kikuchi M, Tokumine J, Matsushima H, Andoh H, Tanaka K, Kanamoto M, Ideno Y. Optical skill-assist device for ultrasound-guided vascular access: A preliminary simulation study. Medicine (Baltimore) 2019; 98:e16126. [PMID: 31261532 PMCID: PMC6616625 DOI: 10.1097/md.0000000000016126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Ultrasound-guided central venous catheterization may cause lethal mechanical complications intraoperatively. We developed a novel device to prevent such complications. It works as a needle guide to supplement the operator's skill. We evaluated the utility of this device in terms of the success rate and visualization of the needle tip while penetrating the target vessel using a simulator.This study was approved by the local ethics committee. The new device - an optical skill-assist device - has a slit and a mirror in the center. The operator can see the needle's reflection in the mirror through the slit and can thus ensure that the needle is directed in line with the ultrasound beam. Participants were recruited by placing an advertisement for a hands-on seminar on ultrasound-guided vascular access. They received hands-on training on the in-plane approach for 2 hours. Pre-test and post-test without the device and an additional test using the device were performed to evaluate the proficiency of ultrasound-guided vascular access. An endoscope inserted into the simulated vessel was used to detect the precise location of the needle tip in the vessel.The primary outcomes were the success rate of the procedure. The secondary outcome was visualization of the needle tip while penetrating the simulated vessel. The chi-squared test was used for comparing the success rate and needle tip visualization between the different tests. P < .05 was considered to indicate significant differences.Forty-two participants were enrolled in this study. The success rate did not increase after the simulation training (P = .1). Using the optical skill-assist device, the rate improved to 100%. There was a significant difference in success rate between the pre-test and additional test using the optical skill-assist device (P = .003). Needle tip visualization significantly improved with the use of the optical skill-assist device compared to the pre-test (P < .001) and post-test (P = .001).Simulation training improved participants' skill for ultrasound-guided vascular access, but the improvement depended on each participant. However, further, improvement was achieved with the use of the optical skill-assist device.The optical skill-assist device is useful for supplementing the operator's skill for ultrasound-guided central venous catheterization.
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Affiliation(s)
- Takayuki Asao
- Gunma University Center for Mathematics and Data Science
| | - Mami Kikuchi
- Center of Regional Medical Research and Education, Gunma University Hospital, Maebashi, Gunma
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo
| | - Hisao Matsushima
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama
| | - Hideaki Andoh
- Akita University Hospital Medical Simulation Center, Akita-City, Akita
| | - Kazumi Tanaka
- Medical Quality and Safety Management Center, Gunma University Hospital
| | - Masafumi Kanamoto
- Intensive Care Unit, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Yuki Ideno
- Gunma University Center for Mathematics and Data Science
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Takeshita J, Nishiyama K, Fukumoto A, Shime N. Comparing Combined Short-Axis and Long-Axis Ultrasound-Guided Central Venous Catheterization With Conventional Short-Axis Out-of-Plane Approaches. J Cardiothorac Vasc Anesth 2019; 33:1029-1034. [DOI: 10.1053/j.jvca.2018.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Indexed: 11/11/2022]
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15
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Yao M, Xiong W, Xu L, Ge F. A modified approach for ultrasound-guided axillary venipuncture in the infraclavicular area: A retrospective observational study. J Vasc Access 2019; 20:630-635. [PMID: 30919718 DOI: 10.1177/1129729819838135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Catheterization of the axillary vein in the infraclavicular area has important advantages in patients with long-term, indwelling central venous catheters. The two most commonly used ultrasound-guided approaches for catheterization of the axillary vein include the long-axis/in-plane approach and the short-axis/out-of-plane approach, but there are certain drawbacks to both approaches. We have modified a new approach for axillary vein catheterization: the oblique-axis/in-plane approach. METHODS This observational study retrospectively collected data from patients who underwent ultrasound-guided placement of an axillary vein infusion port in the infraclavicular area at the Central Venous Access Clinics of Zhongshan Hospital at Fudan University between March 2014 and May 2017. The patients' demographic data, success rate of catheterization, venous catheterization site, and immediate complications associated with catheterization were recorded. RESULTS Between March 2014 and May 2017, a total of 858 patients underwent placement of an axillary vein infusion port in the infraclavicular area at our center. The ultrasound-guided oblique-axis/in-plane approach was used for all patients, and the venipuncture success rate was 100%. Two cases of accidental arterial puncture and one case of local hematoma formation were reported, and no other complications, such as pneumothorax or nerve damage, were reported. CONCLUSION The ultrasound-guided oblique-axis/in-plane approach is a safe and reliable alternative to the routine ultrasound-guided approach for axillary venous catheterization.
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Affiliation(s)
- Minmin Yao
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wanxia Xiong
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liying Xu
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Feng Ge
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
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Norbury JW, Karr NC, Sindhi V, Rathbun KM, Charles SC, McIver MB, Morrison EJ. Improving the Performance Time and Accuracy of Ultrasound-Guided Interventions: A Randomized Controlled Double-Blind Trial of the Line-of-Sight Approach and the "APPLES" Mnemonic. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2909-2914. [PMID: 29665109 DOI: 10.1002/jum.14653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/21/2018] [Accepted: 03/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To determine whether the line-of-sight approach improved the performance time and accuracy of ultrasound (US)-guided needle placement targeting the subdeltoid bursa in a cadaver among novice operators compared to the side approach. A secondary objective was to determine whether participants thought the APPLES (angle, position, perpendicular, line up, entry, sweep) mnemonic was a helpful guide for performing the procedure. METHODS Medical students and residents were randomized into either a line-of-sight or side approach group and then crossed over to the other group. The procedure time was determined by 2 blinded reviewers. A survey was administered to determine which method participants preferred and whether they thought the APPLES mnemonic was helpful. A paired t test was used to compare the performance time, and the McNemar test was used to compare the accuracy of the methods. RESULTS Among the 110 participants, the performance time with the line-of-sight approach (mean, 14.4 seconds; SD, 9.95 seconds) was significantly decreased compared to the side approach (mean, 18.6 seconds; SD, 10.1 seconds; P = .00029). Additionally, participants who only hit the target using one method were more likely to hit the target in 30 seconds using the line-of-sight approach (P = .035). In total, 72.7% of participants preferred the line-of-sight approach over the side approach, and 88.2% of participants thought that APPLES mnemonic was useful. CONCLUSIONS This study highlights the finding that positioning of the operator is important in performing US-guided interventions, and the line-of-sight approach may improve the performance time and accuracy among novice operators. Furthermore, the APPLES mnemonic serves as a useful educational tool for teaching US-guided interventional procedures.
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Affiliation(s)
- John W Norbury
- Department of Physical Medicine and Rehabilitation, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Natalie C Karr
- Department of Physical Medicine and Rehabilitation, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Vivek Sindhi
- Department of Physical Medicine and Rehabilitation, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Kimberly M Rathbun
- Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Stephen C Charles
- Department of Academic Affairs, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Michael B McIver
- Department of Physical Medicine and Rehabilitation, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Eric J Morrison
- Department of Physical Medicine and Rehabilitation, University of Rochester, Rochester, New York, USA
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A Shallow Angle Short-Axis Out-of-Plane Approach Reduces the Rate of Posterior Wall Injuries in Central Venous Catheterization: A Simulation Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4793174. [PMID: 30276208 PMCID: PMC6151846 DOI: 10.1155/2018/4793174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/18/2018] [Accepted: 08/27/2018] [Indexed: 02/05/2023]
Abstract
The short-axis out-of-plane approach (SAX-OOP) is commonly used in ultrasound-guided internal jugular vein catheterization. However, this approach has a risk of posterior vein wall injuries. The authors hypothesized that a shallow angle of approach may reduce the rate of posterior wall injuries compared with the conventional steep angle approach. The present study aimed to evaluate whether a difference in the angle of approach of the needle affects the rate of posterior wall injuries. The present study was a randomized crossover-controlled trial involving 40 medical residents, conducted in the clinical training center at a hospital with a residency program. The primary outcome measure was the rate of posterior vessel wall injuries. Subjects received a didactic lecture during which the instructors taught three SAX-OOP techniques including the conventional free-hand method (procedure C), a needle navigation system (procedure N), and a shallow puncture angle using a guidance system (procedure S). Participants were trained in these approaches under supervision and each technique tested in a simulation environment. Thirty-four of 40 residents had no previous experience with central venous catheterization and were included in the final analysis. The rate of posterior vessel wall injuries in procedure S (9%) was significantly lower than using the other approaches (procedure C, 53%; procedure N, 41%). In conclusion, a shallow angle of approach using the SAX-OOP technique resulted in significantly fewer posterior vein wall injuries in central venous catheterization compared with steep angle techniques.
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Ameri G, Bainbridge D, Peters TM, Chen ECS. Quantitative Analysis of Needle Navigation under Ultrasound Guidance in a Simulated Central Venous Line Procedure. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1891-1900. [PMID: 29858126 DOI: 10.1016/j.ultrasmedbio.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/20/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
Complications in ultrasound-guided central line insertions are associated with the expertise level of the operator. However, a lack of standards for teaching, training and evaluation of ultrasound guidance results in various levels of competency during training. To address such shortcomings, there has been a paradigm shift in medical education toward competency-based training, promoting the use of simulators and quantitative skills assessment. It is therefore necessary to develop reliable quantitative metrics to establish standards for the attainment and maintenance of competence. This work identifies such a metric for simulated central line procedures. The distance between the needle tip and ultrasound image plane was quantified as a metric of efficacy in ultrasound guidance implementation. In a simulated procedure, performed by experienced physicians, this distance was significantly greater in unsuccessful procedures (p = 0.04). The use of this metric has the potential to enhance the teaching, training and skills assessment of ultrasound-guided central line insertions.
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Affiliation(s)
- Golafsoun Ameri
- Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada; Robarts Research Institute, London, Ontario, Canada.
| | - Daniel Bainbridge
- Department of Anesthesiology and Perioperative Medicine, University Hospital-London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Terry M Peters
- Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada; Robarts Research Institute, London, Ontario, Canada
| | - Elvis C S Chen
- Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada; Robarts Research Institute, London, Ontario, Canada
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19
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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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20
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Hsu YH, Hsu HT, Cheng KI. Ultrasound detection of free-floating thrombus during internal jugular vein catheterisation. Br J Anaesth 2018; 120:882-883. [PMID: 29576135 DOI: 10.1016/j.bja.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 01/04/2018] [Accepted: 01/06/2018] [Indexed: 10/18/2022] Open
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McCormick TJ, Miller EC, Chen R, Naik VN. Acquiring and maintaining point-of-care ultrasound (POCUS) competence for anesthesiologists. Can J Anaesth 2018; 65:427-436. [DOI: 10.1007/s12630-018-1049-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 01/16/2023] Open
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22
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Reply to Letter to the Editor by Crocoli A, et al. J Pediatr Surg 2017. [PMID: 28648879 DOI: 10.1016/j.jpedsurg.2017.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Scholten HJ, Pourtaherian A, Mihajlovic N, Korsten HHM, A. Bouwman R. Improving needle tip identification during ultrasound-guided procedures in anaesthetic practice. Anaesthesia 2017; 72:889-904. [DOI: 10.1111/anae.13921] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 12/16/2022]
Affiliation(s)
- H. J. Scholten
- Department of Anaesthesiology; Intensive Care and Pain Medicine; Catharina Hospital; Eindhoven the Netherlands
| | - A. Pourtaherian
- Department of Electrical Engineering; Eindhoven University of Technology; Eindhoven the Netherlands
| | | | - H. H. M. Korsten
- Department of Anaesthesiology; Intensive Care and Pain Medicine; Catharina Hospital; Eindhoven the Netherlands
- Department of Electrical Engineering; Eindhoven University of Technology; Eindhoven the Netherlands
| | - R. A. Bouwman
- Department of Anaesthesiology; Intensive Care and Pain Medicine; Catharina Hospital; Eindhoven the Netherlands
- Department of Electrical Engineering; Eindhoven University of Technology; Eindhoven the Netherlands
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Bigeleisen PE. Design and Production of an Articulating Needle Guide for Ultrasound-Guided Needle Block Manufactured With a Three-Dimensional Printer: Technical Communication. ACTA ACUST UNITED AC 2017; 8:272-275. [PMID: 28328582 DOI: 10.1213/xaa.0000000000000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Needle guides may allow the practitioner to align the needle with the probe when ultrasound-guided nerve block is performed. The author's goal was to design and fabricate an inexpensive ($1.90), disposable, needle guide that could articulate over a range from 85 degrees to 0 degrees with a three-dimension printer. Three-dimensional representations of an L50, L25, and C 60 ultrasound probe (Sono Site, Bothell, WA) were created using a laser scanner. Computer-aided design software (Solid Works, Waltham, MA) was used to design a needle bracket and needle guide to attach to these probes. A three-dimensional printer was used to fabricate the needle bracket and guide with acrylonitrile polybutadiene polystyrene. An echogenic needle was held in plane with the needle guide. The author performed a supraclavicular block in a morbidly obese patient. The needle was easily visualized. Similar guides that are commercially available cost as much as $400. A knowledge of computer-aided design is necessary for this work.
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Affiliation(s)
- Paul E Bigeleisen
- From the Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
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25
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Komasawa N, Berg BW, Minami T. Hybrid simulation utilizing problem-based learning and task trainer for central venous catheter insertion training. Am J Emerg Med 2017; 35:1379. [PMID: 28381336 DOI: 10.1016/j.ajem.2017.03.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 03/25/2017] [Accepted: 03/26/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Benjamin W Berg
- SimTiki Simulation Center, John A Burns School of Medicine, University of Hawai'i, United States
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Ghatak T, Singh RK, Baronia AK. Comparison between marked versus unmarked introducer needle in real-time ultrasound-guided central vein cannulation: A prospective randomized study. Ann Card Anaesth 2017; 19:621-625. [PMID: 27716692 PMCID: PMC5070321 DOI: 10.4103/0971-9784.191563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Introducer needle tip is not clearly visible during the real-time ultrasound (US)-guided central vein cannulation (CVC). Blind tip leads to mechanical complications. This study was designed to evaluate whether real-time US-guided CVC with a marked introducer needle is superior to the existing unmarked needle. METHODOLOGY Sixty-two critically ill patients aged 18-60 years of either sex were included in the study. The patients were randomized into two groups based on whether a marked or unmarked introducer needle was used. Both groups underwent real-time US-guided CVC by a single experienced operator. Aseptically, introducer needle was indented with markings spaced 0.5 cm (single marking) and every 1 cm (double marking). This needle was used in the marked group. Approximate depths (centimeter) of the anterior and posterior wall of the internal jugular vein, anterior wall of the internal carotid artery, and lung pleura were appreciated from the midpoint of the probe in short-axis view at the level of the cricoid cartilage. Access time (seconds) was recorded using a stopwatch. A number of attempts and complications such as arterial puncture, hematoma, and pneumothorax of either procedure were compared. RESULTS Both marked needle and unmarked needle groups were comparable with regard to age, gender, severity scores, platelet counts, prothrombin time, and distance from the midpoint of the probe to the vein, artery, and pleura and skin-to-guide wire insertion access time. However, an average number of attempts (P = 0.03) and complications such as hematoma were significantly lower (P = 0.02) with the marked introducer needle group. Pneumothorax was not reported in any of the groups. CONCLUSION Our study supports the idea that marked introducer needle can further reduce the iatrogenic complications of US-guided CVC.
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Affiliation(s)
- Tanmoy Ghatak
- Department of Anesthesia and Critical Care Medicine, IIMS and R, Lucknow, Uttar Pradesh, India
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Adhikary S, McQuillan P, Fortunato M, Owen D, Liu WM, Thiruvenkatarajan V. A manikin-based evaluation of a teaching modality for ultrasound-guided infraclavicular longitudinal in-plane axillary vein cannulation in comparison with ultrasound-guided internal jugular vein cannulation: A pilot study. J Anaesthesiol Clin Pharmacol 2017; 33:337-341. [PMID: 29109632 PMCID: PMC5672534 DOI: 10.4103/joacp.joacp_189_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: Ultrasound (US)-guided infraclavicular approach for axillary vein (AXV) cannulation has gained popularity in the last decade. Material and Methods: In this manikin study, we evaluated the feasibility of a training model for teaching AXV cannulation. The learning pattern with this technique was assessed among attending anesthesiologists and residents in training. Results: A faster learning pattern was observed for AXV cannulation among the attending anesthesiologists and residents in training, irrespective of their prior experience with US. It was evident that a training modality for this technique could be easily established with a phantom model and that hands-on training motivates trainees to embrace US-based central venous cannulation. Conclusion: A teaching model for US-guided infraclavicular longitudinal in-plane AXV cannulation can be established using a phantom model. A focused educational program would result in an appreciable change in preference in embracing US-based cannulation techniques among residents.
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Affiliation(s)
- Sanjib Adhikary
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Milton S. Hershey Medical Centre, Hershey, Pennsylvania, USA
| | - Patrick McQuillan
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Milton S. Hershey Medical Centre, Hershey, Pennsylvania, USA
| | - Michael Fortunato
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Milton S. Hershey Medical Centre, Hershey, Pennsylvania, USA
| | - David Owen
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Milton S. Hershey Medical Centre, Hershey, Pennsylvania, USA
| | - Wai-Man Liu
- Department of Research Scool, Research School of Finance, Actuarial Studies and Statistics, The Australian National University, Canberra, South, Australia
| | - Venkatesan Thiruvenkatarajan
- Department of Anaesthesia, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia.,Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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Komasawa N, Mihara R, Hattori K, Minami T. Evaluation of artery and vein differentiation methods using ultrasound imaging among medical students. Br J Anaesth 2016; 117:832-833. [DOI: 10.1093/bja/aew371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kim E, Kim BG, Lim YJ, Jeon YT, Hwang JW, Kim HC, Choi YH, Park HP. A prospective randomised trial comparing insertion success rate and incidence of catheterisation-related complications for subclavian venous catheterisation using a thin-walled introducer needle or a catheter-over-needle technique. Anaesthesia 2016; 71:1030-6. [DOI: 10.1111/anae.13543] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- E. Kim
- Department of Anaesthesiology and Pain Medicine; School of Medicine; Catholic University of Daegu; Daegu Korea
| | - B. G. Kim
- Department of Anaesthesiology and Pain Medicine; Inha University Hospital; Inha University College of Medicine; Incheon Korea
| | - Y. J. Lim
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - Y. T. Jeon
- Seoul National University Bundang Hospital; Seoul National University College of Medicine; Seongnam Korea
| | - J. W. Hwang
- Seoul National University Bundang Hospital; Seoul National University College of Medicine; Seongnam Korea
| | - H. C. Kim
- Department of Anaesthesiology and Pain Medicine; Keimyung University Dongsan Hospital; Keimyung University School of Medicine; Daegu Korea
| | - Y. H. Choi
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - H. P. Park
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
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Buzançais G, Roger C, Bastide S, Jeannes P, Lefrant JY, Muller L. Comparison of two ultrasound guided approaches for axillary vein catheterization: a randomized controlled non-inferiority trial. Br J Anaesth 2016; 116:215-22. [PMID: 26787790 DOI: 10.1093/bja/aev458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Axillary vein catheterization via a distal approach is an alternative to the proximal approach to axillary/subclavian vein catheterization under ultrasound (US) guidance. The aim of this trial was to compare the two approaches. METHODS In a randomized single-centre study, all patients requiring central vein catheterization in intensive care or the operating room were randomly assigned to proximal or distal approach groups. If catheterization failed after two attempts using the approach allocated, the non-allocated approach was used. The primary endpoint was the initial success rate of distal to compared with the proximal approach, using a non-inferiority analysis (lower limit 90% CI greater than -8% non-inferiority margin for group difference). The secondary endpoints were: overall success rates, catheter position and complications. RESULTS 119/122 included patients were analysed (57 and 62 in the proximal and distal axillary approach groups, respectively). Primary success rates for proximal and distal sites were 87.7 and 85.5%, respectively (difference -2.2%, 90% CI [-12.5-8.1%], non-inferiority P=0.18). The proximal and distal overall success rates were 96.5 and 98.4%, respectively (difference -1.9%, 90% CI [-4.9-8.7%], non-inferiority P<0.01). Thrombogenic catheter positions were 7 (12.3%) in proximal approach group vs 19 (31.7%) in the distal approach group (P=0.01). Complications were comparable in the two groups (2 (3.3%) vs 4 (6.5%), P=0.68). CONCLUSION In terms of absolute and overall success rates, a distal approach is not non-inferior to a proximal approach. Although associated with a more thrombogenic catheter extremity position, the distal approach can be considered as a rescue alternative after failure of a proximal approach. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01543360.
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Affiliation(s)
- G Buzançais
- Critical Care Unit, Department of Anaesthesiology, Critical Care, Pain and Emergency Medicine Anaesthesiology Unit, Department of Anaesthesiology, Critical Care, Pain and Emergency Medicine
| | - C Roger
- Critical Care Unit, Department of Anaesthesiology, Critical Care, Pain and Emergency Medicine EA 2992, Faculté de Médecine de Nîmes, Université Montpellier 1, Boulevard Kennedy, Nîmes 30000, France
| | - S Bastide
- Department of Biostatistics and Clinical Epidemiology, Nimes University Hospital, Place du Pr Debré, Nîmes cedex 9 30029, France
| | - P Jeannes
- Critical Care Unit, Department of Anaesthesiology, Critical Care, Pain and Emergency Medicine
| | - J Y Lefrant
- Critical Care Unit, Department of Anaesthesiology, Critical Care, Pain and Emergency Medicine EA 2992, Faculté de Médecine de Nîmes, Université Montpellier 1, Boulevard Kennedy, Nîmes 30000, France
| | - L Muller
- Critical Care Unit, Department of Anaesthesiology, Critical Care, Pain and Emergency Medicine EA 2992, Faculté de Médecine de Nîmes, Université Montpellier 1, Boulevard Kennedy, Nîmes 30000, France
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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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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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Ultrasound-guided subclavian venipuncture is more rapidly learned than the anatomic landmark technique in simulation training. J Vasc Access 2015; 16:144-7. [PMID: 25362982 DOI: 10.5301/jva.5000318] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2014] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Both ultrasound-guided subclavian venipuncture (US-SV) and landmark-guided subclavian venipuncture (LM-SV) are important in critical care, because the clinical utility of ultrasound guidance is still debated. Education of residents and medical students should include both techniques. The aim of this study is to compare learning these two techniques in a simulation environment. METHODS This study was approved by the research ethics review committee. Trainees included residents and medical students who were instructed using the "Videos in Clinical Medicine" for LM-SV, or a dedicated slide series for US-SV, using the long-axis in-plane with needle-guide technique. After the lecture, trainees attempted to perform venipuncture in a simulator. All participants performed both techniques. The procedure time from initial skin puncture to detecting back-flow of fluid from the simulated vein was measured. A procedure time over 3 min, arterial puncture, or pneumothorax was counted as a failure. The end-point for each trainee was three successive successful venipunctures without a failure. A trainee who reached the end-point was considered as having acquired adequate skill. Statistical analysis of the procedure time comparing the techniques was done using the Mann-Whitney U test. RESULTS Twenty trainees participated in this training. Adequate skill to perform US-SV was achieved within three tries, but up to nine attempts were needed for LM-SV. One arterial puncture occurred during LM-SV. No pneumothoraxes occurred during the simulation training. CONCLUSIONS US-SV was learned more quickly than LM-SV in a simulation model.
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Mandal M, Karmakar A, Basu S. Coiling of guidewire in the internal jugular vein: Putting some caveats. Indian J Anaesth 2015; 59:334. [PMID: 26019369 PMCID: PMC4445166 DOI: 10.4103/0019-5049.156907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tadokoro T, Tokumine J, Lefor AT, Kawabata T, Yoza K, Kinjo T. The three-step method for ultrasound-guided pediatric internal jugular venous catheterization: a clinical trial. J Anesth 2014; 29:131-3. [PMID: 24981562 DOI: 10.1007/s00540-014-1869-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/06/2014] [Indexed: 02/08/2023]
Abstract
Ultrasound guidance may be a valuable adjunct for pediatric internal jugular vein catheterization. We previously reported a long-axis in plane technique, called the "three-step method", resulting in high success and a low complication rate by novice operators in adult patients. This is the first report of ultrasound-guided internal jugular vein catheterization (US-IJV) using the three-step method in pediatric patients. Fourteen junior residents underwent simulation training, and then participated in a clinical trial. They performed US-IJV in 14 pediatric patients with congenital heart disease before undergoing cardiac surgery under supervision of an experienced clinician. The overall success rate was 93 %, and all catheterizations were performed within two venipunctures. There were no complications associated with the procedure. The three-step method may facilitate pediatric US-IJV even by a novice operator during their first experience.
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Affiliation(s)
- Takahiro Tadokoro
- Department of Anesthesia, Okinawa Prefectural Miyako Hospital, 427-1, Hirara Shimozato, Miyakojima, Okinawa, 906-0013, Japan,
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Tokumine J, Lefor AT, Yonei A. Reply from the authors. Br J Anaesth 2013; 112:170-1. [PMID: 24318700 DOI: 10.1093/bja/aet446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Adachi YU, Hatano T, Hashimoto S, Ejima T, Murase K, Matsuda N. Fourth step for ultrasound-guided central vein catheterization. Br J Anaesth 2013; 112:170. [PMID: 24318701 DOI: 10.1093/bja/aet447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kubodera T, Adachi YU, Hatano T, Ejima T, Numaguchi A, Matsuda N. Subcutaneous emphysema and ultrasound sonography. J Intensive Care 2013; 1:8. [PMID: 25705402 PMCID: PMC4336130 DOI: 10.1186/2052-0492-1-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 10/16/2013] [Indexed: 11/10/2022] Open
Abstract
Subcutaneous emphysema is not a rare complication in intensive care unit patients. Recently, ultrasound guidance for central venous puncture is becoming popular; however, the information on imaging for subcutaneous emphysema is limited. We encountered a patient complicated with severe pneumomediastinum and subsequent subcutaneous emphysema. The catheter replacement was attempted, and we examined the visuality of cervical vessels using ultrasound sonography before the intervention. Internal jugular vein itself was observed despite of subcutaneously migrated air bubble; however, the range of ultrasound image was limited, and the relationship between the vessel and the adjacent tissue was unclear.
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Affiliation(s)
- Toshi Kubodera
- Department of Emergency Medicine, Ogaki Municipal Hospital, Ogaki, Gifu, 503-8502 Japan
| | - Yushi U Adachi
- Department of Emergency Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550 Japan
| | - Toshiyuki Hatano
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550 Japan
| | - Tadashi Ejima
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550 Japan
| | - Atsushi Numaguchi
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550 Japan
| | - Naoyuki Matsuda
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550 Japan
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Kelly LJ. Vascular access: viewing the vein. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2013; 22:S16-S18. [PMID: 24350394 DOI: 10.12968/bjon.2013.22.sup19.s16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Affiliation(s)
- Linda J Kelly
- University of the West of Scotland School of Health, Nursing and Midwifery
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The advanced radial artery cannulation using Insyte-A™ with real-time ultrasound guidance. J Clin Monit Comput 2013; 27:703-4. [DOI: 10.1007/s10877-013-9482-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 05/27/2013] [Indexed: 11/26/2022]
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