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Chen S, Zhang Y, Ma B, Chen J, Hao J, Zhang F, Cui C, Chen M. Practical Electrochemical Method to Enhance Needle Visibility during Ultrasound Imaging. ACS Biomater Sci Eng 2023; 9:5824-5831. [PMID: 37651609 DOI: 10.1021/acsbiomaterials.3c00807] [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: 09/02/2023]
Abstract
Ultrasound-guided needle interventions play a pivotal role in the diagnosis and treatment processes in clinical practice. However, existing echogenic needles face challenges in achieving a balance between effectiveness, ease of manufacturing, and inexpensiveness. In this study, we developed an echogenic needle that encompassed the aforementioned advantages through the use of the electrolysis technology. The overall contour of the needle after electrolysis was observed using bright-field microscopy, while scanning electron microscopy (SEM) was employed to examine the micro-variations on the needle's surface. Subsequently, we validated the enhanced visualization effects in vitro (pork) and in vivo (anesthetized rabbit's thigh) puncture phantoms. To ensure the safety of the needles after the puncture procedure, we conducted Vickers hardness tests, SEM detection, bright-field microscopy, and DAPI staining. The results demonstrated that the surface roughness of the needle increased with the duration of electrolysis. Taking into account the comprehensive safety tests, the needle, subjected to 40 s of electrolysis, demonstrated a safe and effective enhancement of ultrasound visualization.
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Affiliation(s)
- Shaojie Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yanjuan Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Biao Ma
- State Key Laboratory of Digital Medical Engineering, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
| | - Jiuzhou Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jingzhe Hao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Feng Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Chang Cui
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Zhang S, Liu T, Liu Y, Mei W. Effect of ultrasound angle for radial artery cannulation in adults: a randomized controlled trial. Minerva Anestesiol 2022; 88:230-237. [PMID: 35164488 DOI: 10.23736/s0375-9393.22.16090-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although the first attempt success rate of radial artery cannulation has been significantly improved by using dynamic needle tip positioning (DNTP) method, there are still problems with long cannulation time. We hereby observe the effect of ultrasound angle for radial artery cannulation in adult patients. METHODS Adult patients scheduled to undergo elective surgeries with continuous invasive blood pressure monitoring were included and randomly allocated into either a U-P-artery (ultrasound probe perpendicular to the artery) or U-P-needle (ultrasound probe perpendicular to the needle) group. The primary outcome measure was cannulation time at the first attempt, the secondary outcome measures included the first attempt success rate, number of attempts and the total puncture procedure duration. In addition, the incidence of complications was included as secondary outcomes. RESULTS Fifty-nine patients were evaluated finally. The cannulation time at the first attempt in U-P-needle group (N.=28) was significantly lower than that in U-P-artery group (N.=31; median [IQR]: 16 [13.5-20] seconds vs. 41 [25.5-54.5] seconds, P<0.001). The total puncture procedure duration in group U-P-needle was also shorter than that in the group U-P-artery (median [IQR]: 17.4 [13.5-20] seconds vs. 52.2 [25.5-54.5] seconds, P<0.001). No significant difference was observed with respect to first-attempt success rate (96.4% vs. 93.5%, relative risk: 0.97, 95% CI: 0.863-1.0907, P=0.615). The number of attempts showed no statistical difference as well. CONCLUSIONS The usage of the U-P-needle approach could remarkably reduce radial arterial cannulation time at the first attempt as well as total puncture procedure duration, comparing with the U-P-artery approach.
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Affiliation(s)
- Shuang Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Tianzhu Liu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Liu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Mei
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China -
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Hovgesen CH, Wilhjelm JE, Vilmann P, Kalaitzakis E. Echogenic Surface Enhancements for Improving Needle Visualization in Ultrasound: A PRISMA Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:311-325. [PMID: 33870532 DOI: 10.1002/jum.15713] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 03/14/2021] [Accepted: 03/17/2021] [Indexed: 05/12/2023]
Abstract
Optimal visualization of needles in clinical ultrasound imaging is important and challenging, especially at steep angles. Improvement of visualization has been attempted with various techniques, for example, coatings and dimples. This systematic review summarizes enhancement techniques and identifies superior echogenic surface enhancements. Twenty-four papers were identified providing visibility measures for 33 different echogenic needles. These were grouped according to surface characteristics and ranked. Echogenic needles ranked higher than standard needles especially at steeper angles. Among the echogenic needles, coated needles were seemingly better visualized "in vivo" than noncoated needles, despite heterogeneity in study conditions. No unambiguous comparison revealed which needle was best visualized.
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Affiliation(s)
- Caroline Harder Hovgesen
- Biomedical Engineering, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Jens E Wilhjelm
- Biomedical Engineering, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Peter Vilmann
- Gastrounit, Herlev University Hospital, Herlev, Denmark
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De Cassai A, Ferrarese B, Boscolo A, Munari M, Carron M. Comparison of two needles for ultrasound guided interfascial plane block by inexperienced operators. Minerva Anestesiol 2020; 86:574-575. [PMID: 32100515 DOI: 10.23736/s0375-9393.19.14271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alessandro De Cassai
- Section of Anesthesiology and Intensive Care, Department of Medicine (DIMED), University of Padua, Padua, Italy -
| | - Bianca Ferrarese
- Section of Anesthesiology and Intensive Care, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Annalisa Boscolo
- Section of Anesthesiology and Intensive Care, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Marina Munari
- Section of Anesthesiology and Intensive Care, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Michele Carron
- Section of Anesthesiology and Intensive Care, Department of Medicine (DIMED), University of Padua, Padua, Italy
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5
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Sonographic visibility of cannulas using convex ultrasound transducers. BIOMED ENG-BIOMED TE 2019; 64:691-698. [DOI: 10.1515/bmt-2018-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/30/2019] [Indexed: 11/15/2022]
Abstract
Abstract
The key for safe ultrasound (US)-guided punctures is a good visibility of the cannula. When using convex transducers for deep punctures, the incident angle between US beam and cannula varies along the cannula leading to a complex visibility pattern. Here, we present a method to systematically investigate the visibility throughout the US image. For this, different objective criteria were defined and applied to measurement series with varying puncture angles and depths of the cannula. It is shown that the visibility not only depends on the puncture angle but also on the location of the cannula in the US image when using convex transducers. In some image regions, an unexpected good visibility was observed even for steep puncture angles. The systematic evaluation of the cannula visibility is of fundamental interest to sensitise physicians to the handling of convex transducers and to evaluate new techniques for further improvement.
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Prabhakar C, Uppal V, Sondekoppam RV. Effect of Beam Steering on Echogenic and Nonechogenic Needle Visibility at 40°, 50°, and 60° Needle Insertion Angles. Anesth Analg 2018; 126:1926-1929. [PMID: 29116966 DOI: 10.1213/ane.0000000000002618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Currently, there is little understanding of the role of echogenic needles and beam steering at moderate angles of needle insertion. The ultrasound images of the echogenic and nonechogenic needles inserted into pork at 40°, 50°, and 60° were scored by anesthesiologists on a scale of 0-10. The effect of different levels of beam steer was also explored. At 40°, steep beam steering improves visualization of both nonechogenic and echogenic needles to an equal, satisfactory level. At 50° and 60°, visualization of nonechogenic needles is poor, whereas visibility of an echogenic needle was adequate and may be improved with steep beam steering.
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Affiliation(s)
- Christopher Prabhakar
- From the Department of Anesthesiology, Pharmacology and Therapeutics, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vishal Uppal
- Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rakesh V Sondekoppam
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
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7
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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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8
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Park JW, Cheon MW, Lee MH. Phantom Study of a New Laser-Etched Needle for Improving Visibility During Ultrasonography-Guided Lumbar Medial Branch Access With Novices. Ann Rehabil Med 2016; 40:575-82. [PMID: 27606263 PMCID: PMC5012968 DOI: 10.5535/arm.2016.40.4.575] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/30/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the visibility and procedural parameters between a standard spinal needle and a new laser-etched needle (LEN) in real-time ultrasonography guided lumbar medial branch access in a phantom of the lumbosacral spine. METHODS We conducted a prospective single-blinded observational study at a rehabilitation medicine center. A new model of LEN was manufactured with a standard 22-gauge spinal needle and a laser etching machine. Thirty-two inexperienced polyclinic medical students performed ultrasonography-guided lumbar medial branch access using both a standard spinal needle and a LEN with scanning protocol. The outcomes included needle visibility score, needle elapsed time, first-pass success rate, and number of needle sticks. RESULTS The LEN received significantly better visibility scores and shorter needle elapsed time compared to the standard spinal needle. First-pass success rate and the number of needle sticks were not significantly different between needles. CONCLUSION A new LEN is expected to offer better visibility and enable inexperienced users to perform an ultrasonography-guided lumbar medial branch block more quickly. However, further study of variables may be necessary for clinical application.
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Affiliation(s)
| | - Min Woo Cheon
- Department of Hospital Biomedical Engineering, Dongshin University, Gwangju, Korea
| | - Min Hong Lee
- Department of Rehabilitation Medicine, Chosun University Hospital, Gwangju, Korea
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Effect of body mass index on angle of needle insertion during ultrasound-guided lateral sagittal infraclavicular brachial plexus block. J Clin Anesth 2015; 27:375-9. [DOI: 10.1016/j.jclinane.2015.03.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 02/25/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
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10
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Beigi P, Rohling R, Salcudean T, Lessoway VA, Ng GC. Needle Trajectory and Tip Localization in Real-Time 3-D Ultrasound Using a Moving Stylus. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2057-2070. [PMID: 25929997 DOI: 10.1016/j.ultrasmedbio.2015.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 03/04/2015] [Accepted: 03/11/2015] [Indexed: 06/04/2023]
Abstract
Described here is a novel approach to needle localization in 3-D ultrasound based on automatic detection of small changes in appearance on movement of the needle stylus. By stylus oscillation, including its full insertion into the cannula to the tip, the image processing techniques can localize the needle trajectory and the tip in the 3-D ultrasound volume. The 3-D needle localization task is reduced to two 2-D localizations using orthogonal projections. To evaluate our method, we tested it on three different ex vivo tissue types, and the preliminary results indicated that the method accuracy lies within clinical acceptance, with average error ranges of 0.9°-1.4° in needle trajectory and 0.8-1.1 mm in needle tip. Results also indicate that method performance is independent of the echogenicity of the tissue. This technique is a safe way of producing ultrasonic intensity changes and appears to introduce negligible risk to the patient, as the outer cannula remains fixed.
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Affiliation(s)
- Parmida Beigi
- Electrical and Computer Engineering Department, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Robert Rohling
- Electrical and Computer Engineering Department, University of British Columbia, Vancouver, British Columbia, Canada; Mechanical Engineering Department, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim Salcudean
- Electrical and Computer Engineering Department, University of British Columbia, Vancouver, British Columbia, Canada
| | - Victoria A Lessoway
- Department of Ultrasound, British Columbia Women's Hospital, Vancouver, British Columbia, Canada
| | - Gary C Ng
- Philips Ultrasound, Bothell, Washington, USA
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Nakagawa K, Kamiya T, Arakawa K, Akiyama S, Sakai K. Objective and subjective comparison of the visibility of three echogenic needles and a nonechogenic needle on older ultrasound devices. ACTA ACUST UNITED AC 2015; 53:1-6. [DOI: 10.1016/j.aat.2014.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/29/2014] [Accepted: 12/11/2014] [Indexed: 10/24/2022]
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12
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Sujatta S. First of all: Do not harm! Use of simulation for the training of regional anaesthesia techniques: Which skills can be trained without the patient as substitute for a mannequin. Best Pract Res Clin Anaesthesiol 2015; 29:69-80. [DOI: 10.1016/j.bpa.2015.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 02/11/2015] [Accepted: 02/17/2015] [Indexed: 11/30/2022]
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13
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Fuzier R, Casalprim J, Bataille B, Harper I, Magues JP. The echogenicity of nerve blockade needles. Anaesthesia 2014; 70:462-6. [DOI: 10.1111/anae.12977] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- R. Fuzier
- Department of Anaesthesiology; Institut Claudius Regaud; IUCT-O; Toulouse France
- Pharmacoepidemiology Research Unit; INSERM 1027; University of Toulouse; Toulouse France
| | - J. Casalprim
- Department of Anaesthesiology; CHU Purpan; Toulouse France
| | - B. Bataille
- Department of Anaesthesiology and Critical Care; CH Hotel Dieu; Narbonne France
| | - I. Harper
- Department of Anaesthesiology; Wansbeck General Hospital; Ashington UK
| | - J. P. Magues
- Department of Anaesthesiology; CHU Purpan; Toulouse France
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14
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Effect of beam steering on the visibility of echogenic and non-echogenic needles: a laboratory study. Can J Anaesth 2014; 61:909-15. [DOI: 10.1007/s12630-014-0207-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 07/08/2014] [Indexed: 10/25/2022] Open
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Mariano ER, Yun RDH, Kim TE, Carvalho B. Application of echogenic technology for catheters used in ultrasound-guided continuous peripheral nerve blocks. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:905-911. [PMID: 24764346 DOI: 10.7863/ultra.33.5.905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Limited data exist regarding the echogenicity of perineural catheters, but visualization is crucial to ensure accurate placement and efficacy of the subsequent local anesthetic infusion. The objective of this study was to determine the comparative echogenicity of various regional anesthesia catheters. In an in vitro porcine-bovine model, we compared the echogenic qualities of 3 commercially available regional anesthesia catheters and 1 catheter under development to optimize echogenicity. Outcomes included visual echogenicity ranking, image quality, and scanning time, as assessed by 2 blinded investigators. The experimental catheter was found to be more echogenic than 2 of the 3 comparators.
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Affiliation(s)
- Edward R Mariano
- MAS, Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, 3801 Miranda Ave, 112A, Palo Alto, CA 94304 USA.
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Crum T, Adhikari S, Lander L, Blaivas M. Do echo-enhanced needles make a difference in sonographically guided vascular access? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:623-628. [PMID: 24658941 DOI: 10.7863/ultra.33.4.623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to compare sonographically guided vascular access using standard and echo-enhanced needles in a variety of tissue-simulating vascular phantoms. METHODS We conducted a prospective single-blinded observational study at an academic medical center. All participants performed real-time sonographically guided vascular access using both a standard 18-gauge needle and an echo-enhanced needle in both in-plane and out-of plane approaches on 3 different vascular access phantoms. The outcome measures included time to dye flash, first-pass success, visibility of the needle tip at the time of puncture, total number of attempts, number of redirections, and incidence of posterior wall penetration. RESULTS A total of 408 sonographically guided cannulations were performed by 34 participants. The time from needle stick to dye flash, first-pass success, and the total number of attempts were not significantly different between the two needles (P> .05). The tip of the needle was seen at the time of puncture in 79% of attempts with the standard needle (95% confidence interval [CI], 68%-86%) and in 86% of attempts with the echo-enhanced needle (95% CI, 76%-92%), although this difference was not significant (P= .103). The posterior wall was penetrated with the standard needle in 14% of attempts (95% CI, 9.6%-20%) and in 6% of attempts with the echo-enhanced needle (95% CI, 3.5%-11%), and the difference was significant (P < .02). CONCLUSIONS Echo-enhanced needles decreased the incidence of posterior wall punctures when compared to standard needles during sonographically guided vascular access. However, there were no significant differences in other sonographically guided vascular access metrics.
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Affiliation(s)
- Todd Crum
- MS, Department of Emergency Medicine, University of Arizona Medical Center, PO Box 245057, Tucson, AZ 85724 USA.
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17
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Mariano ER, Marshall ZJ, Urman RD, Kaye AD. Ultrasound and its evolution in perioperative regional anesthesia and analgesia. Best Pract Res Clin Anaesthesiol 2014; 28:29-39. [DOI: 10.1016/j.bpa.2013.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/22/2013] [Indexed: 11/30/2022]
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19
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Gupta RK, Lane J, Allen B, Shi Y, Schildcrout JS. Improving Needle Visualization by Novice Residents During an In-Plane Ultrasound Nerve Block Simulation Using an In-Plane Multiangle Needle Guide. PAIN MEDICINE 2013; 14:1600-7. [DOI: 10.1111/pme.12160] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Morillas-Sendin P, Ortega-Romero A, del-Olmo C. Basic considerations before injections and scanning techniques. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.trap.2014.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Hocking G, Mitchell CH. Optimizing the safety and practice of ultrasound-guided regional anesthesia: the role of echogenic technology. Curr Opin Anaesthesiol 2013; 25:603-9. [PMID: 22825047 DOI: 10.1097/aco.0b013e328356b835] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Significant improvements have been made in the quality of ultrasound imaging, and it is now much easier to see nerves. However, the key to safe ultrasound-guided regional anesthesia is to be able to direct the needle to the target. This relies on good needle visibility. We review the recent advances that have been made in this crucial area. RECENT FINDINGS Echogenic needles can improve shaft and tip visibility independent of experience level, compensate for suboptimal scanning technique, allow steeper insertion angles, reduce technical difficulty, and increase both confidence and satisfaction by anesthesiologists. An echogenic needle encourages holding the probe in one place on the patient, only advancing the needle when it can be seen, hence reducing the likelihood of quality-compromising behaviors. The poor visibility of nonechogenic needles when inserted at steeper angles commonly causes the observer to underestimate the insertion depth of the needle. Significant differences in echogenicity are found when comparing the currently available needles. SUMMARY Good echogenic needles should increase safety, efficacy, and simplicity, and hopefully further drive the adoption of ultrasound-guided techniques, to the benefit of our patients.
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Affiliation(s)
- Graham Hocking
- School of Medicine and Pharmacology, The University of Western Australia, Western Australia, Australia.
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22
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Sviggum HP, Ahn K, Dilger JA, Smith HM. Needle echogenicity in sonographically guided regional anesthesia: blinded comparison of 4 enhanced needles and validation of visual criteria for evaluation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:143-148. [PMID: 23269719 DOI: 10.7863/jum.2013.32.1.143] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Needle visualization is important for sonographically guided regional anesthesia procedures. Needle characteristics that improve needle visualization are therefore important to anesthesiologists. This study compared several echogenic needle designs by defining characteristics of needle echogenicity and assessing regional anesthesiologist preferences for these characteristics across various needle angles. METHODS Twelve blinded regional anesthesiologists graded 5 randomized block needles (1 nonechogenic control and 4 echogenic) on 4 predefined characteristics (overall brightness of the needle, overall clarity of the needle, brightness of the needle tip, and clarity of the needle tip). In-plane needle images in a gel phantom were obtained at 4 needle angles (15°, 30°, 45°, and 60°). Participants rated specific needle characteristics for each needle at each angle and then ranked their overall needle preferences. RESULTS Significant differences in all 4 needle characteristics were found across needle types (P< .01). Clarity of the needle tip was significantly associated with overall needle rank (P = .009). Other needle visualization characteristics were not significantly correlated with needle rank. The SonoPlex Stim needle (Pajunk Medical Systems, Tucker, GA) was rated highest in all 4 predefined needle characteristics as well as overall needle rank. CONCLUSIONS This study shows that anesthesiologists prefer certain visual characteristics of needles used in sonographically guided regional anesthesia procedures. Specifically, needle tip clarity most closely predicted clinician needle preferences. These results support the idea that all echogenic needle designs do not uniformly enhance needle visualization. Further studies are needed to determine whether needles with superior tip clarity predict not only clinician preferences but also improved sonographically guided regional anesthetic outcomes.
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Affiliation(s)
- Hans P Sviggum
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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WIESMANN T, BORNTRÄGER A, NEFF M, WULF H, STEINFELDT T. Needle visibility in different tissue models for ultrasound-guided regional anaesthesia. Acta Anaesthesiol Scand 2012; 56:1152-5. [PMID: 22897671 DOI: 10.1111/j.1399-6576.2012.02758.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Models for ultrasound-guided regional anaesthesia (USGRA) are important for research and training. However, the limited data available show great differences in quality of needle and tissue visualisation with regard to the applied model. This study aims to compare common USGRA models and human tissue with regard to their influence on needle visibility. METHODS We conducted this study using four models (embalmed human cadaver, turkey breast, pork, and synthetic gel models) and a volunteer (human control) as well as two different needles [Stimuplex A (StA), conventional needle; Stimuplex D Plus (StD+), needle with improved echogenicity]. We obtained ultrasound videos of needle advancement and withdrawal using the in-plane approach at a 45° angle in all four models and the volunteer. Fifteen test persons were prospectively enrolled. Ultrasound videos were presented in a randomised, blinded manner. The test persons were asked to rate the visibility of the needle shaft (VS) and tip (VT) on a four-point scale (0-3). RESULTS VS and VT were comparable between the human control and cadaver model for both needle types. The pork, turkey, and synthetic gel models had significantly higher visibility scores than the human control for both needle types. VS of StD+ was significantly higher than that of StA in the pork and turkey models, but not in the synthetic model, cadaver model, or human control. CONCLUSION In this pilot study, needle visibility in embalmed cadaver is comparable with that in human control. Needle visibility was significantly higher in other tissue models (turkey breast, pork, synthetic gel models) than in the human control, which may limit their value in training environments.
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Affiliation(s)
- T. WIESMANN
- Department of Anesthesiology and Intensive Care Therapy; University Hospital Giessen-Marburg; Philipps University Marburg; Marburg; Germany
| | - A. BORNTRÄGER
- Department of Anesthesiology and Intensive Care Therapy; University Hospital Giessen-Marburg; Philipps University Marburg; Marburg; Germany
| | - M. NEFF
- Department of Anesthesiology and Intensive Care Therapy; University Hospital Giessen-Marburg; Philipps University Marburg; Marburg; Germany
| | - H. WULF
- Department of Anesthesiology and Intensive Care Therapy; University Hospital Giessen-Marburg; Philipps University Marburg; Marburg; Germany
| | - T. STEINFELDT
- Department of Anesthesiology and Intensive Care Therapy; University Hospital Giessen-Marburg; Philipps University Marburg; Marburg; Germany
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Takatani J, Takeshima N, Okuda K, Uchino T, Noguchi T. Ultrasound visibility of regional anesthesia catheters: an in vitro study. Korean J Anesthesiol 2012; 63:59-64. [PMID: 22870367 PMCID: PMC3408517 DOI: 10.4097/kjae.2012.63.1.59] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 03/26/2012] [Accepted: 06/08/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ultrasound subjective visibility of in-plane needles is correlated with the intensity difference between the needle surface and the background. Regional anesthesia catheters are difficult to visualize by an ultrasound. In the present study, we investigated the ultrasound visibility of the catheters. METHODS Six catheters were placed at 0° and 30° relative to and at a depth of 1 cm below the pork phantom surface. Ultrasound images of in-plane catheters were evaluated, subjectively and objectively. Outer and inner objective visibilities were defined as the difference in the mean pixel intensity between the catheter surface and adjacent background, and between the surface and the center of the catheter, respectively. Evaluations were made based on the portion of the catheters. A P value < 0.05 was considered significant. RESULTS Subjective visibility was more strongly correlated with the inner objective visibility than with the outer objective visibility at both angles. Metallic 19-gauge catheters were more subjectively visible than the non-metallic 20-gauge catheters at 30° degrees (P < 0.01). Subjective, and outer and inner objective visibility were significantly lower at 30° than at 0° (P < 0.01, P < 0.01, P = 0.02). Perifix ONE at 0° and Perifix FX at 30° were the most visible catheters (P < 0.01 for both). CONCLUSIONS Subjective visibility of catheters can not be evaluated in the same manner as that of the needles. For the best possible visualization, we recommend selecting a catheter with a structure that enhances the dark at the center of catheter, rather than basing the catheter selection on the bore size.
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Affiliation(s)
- Junji Takatani
- Department of Anesthesiology and Critical Care Medicine, Oita University Faculty of Medicine, Oita, Japan
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Kawai N, Minamiguchi H, Sato M, Nakai M, Sanda H, Tanaka T, Ikoma A, Nakata K, Shirai S, Sonomura T. Evaluation of vascular puncture needles with specific modifications for enhanced ultrasound visibility: In vitro study. World J Radiol 2012; 4:273-7. [PMID: 22778880 PMCID: PMC3391673 DOI: 10.4329/wjr.v4.i6.273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 06/14/2012] [Accepted: 06/21/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine which modification to a vascular puncture needle results in increased visualization during ultrasound (US)-guided vascular puncture.
METHODS: We evaluated US images of a phantom made of degassed gelatin and each of the following four modified versions of a commercially available vascular puncture needle (18 G): re-cut needle, dimple needle, rough-surface needle (rough over the sections of needle located 3-6 mm from the tip), and a needle with four side holes (side holes covered by the sheath). An unmodified commercially available puncture needle was used as a control. Five interventional radiologists evaluated image quality according to the following classification grade: I, invisible; II, poor; III, moderate; IV, good; V, excellent.
RESULTS: The highest score for needle visualization was obtained for the needle with four side holes. The re-cut needle scored the same as the control. Multiple comparisons were conducted using overall evaluation scores among the commercially available needle, dimple needle, rough-surface needle (3-6 mm), and the needle with four side holes. A significantly higher score was obtained for the needle with four side holes (P < 0.05/6).
CONCLUSION: The needle with four side holes was prominently visualized and gained a significantly higher score (compared with the other needles) in a phantom evaluation.
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Optimization of Cannula Visibility during Ultrasound-Guided Subclavian Vein Catheterization, via a Longitudinal Approach, by Implementing Echogenic Technology. Crit Care Res Pract 2012; 2012:617149. [PMID: 22593825 PMCID: PMC3347863 DOI: 10.1155/2012/617149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 03/01/2012] [Indexed: 01/15/2023] Open
Abstract
Objective. One limitation of ultrasound-guided vascular access is the technical challenge of visualizing the cannula during insertion into the vessel. We hypothesized that the use of an echogenic vascular cannula (EC) would improve visualization when compared with a nonechogenic vascular cannula (NEC) during real-time ultrasound-guided subclavian vein (SCV) cannulation in the ICU. Material and Methods. Eighty mechanically ventilated patients were prospectively enrolled in a randomized study that was conducted in a medical-surgical ICU. Forty patients underwent EC and 40 patients were randomized to NEC. The procedure was ultrasound-guided SCV cannulation via the infraclavicular approach on the longitudinal axis. Results. The EC group exhibited increased cannula visibility as compared to the NEC group (92%±3% versus 85 ± 7%, resp., P < 0.01). There was strong agreement between the procedure operators and independent observers (k = 0.9, 95% confidence intervals assessed by bootstrap analysis = 0.87 to 0.93; P < 0.01). Access time (12.1 s ± 6.5 versus 18.9 s ± 10.9) and the perceived technical difficulty of the ultrasound method (4.5 ± 1.5 versus 7.5 ± 1.5) were both decreased in the EC group compared to the NEC group (P < 0.05). Conclusions. Echogenic technology significantly improved cannula visibility and decreased access time and technical complexity optimizing thus real-time ultrasound-guided SCV cannulation via a longitudinal approach.
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Guo S, Schwab A, McLeod G, Corner G, Cochran S, Eisma R, Soames R. Echogenic regional anaesthesia needles: a comparison study in Thiel cadavers. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:702-707. [PMID: 22390992 DOI: 10.1016/j.ultrasmedbio.2012.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 11/22/2011] [Accepted: 01/01/2012] [Indexed: 05/31/2023]
Abstract
Ultrasound guidance is now the standard procedure for regional nerve block in anesthesiology. However, ultrasonic visualisation of needle manipulation and guidance within tissues remains a problem. Two new echogenic needles (Pajunk and Braun) have been introduced to anesthesiology clinical practice but evaluation has been restricted to preserved animal tissue. In this study, the visibility of both echogenic needles was compared with a standard nonechogenic needle in a Thiel cadaver model. A total of 144 intramuscular injections were made in the upper arm in-plane and out-of-plane to the ultrasound beam at four angles (30°, 45°, 60° and 75°). The visibility of the needle was assessed by two independent, blinded observers using a 5-point Likert ordinal scale. Weighted κ for interobserver agreement was 0.77 (95% confidence interval [CI]: 0.68-0.86). The Pajunk echogenic needle was more visible than the Braun standard needle in-plane (p = 0.04), and the Braun standard and Braun echogenic needles out-of-plane (p = 0.02). Independent predictors of visibility using logistic regression were needle (p < 0.001) and plane of insertion (p = 0.08), receiver operator characteristic (ROC) area under the curve 0.90. In conclusion, the Pajunk echogenic needle offers the best visibility for ultrasound-guided regional anesthesia.
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Affiliation(s)
- Shuo Guo
- Institute for Medical Science and Technology, University of Dundee, Dundee, Scotland, UK
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Stefanidis K, Pentilas N, Dimopoulos S, Nanas S, Savel RH, Shiloh AL, Poularas J, Slama M, Karakitsos D. Echogenic Technology Improves Cannula Visibility during Ultrasound-Guided Internal Jugular Vein Catheterization via a Transverse Approach. Crit Care Res Pract 2012; 2012:306182. [PMID: 22649715 PMCID: PMC3357505 DOI: 10.1155/2012/306182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 03/01/2012] [Indexed: 02/07/2023] Open
Abstract
Objective. Echogenic technology has recently enhanced the ability of cannulas to be visualized during ultrasound-guided vascular access. We studied whether the use of an EC could improve visualization if compared with a nonechogenic vascular cannula (NEC) during real-time ultrasound-guided internal jugular vein (IJV) cannulation in the intensive care unit (ICU). Material and Methods. We prospectively enrolled 80 mechanically ventilated patients who required central venous access in a randomized study that was conducted in two medical-surgical ICUs. Forty patients underwent EC and 40 patients were randomized to NEC. The procedure was ultrasound-guided IJV cannulation via a transverse approach. Results. The EC group exhibited increased visibility as compared to the NEC group (88% ± 8% versus 20% ± 15%, resp. P < 0.01). There was strong agreement between the procedure operators and independent observers (k = 0.9; 95% confidence intervals assessed by bootstrap analysis = 0.87-0.95; P < 0.01). Access time (5.2 s ± 2.5 versus 10.6 s ± 5.7) and mechanical complications were both decreased in the EC group compared to the NEC group (P < 0.05). Conclusion. Echogenic technology significantly improved cannula visibility and decreased access time and mechanical complications during real-time ultrasound-guided IJV cannulation via a transverse approach.
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Affiliation(s)
- Konstantinos Stefanidis
- 1Radiology Department, Evangelismos University Hospital, Athens, Greece
- *Konstantinos Stefanidis:
| | - Nicos Pentilas
- 2Intensive Care Unit, General State Hospital of Athens, Athens, Greece
| | - Stavros Dimopoulos
- 31st Critical Care Department, Evangelismos University Hospital, Athens, Greece
| | - Serafim Nanas
- 31st Critical Care Department, Evangelismos University Hospital, Athens, Greece
| | - Richard H. Savel
- 4Jay B. Langner Critical Care Service, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA
| | - Ariel L. Shiloh
- 4Jay B. Langner Critical Care Service, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA
| | - John Poularas
- 2Intensive Care Unit, General State Hospital of Athens, Athens, Greece
| | - Michel Slama
- 5Intensive Care Unit, CHU Sud, 80054 Amiens Cedex 1, France, France
- 6Unité INSERM 1088, University Picardie Jules Vernes, Amiens, France
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A review of the benefits and pitfalls of phantoms in ultrasound-guided regional anesthesia. Reg Anesth Pain Med 2011; 36:162-70. [PMID: 21425513 DOI: 10.1097/aap.0b013e31820d4207] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
With the growth of ultrasound-guided regional anesthesia, so has the requirement for training tools to practice needle guidance skills and evaluate echogenic needles. Ethically, skills in ultrasound-guided needle placement should be gained in a phantom before performance of nerve blocks on patients in clinical practice. However, phantom technology is varied, and critical evaluation of the images is needed to understand their application to clinical use. Needle visibility depends on the echogenicity of the needle relative to the echogenicity of the tissue adjacent the needle. We demonstrate this point using images of echogenic and nonechogenic needles in 5 different phantoms at both shallow angles (20 degrees) and steep angles (45 degrees). The echogenicity of phantoms varies enormously, and this impacts on how needles are visualized. Water is anechoic, making all needles highly visible, but does not fix the needle to allow practice placement. Gelatin phantoms and Blue Phantoms provide tactile feedback but have very low background echogenicity, which greatly exaggerates needle visibility. This makes skill acquisition easier but can lead to false confidence in regard to clinical ability. Fresh-frozen cadavers retain much of the textural feel of live human tissue and are nearly as echogenic. Similar to clinical practice, this makes needles inserted at steep angles practically invisible, unless they are highly echogenic. This review describes the uses and pitfalls of phantoms that have been described or commercially produced.
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Hebard S, Hocking G, Murray K. Two-Dimensional Mapping to Assess Direction and Magnitude of Needle Tip Error in Ultrasound-Guided Regional Anaesthesia. Anaesth Intensive Care 2011; 39:1076-81. [DOI: 10.1177/0310057x1103900615] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We assessed whether echogenic needles reduce tip location error, by comparing three echogenic designs (Pajunk Sonoplex, Lifetech, B. Braun Stimuplex D+) with a non-echogenic control (Pajunk Uniplex), using a novel assessment technique in unembalmed human cadavers. Multiple images were taken of each needle at shallow (15 to 25°), moderate (35 to 45°) and steep (55 to 65°) insertion angles. Twenty anaesthetists with varied experience in ultrasound-guided nerve blocks identified needle tip position and stated their confidence level in estimates. Actual tip position was determined at the time of image generation but concealed from the anaesthetists. Two-dimensional mapping of ‘tip-error’ involved measurement of the distance and orientation of each clinician's estimate of tip position in relation to the actual tip position. There were no significant differences in confidence or overall needle visibility at shallow insertion angles. At steeper angles, the Sonoplex showed significantly higher confidence and visibility scores. The remaining echogenic designs did not show any significant differences from the non-echogenic control. Objective measurements of tip error followed the same pattern as the subjective data, although were not universally significant. Two-dimensional mapping showed that as needle visibility deteriorated, so precise tip location was lost but the needle shaft/insertion path remained well-identified. As visibility deteriorated further, accuracy in this axis was also lost. When inaccurate, clinicians generally assessed the needle tip to be more superficial and inserted less far than it actually was. This has important implications for the safety of ultrasound-guided regional anaesthesia. Effective echogenic needle technology has the potential to address these concerns.
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Affiliation(s)
- S. Hebard
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - G. Hocking
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - K. Murray
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia
- School of Mathematics and Statistics, The University of Western Australia
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Echogenic Technology Can Improve Needle Visibility During Ultrasound-Guided Regional Anesthesia. Reg Anesth Pain Med 2011; 36:185-9. [DOI: 10.1097/aap.0b013e31820d4349] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Warman P, Nicholls B. Ultrasound-guided nerve blocks: efficacy and safety. Best Pract Res Clin Anaesthesiol 2009; 23:313-26. [PMID: 19862890 DOI: 10.1016/j.bpa.2009.02.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The introduction of affordable, portable and high-resolution ultrasound machines has rejuvenated interest in regional anaesthesia. The inherent benefits of direct visualisation of nerves and surrounding anatomy, continual observation of the needle tip and spread of local anaesthetic make ultrasound-guided regional anaesthesia highly appealing. However, in the cost-conscious health-care setting and to convince sceptics, there also needs to be evidence of increased benefits and reduced complications. Ultrasound is a rapidly developing area of technology and some of the newer modalities are discussed. This article focusses on the recent growing evidence to support the benefits of its use in nerve and plexus blocks. Common complications of nerve blocks can be avoided with ultrasound but have still been reported. Anatomical variants have been demonstrated by ultrasound and it has proved to be useful in performing regional anaesthesia in difficult situations or where peripheral nerve stimulation is unsuccessful or inappropriate.
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Affiliation(s)
- Paul Warman
- Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, Devon EX2 5DW, UK.
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