A randomized crossover study comparing a novel needle guidance technology for simulated internal jugular vein cannulation

Technical feasibility and efficacy of a standard needle magnetization system for ultrasound needle guidance in thyroid nodule-targeting punctures: a phantom study

PURPOSE

The aim of this study was to assess the feasibility and efficacy of an ultrasound needle guidance system (NGS) based on standard needle magnetization in a phantom study of thyroid nodule (TN)-targeting punctures.

METHODS

Six trainees and a staff radiologist performed TN-targeting punctures with or without the NGS in phantom models (group 1, experience <50 cases; group 2, experience ≥50 cases and <100 cases; group 3, experience ≥100 cases of TN-targeting punctures). The feasibility, technical success rate, number of punctures, and procedure time were recorded.

RESULTS

The feasibility of NGS was 98.6% (138/140). In group 1, the technical success rate increased from 60.0%±8.2% to 80.0%±8.2% when the NGS was used (P=0.046), with a reduction in the number of punctures from 2.2 to 1.2 (P=0.005). In group 2, the rate changed from 95.0%±5.8% to 100.0%±0.0% with the NGS (P=0.157), with a minimal decrease in the number of punctures from 1.1 to 1.0 (P=0.157). The procedure time significantly decreased in both groups (P=0.041 and P=0.010, respectively) when the NGS was used. In group 3, there were no significant differences in the technical success rate and the number of punctures according to whether the NGS was used (P=0.317 and P=0.317, respectively).

CONCLUSION

NGS using standard needle magnetization is technically feasible and has potential to improve the efficacy of TN-targeting punctures for less-experienced operators, especially beginners, according to the findings of this phantom study.

A novel electromagnetic guidance ultrasound system on radial artery cannulation: a prospective randomized controlled trial

Background

Radial artery cannulation can cause complications such as haematoma formation or thrombosis due to its small diameter. Recently, a novel ultrasound device equipped with an electromagnetic guidance system was introduced, showing the path and alignment of the needle during the procedure. The aim of this study was to investigate the effects of this novel system on both success and complication rates during radial artery cannulation under ultrasound guidance.

Methods

In this randomized controlled trial, 76 adults scheduled for neurosurgery requiring radial artery cannulation were recruited. In group E (n = 38), radial artery cannulation was performed using the electromagnetic guidance ultrasound system, whereas in group C (n = 38), the procedure was performed using conventional ultrasound guidance. The success rates of cannulation on the first attempt, cannulation times, number of attempts, and incidence of complications were compared between the two groups.

Results

There was a significant difference in the success rates on the first attempt between the two groups (group C = 78.9% vs. group E = 94.7%, P = 0.042). Incidences of posterior wall puncture and haematoma formation (group C = 8 vs. group E = 1; P = 0.028) were significantly lower in group E than in group C. The median cannulation time for successful attempts was comparable between groups.

Conclusions

Use of the novel electromagnetic guidance system resulted in a better success rate on the first attempt and a lower incidence of complications during radial artery cannulation.

Trial registration

This study was registered at http://cris.nih.go.kr (registration number: KCT0002476).

Standard Needle Magnetization for Ultrasound Needle Guidance: First Clinical Experiences in Fine-Needle Aspiration Cytology of Thyroid Nodules

Fine-needle aspiration cytology using a novel ultrasound needle guidance system on the basis of standard needle magnetization was consecutively performed in 30 (15 in-plane and 15 out-of-plane) suspicious thyroid nodules. Nondedicated, commercially available needles were used. The technical effectiveness and safety of the system were satisfying; system failures were observed in 2 cases. The needle tip could be (at least occasionally) visualized inside the thyroid nodule in 96%, and the subjective procedure ratings were excellent in 57%. The out-of-plane technique was significantly superior in both respects (P = .021 and .027, respectively). Standard needle magnetization ultrasound needle guidance was easy to apply and cost-effective and has the potential to improve fine-needle aspiration cytology performance.

Ultrasound-guided central venous vascular access-novel needle navigation technology compared with conventional method: A randomized study

PURPOSE

Central venous catheter insertion is a common procedure in the intensive care setting. However, complications persist despite real-time ultrasound guidance. Recent innovation in needle navigation technology using guided positioning system enables the clinician to visualize the needle's real-time position and trajectory as it approaches the target. We hypothesized that the guided positioning system would improve performance time in central venous catheter insertion.

METHODS

A prospective randomized study was conducted in a single-center adult intensive care unit. In total, 100 patients were randomized into two groups. These patients underwent internal jugular vein central venous catheter cannulation with ultrasound guidance (short-axis scan, out-of-plane needling approach) in which one group adopted conventional method, while the other group was aided with the guided positioning system. Outcomes were measured by procedural efficacy (success rate, number of attempts, time to successful cannulation), complications, level of operators' experience, and their satisfaction.

RESULTS

All patients had successful cannulation on the first attempt except for one case in the conventional group. The median performance time for the guided positioning system method was longer (25.5 vs 15.5 s; p = 0.01). And 86% of the operators had more than 3-year experience in anesthesia. One post-insertion hematoma occurred in the conventional group. Only 88% of the operators using the guided positioning system method were satisfied compared to 100% in the conventional group.

CONCLUSION

Ultrasound-guided central venous catheter insertion via internal jugular vein was a safe procedure in both conventional and guided positioning system methods. The guided positioning system did not confer additional benefit but was associated with slower performance time and lower satisfaction level among the experienced operators.

A Shallow Angle Short-Axis Out-of-Plane Approach Reduces the Rate of Posterior Wall Injuries in Central Venous Catheterization: A Simulation Study

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.

Ultrasound-guided lumbar puncture with a needle-guidance system: A prospective and controlled study to evaluate the learnability and feasibility of a newly developed approach

Objective

To evaluate the learnability and feasibility of a new technique comprising a needle-guidance-system (NGS) for ultrasound-assisted lumbar puncture.

Method

Using a randomized crossover study design, 24 medical students were asked to perform an ultrasound-assisted lumbar puncture on a gel phantom using two different techniques that each included a paramedian insertion site. Procedure 1 (P1) used a pre-procedural ultrasound scan to predetermine the ideal insertion point. Procedure 2 (P2) applied a new technique comprising an NGS for performing real-time ultrasound-guided lumbar puncture. Success rates and performance times for both procedures were compared. Participants were also asked to complete a post-study questionnaire, both to quantitatively assess the workload involved and state their personal preferences.

Results

In comparison to the pre-procedural scan (P1), the NGS (P2) was associated with a significant increase in the number of successful punctures per participant (5 (P2) [interquartile range: 3.3–5.0] vs. 3 (P1) [interquartile range: 1.3–4.0], p = 0.005), and led to a significant reduction in performance time (118 seconds vs. 80.6 seconds, p < 0.001). In terms of workload perception, NGS use was associated with significantly better performances and lower frustration levels, as rated by students in the post-study questionnaire. Finally, 23/24 participants stated their preference for P2.

Conclusion

Our newly-developed technique for real-time ultrasound-guided lumbar puncture proved to be learnable and feasible for novices, and only required a small amount of training. The use of an NGS therefore has the potential to serve as a key feature of the ultrasound-assisted lumbar puncture.

Simulated internal jugular vein cannulation using a needle-guiding device

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.