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Savage M, Spence A, Turbitt L. The educational impact of technology-enhanced learning in regional anaesthesia: a scoping review. Br J Anaesth 2024; 133:400-415. [PMID: 38824073 DOI: 10.1016/j.bja.2024.04.045] [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: 12/31/2023] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Effective training in regional anaesthesia (RA) is paramount to ensuring widespread competence. Technology-based learning has assisted other specialties in achieving more rapid procedural skill acquisition. If applicable to RA, technology-enhanced training has the potential to provide an effective learning experience and to overcome barriers to RA training. We review the current evidence base for use of innovative technologies in assisting learning of RA. METHODS Using scoping review methodology, three databases (MEDLINE, Embase, and Web of Science) were searched, identifying 158 relevant citations. Citations were screened against defined eligibility criteria with 27 studies selected for inclusion. Data relating to study details, technological learning interventions, and impact on learner experience were extracted and analysed. RESULTS Seven different technologies were used to train learners in RA: artificial intelligence, immersive virtual reality, desktop virtual reality, needle guidance technology, robotics, augmented reality, and haptic feedback devices. Of 27 studies, 26 reported a positive impact of technology-enhanced RA training, with different technologies offering benefits for differing components of RA training. Artificial intelligence improved sonoanatomical knowledge and ultrasound skills for RA, whereas needle guidance technologies enhanced confidence and improved needling performance, particularly in novices. Immersive virtual reality allowed more rapid acquisition of needling skills, but its functionality was limited when combined with haptic feedback technology. User friendly technologies enhanced participant experience and improved confidence in RA; however, limitations in technology-assisted RA training restrict its widespread use. CONCLUSIONS Technology-enhanced RA training can provide a positive and effective learning experience, with potential to reduce the steep learning curve associated with gaining RA proficiency. A combined approach to RA education, using both technological and traditional approaches, should be maintained as no single method has been shown to provide comprehensive RA training.
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Affiliation(s)
- Mairead Savage
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK.
| | - Andrew Spence
- Department of Gastroenterology, Belfast Health and Social Care Trust, Belfast, UK; School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Lloyd Turbitt
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
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Boulet N, Bobbia X, Gavoille A, Louart B, Lefrant JY, Roger C, Muller L. Axillary vein catheterization using ultrasound guidance: A prospective randomized cross-over controlled simulation comparing standard ultrasound and new needle-pilot device. J Vasc Access 2023; 24:1042-1050. [PMID: 34965763 DOI: 10.1177/11297298211063705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Real-time ultrasound (US) guidance facilitates central venous catheterization in intensive care unit (ICU). New magnetic needle-pilot devices could improve efficiency and safety of central venous catheterization. This simulation trial was aimed at comparing venipuncture with a new needle-pilot device to conventional US technique. METHODS In a prospective, randomized, simulation trial, 51 ICU physicians and residents cannulated the right axillary vein of a human torso mannequin with standard US guidance and with a needle-pilot system, in a randomized order. The primary outcome was the time from skin puncture to successful venous cannulation. The secondary outcomes were the number of skin punctures, the number of posterior wall puncture of the axillary vein, the number of arterial punctures, the number of needle redirections, the failure rate, and the operator comfort. RESULTS Time to successful cannulation was shorter with needle-pilot US-guided technique (22 s (interquartile range (IQR) = 16-42) vs 25 s (IQR = 19-128); median of difference (MOD) = -9 s (95%-confidence interval (CI) -5, -22), p < 0.001). The rates of skin punctures, posterior wall puncture of axillary vein, and needle redirections were also lower (p < 0.01). Comfort was higher in needle-pilot US-guided group on a 11-points numeric scale (8 (IQR = 8-9) vs 6 (IQR = 6-8), p < 0.001). CONCLUSIONS In a simulation model, US-guided axillary vein catheterization with a needle-pilot device was associated with a shorter time of successful cannulation and a decrease in numbers of skin punctures and complications. The results plea for investigating clinical performance of this new device.
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Affiliation(s)
- Nicolas Boulet
- Intensive Care Unit, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Xavier Bobbia
- EA 2992 IMAGINE, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Antoine Gavoille
- Department of Biostatistics-Bioinformatic, Hospices Civils de Lyon, Lyon, France
| | - Benjamin Louart
- Intensive Care Unit, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Jean Yves Lefrant
- Intensive Care Unit, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Claire Roger
- Intensive Care Unit, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Laurent Muller
- Intensive Care Unit, Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
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Shevlin SP, Turbitt L, Burckett-St Laurent D, Macfarlane AJ, West S, Bowness JS. Augmented Reality in Ultrasound-Guided Regional Anaesthesia: An Exploratory Study on Models With Potential Implications for Training. Cureus 2023; 15:e42346. [PMID: 37621802 PMCID: PMC10445048 DOI: 10.7759/cureus.42346] [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: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction Needle tip visualisation is a key skill required for the safe practice of ultrasound-guided regional anaesthesia (UGRA). This exploratory study assesses the utility of a novel augmented reality device, NeedleTrainer™, to differentiate between anaesthetists with varying levels of UGRA experience in a simulated environment. Methods Four groups of five participants were recruited (n = 20): novice, early career, experienced anaesthetists, and UGRA experts. Each participant performed three simulated UGRA blocks using NeedleTrainer™ on healthy volunteers (n = 60). The primary aim was to determine whether there was a difference in needle tip visibility, as calculated by the device, between groups of anaesthetists with differing levels of UGRA experience. Secondary aims included the assessment of simulated block conduct by an expert assessor and subjective participant self-assessment. Results The percentage of time the simulated needle tip was maintained in view was higher in the UGRA expert group (57.1%) versus the other three groups (novice 41.8%, early career 44.5%, and experienced anaesthetists 43.6%), but did not reach statistical significance (p = 0.05). An expert assessor was able to differentiate between participants of different UGRA experience when assessing needle tip visibility (novice 3.3 out of 10, early career 5.1, experienced anaesthetists 5.9, UGRA expert group 8.7; p < 0.01) and final needle tip placement (novice 4.2 out of 10, early career 5.6, experienced anaesthetists 6.8, UGRA expert group 8.9; p < 0.01). Subjective self-assessment by participants did not differentiate UGRA experience when assessing needle tip visibility (p = 0.07) or final needle tip placement (p = 0.07). Discussion An expert assessor was able to differentiate between participants with different levels of UGRA experience in this simulated environment. Objective NeedleTrainer™ and subjective participant assessments did not reach statistical significance. The findings are novel as simulated needling using live human subjects has not been assessed before, and no previous studies have attempted to objectively quantify needle tip visibility during simulated UGRA techniques. Future research should include larger sample sizes to further assess the potential use of such technology.
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Affiliation(s)
- Sean P Shevlin
- Anaesthesia, Belfast Health and Social Care Trust, Belfast, GBR
| | - Lloyd Turbitt
- Anaesthesia, Belfast Health and Social Care Trust, Belfast, GBR
| | | | | | - Simeon West
- Anaesthesia, University College London Hospital, London, GBR
| | - James S Bowness
- Anaesthesia, Aneurin Bevan University Health Board, Newport, GBR
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Inklebarger J, Totlis T, Feigl G, Tishukov M, Galanis N. Transverse plane ultrasound-guided caudal epidural injections: sonographic anatomy and stepwise technique. Surg Radiol Anat 2021; 43:1527-1535. [PMID: 34080063 DOI: 10.1007/s00276-021-02776-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The present study aims to provide a step-by-step procedural and anatomical familiarization guide for transverse plane ultrasound (US)-guided caudal epidural (CE) injection. METHODS The study cohort consisted of 23 chronic low back pain patients (23-67 years old) previously unresponsive to conservative management. A transverse plane US-guided CE injection was performed, with each procedure step documenting and emphasizing sonographic anatomy. Several Thiel's method fixed cadaveric specimen dissections were also performed to demonstrate relevant CE injection-related anatomy. RESULTS The sacral hiatus location can be estimated by visually forming an equilateral triangle between the posterior superior iliac spines and the sacral apex (trigonum sacrale). Follow-up palpation locates the sacral cornua, guiding transducer placement visualizing over the paired cornua 'bull frog's eye's appearance, with the epidural space visualized as a hypoechoic line, between the eyes. Then, 2-3 ml of 1% lidocaine is injected subcutaneously at the mid-point between the sacral cornua and superficial to the posterior sacrococcygeal ligament (SCL). Although keeping the cornua, superficial posterior SCL and epidural space in view, the needle is slowly advanced to the epidural space at around a 20 degree cephalad angle till the tip becomes visible. Expansion of the epidural space is monitored under the transverse sacral ligament as the injectant is slowly introduced. CONCLUSION The present study demonstrated the anatomical landmarks necessary for the transverse ultrasound caudal epidural technique and that the cornua, superficial posterior SCL, CE space, and other relevant sacral hiatal anatomy are well visualized with this technique.
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Affiliation(s)
- James Inklebarger
- The London College of Osteopathic Medicine, 8-10 Boston Place, London, NW1 6QH, UK
| | - Trifon Totlis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| | - Georg Feigl
- Institute for Anatomy and Clinical Morphology, Department for Human Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Department of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria
| | - Maksim Tishukov
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Nikiforos Galanis
- 1st Orthopaedic Department, George Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Gallo C, Foroughi P, Meagher E, Vellody R, Yadav B, Ho A, Demir A, Heisenberg D, Cleary K, Sharma K. Computer-assisted needle navigation for pediatric internal jugular central venous cannulation: A feasibility study. J Vasc Access 2020; 21:931-937. [PMID: 32339064 DOI: 10.1177/1129729820915035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Vascular access for central venous catheter placement is technically challenging in children. Ultrasound guidance is recommended for pediatric central venous catheter placement, yet many practitioners rely on imprecise anatomic landmark techniques risking procedure failure due to difficulty mastering ultrasound guidance. A novel navigation system provides a visual overlay on real-time ultrasound images to depict needle trajectory and tip location during cannulation. We report the first pediatric study assessing feasibility and preliminary safety of using a computer-assisted needle navigation system to aid in central venous access. METHODS A prospective, institutional review board-approved feasibility study was performed. All participants provided written informed consent. Ten patients (mean age: 11.4 years, five males) underwent central venous catheter placement with ultrasound and navigation system guidance. All procedures were performed by interventional radiologists expert in vascular access. Feasibility was measured through binary (yes/no) responses from participating users assessing device usability and feasibility. The number of needle passes and procedure time measures were also recorded. RESULTS Internal jugular veins (seven right sided, three left sided) were cannulated in all patients with no complications. Users confirmed navigation system feasibility in all 10 participants. Mean vein diameter and depth was 13.3 × 9.8 ± 3.4 × 2.1 and 7.0 ± 1.7 mm, respectively. Successful cannulation occurred in all patients and required only a single needle pass in 9 of 10 patients. Mean device set-up and vascular access times were 5:31 ± 2:28 and 1:48 ± 2:35 min, respectively. CONCLUSION This pilot study suggests that it is feasible to use a novel computer-assisted needle navigation system to safely obtain central venous access under ultrasound guidance in pediatric patients.
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Affiliation(s)
| | | | | | | | | | - Anthony Ho
- Children's National Hospital, Washington, DC, USA
| | | | | | - Kevin Cleary
- Children's National Hospital, Washington, DC, USA
| | - Karun Sharma
- Children's National Hospital, Washington, DC, USA
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Chew SC, Beh ZY, Hakumat Rai VR, Jamaluddin MF, Ng CC, Chinna K, Hasan MS. Ultrasound-guided central venous vascular access-novel needle navigation technology compared with conventional method: A randomized study. J Vasc Access 2019; 21:26-32. [PMID: 31148509 DOI: 10.1177/1129729819852057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Sou Chen Chew
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zhi Yuen Beh
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Vineya Rai Hakumat Rai
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Ching Choe Ng
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - M Shahnaz Hasan
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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A novel finite element model-based navigation system-supported workflow for breast tumor excision. Med Biol Eng Comput 2019; 57:1537-1552. [PMID: 30980230 DOI: 10.1007/s11517-019-01977-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
In the case of female breast cancer, a breast-conserving excision is often desirable. This surgery is based on preoperatively gathered MRI, mammography, and sonography images. These images are recorded in multiple patient positions, e. g., 2D mammography images in standing position with a compressed breast and 3D MRI images in prone position. In contrast, the surgery happens in supine or beach chair position. Due to these different perspectives and the flexible, thus challenging, breast tissue, the excision puts high demands on the physician. Therefore, this publication presents a novel eight-step excision support workflow that can be used to include information captured preoperatively through medical imaging based on a finite element (FE) model. In addition, an indoor positioning system is integrated in the workflow in order to track surgical devices and the sonography transducer during surgery. The preoperative part of the navigation system-supported workflow is outlined exemplarily based on first experimental results including 3D scans of a patient in different patient positions and her MRI images. Graphical Abstract Finite Element model based navigation system supported workflow for breast tumor excision is based on eight steps and allows inclusion of information from medical images recorded in multiple patient positions.
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Abstract
For inexperienced users, training with phantoms is an important part of training. Inexperienced users can teach themselves to gain significant procedural skills. Participating in training courses or practising with experts can enhance the outcomes. Inexperienced users need to understand the indications, clinical pearls, and pitfalls of each procedure to avoid potential complications. Inexperienced users can also train and teach themselves to become proficient in ultrasound techniques.
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Affiliation(s)
- Jeffrey Huang
- Anesthesiology, University of Central Florida, Orlando, USA
| | - Jinlei Li
- Anesthesiology, Yale University, New Haven , USA
| | - Hong Wang
- Anesthesiology, West Virginia University, Morgantown, USA
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Thomas A, Ewald J, Kelly I, Pierce M, Thomas J, Mattison B, West B, Ruckle D, Keheila M, Abourbih S, Krause R, Dinh VA, Baldwin DD, Baldwin DD. Conventional vs Computer-Assisted Stereoscopic Ultrasound Needle Guidance for Renal Access: A Randomized Crossover Bench-Top Trial. J Endourol 2018; 32:424-430. [DOI: 10.1089/end.2018.0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Alexander Thomas
- Department of Urology, Loma Linda University Health, Loma Linda, California
| | - Jonathan Ewald
- Department of Urology, Loma Linda University Health, Loma Linda, California
| | - Isaac Kelly
- Department of Urology, Loma Linda University Health, Loma Linda, California
| | - Matthew Pierce
- Department of Urology, Loma Linda University Health, Loma Linda, California
| | - Jerry Thomas
- Department of Urology, Loma Linda University Health, Loma Linda, California
| | - Braden Mattison
- Department of Urology, Loma Linda University Health, Loma Linda, California
| | - Benjamin West
- Department of Urology, Loma Linda University Health, Loma Linda, California
| | - David Ruckle
- Department of Urology, Loma Linda University Health, Loma Linda, California
| | - Mohamed Keheila
- Department of Urology, Loma Linda University Health, Loma Linda, California
| | - Samuel Abourbih
- Department of Urology, Loma Linda University Health, Loma Linda, California
| | - Reed Krause
- Department of Urology, Loma Linda University Health, Loma Linda, California
| | - Vi Am Dinh
- Department of Urology, Loma Linda University Health, Loma Linda, California
| | - D. Daniel Baldwin
- Department of Urology, Loma Linda University Health, Loma Linda, California
| | - D. Duane Baldwin
- Department of Urology, Loma Linda University Health, Loma Linda, California
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Backhaus T, von Cranach M, Brich J. 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. PLoS One 2018; 13:e0195317. [PMID: 29630646 PMCID: PMC5891015 DOI: 10.1371/journal.pone.0195317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 03/20/2018] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Tilo Backhaus
- Department of Neurology and Neuroscience, Medical Center – University of Freiburg, Freiburg, Germany
- * E-mail:
| | - Moritz von Cranach
- Department of Neurology and Neuroscience, Medical Center – University of Freiburg, Freiburg, Germany
| | - Jochen Brich
- Department of Neurology and Neuroscience, Medical Center – University of Freiburg, Freiburg, Germany
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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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Abstract
PURPOSE OF REVIEW Ultrasound-guided regional anesthesia is a challenging, complex skill and requires competence in teaching. The aim of this study was to review current literature on identification of education and learning of ultrasound-guided regional anesthesia and to summarize recent findings on teaching concepts. RECENT FINDINGS Several teaching programs have been described and implemented into daily routine. Factors relevant to current practice are the knowledge of sonoanatomy, the acquisition of manual skills, the teaching ability, and the feedback given to the trainee. Simulation is a rapidly growing field and is supported by the development of phantoms. Needle visualization is one of the core competencies that is necessary for successful ultrasound-guided procedures and could be supported by technical developments in the future to improve teaching concepts. SUMMARY Although a lot of key questions cannot be answered by the latest study results, some interesting findings were able to improve existing education programs. These results should be tailored to the individual need of a trainee, and the effects of improved training programs on patient safety and quality of care have to be investigated. The see one, do one, teach one approach is obsolete and should be abandoned.
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Stauffer S, Cordner B, Dixon J, Witte T. Maxillary nerve blocks in horses: an experimental comparison of surface landmark and ultrasound-guided techniques. Vet Anaesth Analg 2017; 44:951-958. [DOI: 10.1016/j.vaa.2016.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/26/2016] [Accepted: 09/15/2016] [Indexed: 10/19/2022]
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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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Menacé C, Choquet O, Abbal B, Bringuier S, Capdevila X. Comparison of a GPS needle-tracking system, multiplanar imaging and 2D imaging for real-time ultrasound-guided epidural anaesthesia: A randomized, comparative, observer-blinded study on phantoms. Anaesth Crit Care Pain Med 2017; 36:83-89. [DOI: 10.1016/j.accpm.2016.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 05/13/2016] [Accepted: 05/20/2016] [Indexed: 11/25/2022]
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16
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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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17
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Fevre MC, Vincent C, Picard J, Vighetti A, Chapuis C, Detavernier M, Allenet B, Payen JF, Bosson JL, Albaladejo P. Reduced variability and execution time to reach a target with a needle GPS system: Comparison between physicians, residents and nurse anaesthetists. Anaesth Crit Care Pain Med 2016; 37:55-60. [PMID: 27659968 DOI: 10.1016/j.accpm.2016.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 05/12/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
Abstract
Ultrasound (US) guided needle positioning is safer than anatomical landmark techniques for central venous access. Hand-eye coordination and execution time depend on the professional's ability, previous training and personal skills. Needle guidance positioning systems (GPS) may theoretically reduce execution time and facilitate needle positioning in specific targets, thus improving patient comfort and safety. Three groups of healthcare professionals (41 anaesthesiologists and intensivists, 41 residents in anaesthesiology and intensive care, 39 nurse anaesthetists) were included and required to perform 3 tasks (positioning the tip of a needle in three different targets in a silicon phantom) by using successively a conventional US-guided needle positioning and a needle GPS. We measured execution times to perform the tasks, hand-eye coordination and the number of repositioning occurrences or errors in handling the needle or the probe. Without the GPS system, we observed a significant inter-individual difference for execution time (P<0.05), hand-eye coordination and the number of errors/needle repositioning between physicians, residents and nurse anaesthetists. US training and video gaming were found to be independent factors associated with a shorter execution time. Use of GPS attenuated the inter-individual and group variability. We observed a reduced execution time and improved hand-eye coordination in all groups as compared to US without GPS. Neither US training, video gaming nor demographic personal or professional factors were found to be significantly associated with reduced execution time when GPS was used. US associated with GPS systems may improve safety and decrease execution time by reducing inter-individual variability between professionals for needle-handling procedures.
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Affiliation(s)
| | | | - Julien Picard
- Pôle Anesthésie Réanimation, CHU de Grenoble, 38000 Grenoble, France; Univ. Grenoble Alpes, CNRS, TIMC-IMAG, 38000 Grenoble, France
| | - Arnaud Vighetti
- Pôle Anesthésie Réanimation, CHU de Grenoble, 38000 Grenoble, France
| | | | | | - Benoît Allenet
- Pôle Pharmacie, CHU de Grenoble, 38000 Grenoble, France; Univ. Grenoble Alpes, CNRS, TIMC-IMAG, 38000 Grenoble, France; Inserm CIC 1406, 38000 Grenoble, France
| | | | - Jean-Luc Bosson
- Univ. Grenoble Alpes, CNRS, TIMC-IMAG, 38000 Grenoble, France; Inserm CIC 1406, 38000 Grenoble, France
| | - Pierre Albaladejo
- Pôle Anesthésie Réanimation, CHU de Grenoble, 38000 Grenoble, France; Univ. Grenoble Alpes, CNRS, TIMC-IMAG, 38000 Grenoble, France; Inserm CIC 1406, 38000 Grenoble, France.
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Abstract
PURPOSE OF REVIEW Ultrasound-guided cannulation of the internal jugular vein has become a standard practice over recent years. Despite known benefits, ultrasound is less frequently used for other vascular applications probably because these are technically demanding and require more experience. The authors of this review focus on pitfalls of ultrasound guidance: most important practical aspects as well as nonroutine vascular applications are discussed. RECENT FINDINGS Ultrasound guidance increases the first-pass and overall success rates and reduces the risk of complications of central venous catheterization through the subclavian and femoral routes, as well as arterial and difficult peripheral venous access. Ultrasound is also useful to detect catheter malposition and complications. Technical improvements and new modifications of old ultrasound-guided techniques may result in better outcomes. SUMMARY Growing evidence suggests that routine utilization of ultrasound guidance is beneficial for all types of vascular access. The presence of a skilled operator and proper technique are, however, required to achieve success and avoid complications.
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Kim EJ, Min J, Song J, Song K, Song JH, Byon HJ. The effect of electromagnetic guidance system on early learning curve of ultrasound for novices. Korean J Anesthesiol 2016; 69:15-20. [PMID: 26885296 PMCID: PMC4754260 DOI: 10.4097/kjae.2016.69.1.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/10/2015] [Accepted: 08/12/2015] [Indexed: 02/07/2023] Open
Abstract
Background Electromagnetic guidance reveals needle alignment and position relative to the image plane on an ultrasound view. This study compared the early learning curves of novices performing ultrasound-guided needle placement with (n = 10) or without electromagnetic guidance (n = 10). Methods Participants performed 30 ultrasound-guided needle placements using an echogenic stick (0.3-cm diameter) as a target inside a phantom model; this early learning period was divided into sequential periods (P1: 1–5, P2: 6–10, P3: 11–15, P4: 16–20, P5: 21–25, P6: 26–30 attempts). Results Using an in-plane approach, the time required for needle placement in the EMG group was significantly shorter than that of the non-EMG group in P1, P2, P4, and P6 and the number of needle advances of the EMG group was significantly smaller than that of the non-EMG group in P1 and P2. Using an out-of-plane approaches, the time required for needle placement in the EMG group was significantly shorter than that of the non-EMG group in all periods, but the number of needle advances was similar between both groups in P1–P5. Conclusions The electromagnetic guidance system may be beneficial when performing ultrasound guided peripheral nerve blocks or vascular cannulation in the early learning period, especially by inexperienced operators with reducing patient risk.
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Affiliation(s)
- Eun Jung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jiyoung Min
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeongyun Song
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Kyungchul Song
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jang-Ho Song
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Hyo Jin Byon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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20
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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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21
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Real-time needle-tracking ultrasound facilitates needle placement in a phantom gel model. Eur J Anaesthesiol 2015; 32:659-61. [DOI: 10.1097/eja.0000000000000271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Faulke DJ, Hall TH, Nixon C. Electromagnetic Needle Tracking during Simulated Right Internal Jugular Cannulation. Anaesth Intensive Care 2015; 43:497-502. [DOI: 10.1177/0310057x1504300413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study used three-dimensional information from Stealth navigation technology during simulated right internal jugular vein cannulation to define the initial needle trajectory taken when using three approaches: landmark (LM), short-axis (SAX) ultrasound and long-axis (LAX) ultrasound. Nineteen volunteers indicated the entry site and needle direction (track) they would use in performing right internal jugular vein cannulation by the three approaches. The likelihood of cannulation success, arterial puncture and needle direction were recorded. Volunteers were asked to assess the suitability of the simulation system for validity and educational benefit. The SAX track crossed the jugular vein more frequently than the LAX and LM tracks (SAX: 94%; LAX: 80%; LM: 47% [SAX versus LM, P <0.01]). The mean indicated needle direction in the coronal plane for LM, SAX and LAX were -4, 13 and 11 degrees, respectively. The track associated with the LAX technique would have entered the carotid artery by 16% of volunteers. At needle depths of over 40 mm, the track crossed the vertebral artery at the following rates (LM: 11%; SAX: 16%; LAX: 16%). The use of Stealth technology to provide three-dimensional feedback of the needle path taken during simulated right internal jugular cannulation was considered realistic (16/19) and of benefit for 18 of 19 (95%) respondents. The SAX track was associated with the highest likelihood of successful jugular cannulation and the lowest cross rate of the carotid artery. The simulation model using Stealth was considered to be valuable and realistic by participants despite some limitations.
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Affiliation(s)
- D. J. Faulke
- Department of Anaesthesia, The Prince Charles Hospital, Brisbane, Queensland
| | - T. H. Hall
- Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
| | - C. Nixon
- Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
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23
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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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24
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Munirama S, Joy J, Columb M, Habershaw R, Eisma R, Corner G, Cochran S, McLeod G. A randomised, single-blind technical study comparing the ultrasonic visibility of smooth-surfaced and textured needles in a soft embalmed cadaver model. Anaesthesia 2014; 70:537-42. [DOI: 10.1111/anae.12925] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2014] [Indexed: 11/28/2022]
Affiliation(s)
- S. Munirama
- Institute of Academic Anaesthesia; University of Dundee; Dundee UK
| | - J. Joy
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
| | - M. Columb
- Departments of Anaesthesia & Intensive Care Medicine; Wythenshawe Hospital; Manchester UK
| | - R. Habershaw
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
| | - R. Eisma
- Centre for Anatomy and Human Identification; University of Dundee; Dundee UK
| | | | - S. Cochran
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
| | - G. McLeod
- Institute of Academic Anaesthesia; University of Dundee; Dundee UK
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25
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Tielens LKP. A reply. Anaesthesia 2014; 69:1061-2. [PMID: 25117022 DOI: 10.1111/anae.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L K P Tielens
- Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
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26
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Affiliation(s)
- R. Tang
- Vancouver Coastal Health; Vancouver Canada
| | - A. Sawka
- Vancouver Coastal Health; Vancouver Canada
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