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Steinwandel U, Coventry LL, Kheirkhah H. Evaluation of a Point-of-care ultrasound (POCUS) workshop for peripheral intravenous cannulation. BMC MEDICAL EDUCATION 2023; 23:451. [PMID: 37337172 DOI: 10.1186/s12909-023-04428-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is increasingly used as a non-invasive vascular access assessment method by clinicians from multiple disciplines worldwide, prior and during vascular access cannulations. While POCUS is a relatively new method to establish a vascular access in patients with complex vascular conditions, it is also essential to train and educate individuals who are novices in the techniques of cannulation so that they become proficient in performing this task subsequently on patients safely and successfully. A simulated environment may be a helpful tool to help healthcare providers establish skills in using POCUS safely and may also help them to successfully establish vascular access in patients. With this project, we sought to determine if participants of a simulated POCUS workshop for vascular access can use this technique successfully in their individual clinical environment after their attendance of a half-day workshop. METHODS A mixed-methods longitudinal study design was chosen to evaluate a point-of-care ultrasound workshop for peripheral intravenous cannula insertion. The workshops used simulation models for cannulation in combination with multiple ultrasound devices from various manufacturers to expose participants to a broader variety of POCUS devices as they may also vary in different clinical areas. Participants self-assessed their cannulation skills using questionnaires on a 10-point rating scale prior to and directly after the workshop. RESULTS A total of 85 Individuals participated in eleven half-day workshops through 2021 and 2022. Workshop participants claimed that attending the workshop had significantly enhanced their clinical skill of using ultrasound for the purpose of cannulating a venous vessel. The level of confidence in using this technique had increased in all participants directly after conclusion of the workshop. CONCLUSIONS Globally, clinicians are increasingly using POCUS to establish vascular access in patients, and it is necessary that they receive sufficient and adequately structured and formal training to successfully apply this technique in their clinical practice. Offering a workshop which uses simulation models in combination with various POCUS devices to demonstrate this technique in a hands-on approach has proven to be useful to establish this newly learned skill in clinicians.
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Affiliation(s)
- Ulrich Steinwandel
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027, WA, Australia.
| | - Linda L Coventry
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027, WA, Australia
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, Australia
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Homa Kheirkhah
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027, WA, Australia
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Gutte S, Azim A, Poddar B, Gurjar M, Kumar A. Arterial cannulation in adult critical care patients: A comparative study between ultrasound guidance and palpation technique. Med Intensiva 2023:S2173-5727(23)00006-1. [PMID: 36868961 DOI: 10.1016/j.medine.2023.02.001] [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: 10/27/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE To compare first attempt success rate for ultrasound-guided (USG) versus direct palpation (DP) for radial, femoral, and dorsalis pedis artery cannulations in adult intensive care unit (ICU) patients. DESIGN Prospective randomized clinical trial. SETTING Mixed adult ICU of a University Hospital. PARTICIPANTS Adult patients (≥18 years) admitted to the ICU requiring invasive arterial pressure monitoring were included. Exclusion criteria were patients with a pre-existing arterial line and cannulated with other than a 20-gauge cannula for radial and dorsalis pedis artery. INTERVENTION Comparison of arterial cannulation by USG versus palpation technique in radial, femoral and dorsalis pedis arteries. MAIN VARIABLES OF INTEREST Primary outcome was first attempt success rate, secondary outcomes were assessing time for cannulations, number of attempts, overall success rate, complications, and comparison of two techniques on patients requiring vasopressor. RESULTS 201 patients were enrolled in study, with 99 randomized to DP group and 102 to USG group. Arteries (radial, dorsalis pedis, femoral) cannulated in both groups were comparable (P = .193). Arterial line was placed on first attempt in 85 (83.3%) in USG group versus 55 (55.6%) in DP group (P = .02). Cannulation time in USG group was significantly shorter compared to DP group. CONCLUSIONS In our study, USG arterial cannulation, compared to palpatory technique, had a higher success rate at first attempt and a shorter cannulation time. CLINICAL TRIAL REGISTRY OF INDIA NUMBER CTRI/2020/01/022989.
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Affiliation(s)
- Shreyas Gutte
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India.
| | - Banani Poddar
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
| | - Anup Kumar
- Department of Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow 226014, India
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Alsbrooks K, Hoerauf K. Comparative Effectiveness, Efficiency, and ED Nurse Preference Between Two Methods of Visualization for Midline Catheter Insertion: A Pilot Study. SAGE Open Nurs 2023; 9:23779608221150721. [PMID: 36643785 PMCID: PMC9834413 DOI: 10.1177/23779608221150721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/13/2022] [Accepted: 12/24/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction Rapid and reliable peripheral IV access is essential for many patients admitted to the emergency department (ED) to ensure administration of life-saving medications, and successful intravenous cannulation can significantly affect patient care. Objective The objective of this study was to assess the impact of a continuous needle tracking system on the accuracy, speed, and quality of ultrasound-guided peripheral venous catheter insertions. Methods A convenient sample study based on the study setting using simulated tissue was conducted with 49 US-based ED nurses to compare the insertion of a midline catheter using traditional ultrasound guidance versus an advanced needle-tracking technology along with ultrasound guidance. The purpose of this evaluation was to assess the impact of continuous needle tracking system. Informed consent was obtained from all individual participants involved in this study. All participants were made aware that the results may be published. There was no IRB approval for this study. All sources were properly disclosed within the text. Results The addition of the advanced needle-tracking technology significantly reduced total insertion attempts, insertion time, backwall penetrations, and redirects (probes to hit the target vein), while improving image clarity and confidence for participants. Conclusion The innovative needle-tracking system evaluated in this pilot study has the potential to improve emergent difficult vascular access. EDs should assess the value of this technology to potentially improve the management of difficult intravenous access patients in their settings.
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Affiliation(s)
- Kimberly Alsbrooks
- Becton Dickinson and Co, Franklin Lakes, NJ, USA,Kimberly Alsbrooks, Becton Dickinson and Co, Franklin Lakes, NJ, USA.
| | - Klaus Hoerauf
- Becton Dickinson and Co, Franklin Lakes, NJ, USA,Department of Anesthesiology and Intensive Care, Medical University, Vienna, Austria
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Meijers TA, Nap A, Aminian A, Dens J, Teeuwen K, van Kuijk JP, van Wely M, Schmitz T, Bataille Y, Kraaijeveld AO, Roolvink V, Hermanides RS, Braber TL, van Royen N, van Leeuwen MAH. ULTrasound-guided TRAnsfemoral puncture in COmplex Large bORe PCI: study protocol of the UltraCOLOR trial. BMJ Open 2022; 12:e065693. [PMID: 36456007 PMCID: PMC9716808 DOI: 10.1136/bmjopen-2022-065693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Although recently published evidence favours transradial access (TRA) when using large-bore guiding catheters for percutaneous coronary intervention (PCI) of complex coronary lesions, the femoral artery will still be used in a considerate proportion of patients undergoing complex PCI, especially in PCI of chronic total occlusions (CTO). Ultrasound-guided puncture of the femoral artery may reduce clinically relevant access site complications, but robust evidence is lacking up to date. METHODS AND ANALYSIS A total of 542 patients undergoing complex PCI, defined as PCI of CTO, complex bifurcation, heavy calcified lesion or left main, in which the 7-F or 8-F transfemoral access is required, will be randomised to ultrasound-guided puncture or fluoroscopy-guided puncture. The primary outcome is the incidence of the composite end-point of clinically relevant access site related bleeding and/or vascular complications requiring intervention. Access site complications and major adverse cardiovascular events up to 1 month will also be compared between both groups. ETHICS AND DISSEMINATION Ethical approval for the study was granted by the local Ethics Committee ('Medisch Ethische Toetsing Commissie Isala Zwolle') for all Dutch sites, 'Comité Medische Ethiek Ziekenhuis Oost-Limburg' for Hospital Oost-Limburg, 'Comité d'éthique CHU-Charleroi-ISPPC' for Centre Hospilatier Universitaire de Charleroi and 'Ethik Kommission de Ärztekammer Nordrhein' for Elisabeth-Krankenhaus). The trial outcomes will be published in peer-reviewed journals of the concerned literature. The ultrasound guided transfemoral access in complex large bore PCI trial has been administered in the ClinicalTrials.gov database, reference number: NCT03846752. REGISTRATION DETAILS ClinicalTrials.gov identifier: NCT03846752.
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Affiliation(s)
- Thomas A Meijers
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | - Alexander Nap
- Department of Cardiology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Joseph Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Koen Teeuwen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jan-Peter van Kuijk
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Thomas Schmitz
- Department of Cardiology, Elisabeth-Krankenhaus-Essen GmbH, Essen, Germany
| | - Yoann Bataille
- Department of Cardiology, Jessa Ziekenhuis vwz, Hasselt, Belgium
| | - Adriaan O Kraaijeveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Vincent Roolvink
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | | | - Thijs L Braber
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
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Bloom D, Colombo JN, Miller N, Southworth MK, Andrews C, Henry A, Orr WB, Silva JR, Avari Silva JN. Early preclinical experience of a mixed reality ultrasound system with active GUIDance for NEedle-based interventions: The GUIDE study. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 3:232-240. [PMID: 36310686 PMCID: PMC9596321 DOI: 10.1016/j.cvdhj.2022.07.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Use of ultrasound (US) to facilitate vascular access has increased compared to landmark-based procedures despite ergonomic challenges and need for extrapolation of 2-dimensional images to understand needle position. The MantUS™ system (Sentiar, Inc.,) uses a mixed reality (MxR) interface to display US images and integrate real-time needle tracking. Objective The purpose of this prospective preclinical study was to evaluate the feasibility and usability of MantUS in a simulated environment. Methods Participants were recruited from pediatric cardiology and critical care. Access was obtained in 2 vascular access training models: a femoral access model and a head and neck model for a total of 4 vascular access sites under 2 conditions—conventional US and MantUS. Participants were randomized for order of completion. Videos were obtained, and quality of access including time required, repositions, number of attempts, and angle of approach were quantified. Results Use of MantUS resulted in an overall reduction in number of needle repositions (P = .03) and improvement in quality of access as measured by distance (P <.0001) and angle of elevation (P = .006). These findings were even more evident in the right femoral vein (RFV) access site, which was a simulated anatomic variant with a deeper more oblique vascular course. Use of MantUS resulted in faster time to access (P = .04), fewer number of both access attempts (P = .02), and number of needle repositions (P <.0001) compared to conventional US. Postparticipant survey showed high levels of usability (87%) and a belief that MantUS may decrease adverse outcomes (73%) and failed access attempts (83%). Conclusion Use of MantUS improved vascular access among all comers, including the quality of access. This improvement was even more notable in the vascular variant (RFV). MantUS readily benefited users by providing improved spatial understanding. Further development of MantUS will focus on improving user interface and experience, with larger clinical usage and in-human studies.
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Affiliation(s)
- David Bloom
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jamie N. Colombo
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Nathan Miller
- Pediatric Electrophysiology Laboratory, St. Louis Children’s Hospital, St. Louis, Missouri
| | | | | | | | - William B. Orr
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jonathan R. Silva
- Sentiar, Inc., St. Louis, Missouri
- Department of Biomedical Engineering, Washington University McKelvey School of Engineering, St. Louis, Missouri
| | - Jennifer N. Avari Silva
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Sentiar, Inc., St. Louis, Missouri
- Department of Biomedical Engineering, Washington University McKelvey School of Engineering, St. Louis, Missouri
- Address reprint requests and correspondence: Dr Jennifer N. Avari Silva, Division of Pediatric Cardiology, Washington University School of Medicine, 1 Children’s Place, CB 8116 NWT, St. Louis, MO 63110.; OR Dr Jonathan R. Silva, Department of Biomedical Engineering, Washington University McKelvey School of Engineering, 1 Brookings Place, St. Louis, MO 63130.
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de la Vieja-Soriano M, Blanco-Daza M, Macip-Belmonte S, Dominguez-Muñoz M, López-Sánchez E, Pérez-Pérez E. Difficult intravenous access in a paediatric intensive care unit. ENFERMERIA INTENSIVA 2022; 33:67-76. [PMID: 35562260 DOI: 10.1016/j.enfie.2021.03.006] [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: 05/14/2020] [Accepted: 03/22/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Multiple attempts during peripheral cannulation can have major consequences for patients, relatives, and healthcare professionals, therefore we set out to determine the extent of this problem in a paediatric intensive care unit (PICU). OBJECTIVES The main aim was to describe peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) cannulation in children in the PICU. Secondary objectives were to determine the success rate of the first cannulation attempt, to quantify patients with difficult venous access (DVA), and to explore the association between DVA and sociodemographic, technique and nursing-related characteristics. METHOD A cross-sectional descriptive study. Consecutive sampling was used to recruit patients aged 0-18 years admitted to the PICU who required peripheral venous cannulation. An ad hoc questionnaire was used for this purpose, including the presence of DVA as an independent variable. RESULTS A total of 163 venous cannulations were reported. A total of 55.8% (91) were performed in patients under 1 year of age. Of these, 38.7% (63) were successful on the first attempt and 36.8% (60) had DVA. When there was DVA, 85% (51) of patients had complications, median time to cannulation by short CVP was 30 minutes [15-53] and 2 or more nurses were required on 80% (48) of occasions. CONCLUSIONS We found a low success rate at first attempt and a high proportion of DVA. More nurses and time were employed during cannulation and complications increased if the patient had DVA. A statistically significant association was found between DVA and age, weight, poor perfusion, veins that were neither visible nor palpable, DIVA score ≥ 4, history of difficult intravenous access, complications, number of nurses and time spent.
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Affiliation(s)
- M de la Vieja-Soriano
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - M Blanco-Daza
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - S Macip-Belmonte
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Dominguez-Muñoz
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E López-Sánchez
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Pérez-Pérez
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain
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Pandya L, Cooper M, Patel N, Leonard D, Fernandes N, Spear D, Nesiama JA. Point-of-Care Ultrasound for Central Venous Assessment in the Emergency Department: A Prospective Study Comparing the Femoral and Internal Jugular Veins. Pediatr Emerg Care 2022; 38:e278-e282. [PMID: 33065673 DOI: 10.1097/pec.0000000000002252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study was to estimate the width, height, and depth of the femoral vein (FV) and internal jugular vein (IJV), both sites of potential central line placement in children, using point-of-care ultrasound. METHODS This was a prospective observational study. Point-of-care ultrasound was used to measure the width, height, and depth of the right FV and IJV in 100 children. The primary outcome was a comparison of the widths of the FV and the IJV in the same child. Our primary hypothesis was that the IJV would be wider than the FV. Secondary outcome measures included comparison of the heights and depths the FV and IJV and description of vessel overlap frequency between the 2 sites. RESULTS A total of 106 children were enrolled, with 6 subjects excluded, and equally divided into 5 age groups (0-30 days, 1-24 months, 2-5 years, 6-11 years, and 12-17 years). The FV/IJV width ratios (95% confidence interval) by age were 0.58 (0.49-0.68), 0.53 (0.43-0.66), 0.57 (0.49-0.67), 0.68 (0.55-0.85), and 0.73 (0.62-0.85), all P < 0.002. The FV/IJV height ratios were <1 in all age groups, with P < 0.003 in the 4 youngest age groups. The FV/IJV depth ratios were >1 in 6 to 11 years (P = 0.018) and 12 to 17 years (P < 0.001). CONCLUSIONS The IJV was significantly wider and taller than the FV in the same child in all age groups. The FV was significantly deeper than the IJV in children 6 years and older. This supports the use of the IJV as a potential site when placing ultrasound-guided central lines in children.
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Affiliation(s)
- Lori Pandya
- From the Department of Pediatrics, Division of Emergency Medicine, UT Southwestern Medical Center
| | - Michael Cooper
- From the Department of Pediatrics, Division of Emergency Medicine, UT Southwestern Medical Center
| | - Nishit Patel
- From the Department of Pediatrics, Division of Emergency Medicine, UT Southwestern Medical Center
| | | | - Neil Fernandes
- Department of Pediatrics, Division of Radiology, UT Southwestern Medical Center, Dallas
| | - Dave Spear
- Department of Emergency Medicine, Texas Health Resources, Fort Worth, Dallas, TX
| | - Jo-Ann Nesiama
- From the Department of Pediatrics, Division of Emergency Medicine, UT Southwestern Medical Center
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Bastos MG. Lung ultrasound: an opportunity to increase the accuracy of the physical examination by the nephrologist. Rev Assoc Med Bras (1992) 2021; 67:1729-1734. [DOI: 10.1590/1806-9282.20210476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/04/2021] [Indexed: 11/21/2022] Open
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Flumignan RL, Trevisani VF, Lopes RD, Baptista-Silva JC, Flumignan CD, Nakano LC. Ultrasound guidance for arterial (other than femoral) catheterisation in adults. Cochrane Database Syst Rev 2021; 10:CD013585. [PMID: 34637140 PMCID: PMC8507521 DOI: 10.1002/14651858.cd013585.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Arterial vascular access is a frequently performed procedure, with a high possibility for adverse events (e.g. pneumothorax, haemothorax, haematoma, amputation, death), and additional techniques such as ultrasound may be useful for improving outcomes. However, ultrasound guidance for arterial access in adults is still under debate. OBJECTIVES To assess the effects of ultrasound guidance for arterial (other than femoral) catheterisation in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, LILACS, and CINAHL on 21 May 2021. We also searched IBECS, WHO ICTRP, and ClinicalTrials.gov on 16 June 2021, and we checked the reference lists of retrieved articles. SELECTION CRITERIA Randomised controlled trials (RCTs), including cross-over trials and cluster-RCTs, comparing ultrasound guidance, alone or associated with other forms of guidance, versus other interventions or palpation and landmarks for arterial (other than femoral) guidance in adults. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, extracted data, assessed risk of bias, and assessed the certainty of evidence using GRADE. MAIN RESULTS We included 48 studies (7997 participants) that tested palpation and landmarks, Doppler auditory ultrasound assistance (DUA), direct ultrasound guidance with B-mode, or any other modified ultrasound technique for arterial (axillary, dorsalis pedis, and radial) catheterisation in adults. Radial artery Real-time B-mode ultrasound versus palpation and landmarks Real-time B-mode ultrasound guidance may improve first attempt success rate (risk ratio (RR) 1.44, 95% confidence interval (CI) 1.29 to 1.61; 4708 participants, 27 studies; low-certainty evidence) and overall success rate (RR 1.11, 95% CI 1.06 to 1.16; 4955 participants, 28 studies; low-certainty evidence), and may decrease time needed for a successful procedure (mean difference (MD) -0.33 minutes, 95% CI -0.54 to -0.13; 4902 participants, 26 studies; low-certainty evidence) up to one hour compared to palpation and landmarks. Real-time B-mode ultrasound guidance probably decreases major haematomas (RR 0.35, 95% CI 0.23 to 0.56; 2504 participants, 16 studies; moderate-certainty evidence). It is uncertain whether real-time B-mode ultrasound guidance has any effect on pseudoaneurysm, pain, and quality of life (QoL) compared to palpation and landmarks (very low-certainty evidence). Real-time B-mode ultrasound versus DUA One study (493 participants) showed that real-time B-mode ultrasound guidance probably improves first attempt success rate (RR 1.35, 95% CI 1.11 to 1.64; moderate-certainty evidence) and time needed for a successful procedure (MD -1.57 minutes, 95% CI -1.78 to -1.36; moderate-certainty evidence) up to 72 hours compared to DUA. Real-time B-mode ultrasound guidance may improve overall success rate (RR 1.13, 95% CI 0.99 to 1.29; low-certainty evidence) up to 72 hours compared to DUA. Pseudoaneurysm, major haematomas, pain, and QoL were not reported. Real-time B-mode ultrasound versus modified real-time B-mode ultrasound Real-time B-mode ultrasound guidance may decrease first attempt success rate (RR 0.68, 95% CI 0.55 to 0.84; 153 participants, 2 studies; low-certainty evidence), may decrease overall success rate (RR 0.93, 95% CI 0.86 to 1.01; 153 participants, 2 studies; low-certainty evidence), and may lead to no difference in time needed for a successful procedure (MD 0.04 minutes, 95% CI -0.01 to 0.09; 153 participants, 2 studies; low-certainty evidence) up to one hour compared to modified real-time B-mode ultrasound guidance. It is uncertain whether real-time B-mode ultrasound guidance has any effect on major haematomas compared to modified real-time B-mode ultrasound (very low-certainty evidence). Pseudoaneurysm, pain, and QoL were not reported. In-plane versus out-of-plane B-mode ultrasound In-plane real-time B-mode ultrasound guidance may lead to no difference in overall success rate (RR 1.00, 95% CI 0.96 to 1.05; 1051 participants, 8 studies; low-certainty evidence) and in time needed for a successful procedure (MD -0.06 minutes, 95% CI -0.16 to 0.05; 1134 participants, 9 studies; low-certainty evidence) compared to out-of-plane B-mode ultrasound up to one hour. It is uncertain whether in-plane real-time B-mode ultrasound guidance has any effect on first attempt success rate or major haematomas compared to out-of-plane B-mode ultrasound (very low-certainty evidence). Pseudoaneurysm, pain, and QoL were not reported. DUA versus palpation and landmarks DUA may lead to no difference in first attempt success rate (RR 1.01, 95% CI 0.90 to 1.14; 666 participants, 2 studies; low-certainty evidence) or overall success rate (RR 0.99, 95% CI 0.92 to 1.07; 666 participants, 2 studies; low-certainty evidence) and probably increases time needed for a successful procedure (MD 0.45 minutes, 95% CI 0.20 to 0.70; 500 participants, 1 study; moderate-certainty evidence) up to 72 hours compared to palpation and landmarks. Pseudoaneurysm, major haematomas, pain, and QoL were not reported. Oblique-axis versus long-axis in-plane B-mode ultrasound Oblique-axis in-plane B-mode ultrasound guidance may increase overall success rate (RR 1.27, 95% CI 1.05 to 1.53; 215 participants, 2 studies; low-certainty evidence) up to 72 hours compared to long-axis in-plane B-mode ultrasound. It is uncertain whether oblique-axis in-plane B-mode ultrasound guidance has any effect on first attempt success rate, time needed for a successful procedure, and major haematomas compared to long-axis in-plane B-mode ultrasound. Pseudoaneurysm, pain, and QoL were not reported. We are uncertain about effects in the following comparisons due to very low-certainty evidence and unreported outcomes: real-time B-mode ultrasound versus palpation and landmarks (axillary and dorsalis pedis arteries), real-time B-mode ultrasound versus near-infrared laser (radial artery), and dynamic versus static out-of-plane B-mode ultrasound (radial artery). AUTHORS' CONCLUSIONS Real-time B-mode ultrasound guidance may improve first attempt success rate, overall success rate, and time needed for a successful procedure for radial artery catheterisation compared to palpation, or DUA. In addition, real-time B-mode ultrasound guidance probably decreases major haematomas compared to palpation. However, we are uncertain about the evidence on major haematomas and pain for other comparisons due to very low-certainty evidence and unreported outcomes. We are also uncertain about the effects on pseudoaneurysm and QoL for axillary and dorsalis pedis arteries catheterisation. Given that first attempt success rate and pseudoaneurysm are the most relevant outcomes for people who underwent arterial catheterisation, future studies must measure both. Future trials must be large enough to detect effects, use validated scales, and report longer-term follow-up.
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Affiliation(s)
- Ronald Lg Flumignan
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Virginia Fm Trevisani
- Emergency Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
- Rheumatology, Universidade de Santo Amaro, São Paulo, Brazil
| | - Renato D Lopes
- Division of Cardiology, Duke University Medical Center, Durham, USA
| | - Jose Cc Baptista-Silva
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
- Evidence-based Medicine, Cochrane Brazil, São Paulo, Brazil
| | - Carolina Dq Flumignan
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luis Cu Nakano
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
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de la Vieja-Soriano M, Blanco-Daza M, Macip-Belmonte S, Dominguez-Muñoz M, López-Sánchez E, Pérez-Pérez E. Difficult intravenous access in a paediatric intensive care unit. ENFERMERIA INTENSIVA 2021; 33:S1130-2399(21)00057-2. [PMID: 34246557 DOI: 10.1016/j.enfi.2021.03.007] [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: 05/14/2020] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Multiple attempts during peripheral cannulation can have major consequences for patients, relatives, and healthcare professionals, therefore we set out to determine the extent of this problem in a paediatric intensive care unit (PICU). OBJECTIVES The main aim was to describe peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) cannulation in children in the PICU. Secondary objectives were to determine the success rate of the first cannulation attempt, to quantify patients with difficult venous access (DVA), and to explore the association between DVA and sociodemographic, technique and nursing-related characteristics. METHOD A cross-sectional descriptive study. Consecutive sampling was used to recruit patients aged 0-18 years admitted to the PICU who required peripheral venous cannulation. An ad hoc questionnaire was used for this purpose, including the presence of DVA as an independent variable. RESULTS A total of 163 venous cannulations were reported. A total of 55.8% (91) were performed in patients under 1 year of age. Of these, 38.7% (63) were successful on the first attempt and 36.8% (60) had DVA. When there was DVA, 85% (51) of patients had complications, median time to cannulation by short CVP was 30minutes [15-53] and 2 or more nurses were required on 80% (48) of occasions. CONCLUSIONS We found a low success rate at first attempt and a high proportion of DVA. More nurses and time were employed during cannulation and complications increased if the patient had DVA. A statistically significant association was found between DVA and age, weight, poor perfusion, veins that were neither visible nor palpable, DIVA score≥4, history of difficult intravenous access, complications, number of nurses and time spent.
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Affiliation(s)
- M de la Vieja-Soriano
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España.
| | - M Blanco-Daza
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España
| | - S Macip-Belmonte
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Dominguez-Muñoz
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España
| | - E López-Sánchez
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España
| | - E Pérez-Pérez
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, España
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11
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Shields LBE, Sutton B, Iyer VG, Shields CB, Rao AJ. Venipuncture-Related Median Nerve Palsy Disguised as Intraoperative Brachial Plexus Injury. Case Rep Neurol 2021; 13:361-368. [PMID: 34248570 PMCID: PMC8255717 DOI: 10.1159/000515474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/17/2021] [Indexed: 11/19/2022] Open
Abstract
Iatrogenic peripheral nerve injuries may result from transection, stretch, compression, injections, ligature, heat, anticoagulant use, and radiation. Iatrogenic median nerve palsy has been reported rarely. We report a case of a woman who underwent craniectomy for treatment of trigeminal neuralgia. Intraoperatively, a transient decline in the amplitude of the left upper extremity somatosensory evoked potentials (SSEPs) was noted. This finding was presumed to be due to the traction on the brachial plexus as it improved with repositioning. Immediately upon waking from anesthesia, the patient experienced sensorimotor deficits in the left median nerve distribution. Ecchymoses from venipuncture were observed in this area. Electrodiagnostic studies confirmed a left median nerve neuropathy localized in the antebrachial area. Neurosurgeons and neurologists should be alert to potential iatrogenic median nerve palsy following vascular access at the antebrachial region. Vascular access could be performed under the ultrasound guidance when a patient is under anesthesia or unable to give sensory feedback. Furthermore, placing an additional recording electrode over the proximal upper arm during intraoperative SSEP monitoring aids in distinguishing between brachial plexus and peripheral nerve injuries.
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Affiliation(s)
- Lisa B E Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA
| | | | - Vasudeva G Iyer
- Neurodiagnostic Center of Louisville, Louisville, Kentucky, USA
| | - Christopher B Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA.,Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Abigail J Rao
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA
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12
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Tatsuru K, Keisuke Y, Shun O, Mayu M, Ayaka N, Masakazu M, Koshiro S, Toshio H, Koji Y, Waka Y, Makoto M, Mitsuru M, Kazuhiko N, Satoshi I. The evaluation of eye gaze using an eye tracking system in simulation training of real-time ultrasound-guided venipuncture. J Vasc Access 2021; 23:360-364. [PMID: 33579184 DOI: 10.1177/1129729820987362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Real-time ultrasound (RTUS)-guided central venipuncture using the short-axis approach is complicated and likely to result in losing sight of the needle tip. Therefore, we focused on the eye gaze in our evaluation of the differences in eye gaze between medical students and experienced participants using an eye tracking system. METHODS Ten medical students (MS group), five residents (R group) and six pediatric surgeon fellows (F group) performed short-axis RTUS-guided venipuncture simulation using a modified vessel training system. The eye gaze was captured by the tracking system (Tobii Eye Tacker 4C) and recorded. The evaluation endpoints were the task completion time, total time and number of occurrences of the eye tracking marker outside US monitor and success rate of venipuncture. RESULT There were no significant differences in the task completion time and total time of the tracking marker outside the US monitor. The number of occurrences of the eye tracking marker outside US monitor in the MS group was significantly higher than in the F group (MS group: 9.5 ± 3.4, R group: 6.0 ± 2.9, F group: 5.2 ± 1.6; p = 0.04). The success rate of venipuncture in the R group tended to be better than in the F group. CONCLUSION More experienced operators let their eye fall outside the US monitor fewer times than less experienced ones. The eye gaze was associated with the success rate of RTUS-guided venipuncture. Repeated training while considering the eye gaze seems to be pivotal for mastering RTUS-guided venipuncture.
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Affiliation(s)
- Kaji Tatsuru
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.,Clinical Training Center, Kagoshima University Hospital
| | - Yano Keisuke
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Onishi Shun
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Matsui Mayu
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Nagano Ayaka
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Murakami Masakazu
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Sugita Koshiro
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Harumatsu Toshio
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Yamada Koji
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Yamada Waka
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.,Clinical Training Center, Kagoshima University Hospital
| | - Matsukubo Makoto
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Muto Mitsuru
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Nakame Kazuhiko
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Ieiri Satoshi
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
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13
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Lee S, Chang JE, Oh Y, Yang HJ, Bae J, Cho YJ, Jeon Y, Nam K, Kim TK. Comparison of dynamic needle tip positioning versus conventional long-axis in-plane techniques for ultrasound-guided internal jugular venous catheterization: a randomized controlled trial. Minerva Anestesiol 2020; 87:294-301. [PMID: 33319947 DOI: 10.23736/s0375-9393.20.14734-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Continuous visualization of the needle tip is essential for successful ultrasound-guided central venous catheterization, and the dynamic needle tip positioning (DNTP) technique enables it. The aim of this randomized, dual-center trial was to compare the first-attempt success rate of ultrasound-guided internal jugular catheterization between the DNTP and conventional long-axis in-plane (LAX-IP) techniques. METHODS Patients undergoing cardiac surgery at two tertiary teaching hospitals were randomly allocated to either the DNTP or LAX-IP group. Internal jugular venous catheterization was performed by four anesthesiologists. The primary outcome was the first-attempt success rate of central venous catheterization. Procedural time and complications related to catheterization were compared as secondary outcomes. RESULTS In total, 142 patients were analysed. The first-attempt success rate was significantly higher in the DNTP group (59/72, 81.9%) than in the LAX-IP group (46/70, 65.7%; odds ratio, 2.37; 95% confidence interval 1.09-5.15; P=0.028). In addition, the needle was redirected less frequently in the DNTP group than the LAX-IP group (P=0.026). Procedural time was comparable between the groups. No significant differences were observed in complications related to catheterization, including posterior wall puncture, carotid artery puncture, or hematoma. CONCLUSIONS The DNTP technique resulted in a significantly higher success rate on the first attempt at internal jugular venous catheterization and required less frequent redirection of the needle during the procedure than the conventional LAX-IP technique.
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Affiliation(s)
- Seohee Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jee-Eun Chang
- Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Yoomin Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyo-Jun Yang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Jinyoung Bae
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Youn-Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Yunseok Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Karam Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Tae-Kyong Kim
- Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea -
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Ultrasound-guided peripheral vascular catheterization in pediatric patients: a narrative review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:592. [PMID: 32998762 PMCID: PMC7526377 DOI: 10.1186/s13054-020-03305-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
Peripheral vascular catheterization (PVC) in pediatric patients is technically challenging. Ultrasound guidance has gained the most interest in perioperative and intensive care fields because it visualizes the exact location of small target vessels and is less invasive than other techniques. There have been a growing number of studies related to ultrasound guidance for PVC with or without difficult access in pediatric patients, and most findings have demonstrated its superiority to other techniques. There are various ultrasound guidance approaches, and a comprehensive understanding of the basics, operator experience, and selection of appropriate techniques is required for the successful utilization of this technique. This narrative review summarizes the literature regarding ultrasound-guided PVC principles, approaches, and pitfalls to improve its clinical performance in pediatric settings.
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15
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Flumignan RLG, Trevisani VFM, Lopes RD, Baptista-Silva JCC, Flumignan CDQ, Nakano LCU. Ultrasound guidance for arterial (other than femoral) catheterisation in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd013585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ronald LG Flumignan
- Universidade Federal de São Paulo; Department of Surgery, Division of Vascular and Endovascular Surgery; Rua Borges Lagoa, 754 São Paulo SP Brazil 04038-001
| | - Virginia FM Trevisani
- Escola Paulista de Medicina, Universidade Federal de São Paulo and Universidade de Santo Amaro; Medicina de Urgência and Rheumatology; Rua Botucatu, 740 Vila Clementino São Paulo São Paulo Brazil 04023-900
| | - Renato D Lopes
- Duke University Medical Center; Division of Cardiology; Durham USA
| | - Jose CC Baptista-Silva
- Universidade Federal de São Paulo; Department of Surgery, Division of Vascular and Endovascular Surgery; Rua Borges Lagoa, 754 São Paulo SP Brazil 04038-001
- Universidade Federal de São Paulo; Evidence Based Medicine, Cochrane Brazil; Rua Borges Lagoa, 564, cj 124 São Paulo São Paulo Brazil 04038-000
| | - Carolina DQ Flumignan
- Universidade Federal de São Paulo; Department of Surgery, Division of Vascular and Endovascular Surgery; Rua Borges Lagoa, 754 São Paulo SP Brazil 04038-001
| | - Luis CU Nakano
- Universidade Federal de São Paulo; Department of Surgery, Division of Vascular and Endovascular Surgery; Rua Borges Lagoa, 754 São Paulo SP Brazil 04038-001
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16
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Boran OF, Urfalıoglu A, Arslan M, Yazar FM, Bilal B, Orak Y, Eroğlu E. Effects of vascular morphological features and ultrasound-guided vascular cannulation techniques on the success of femoral artery catheterisation in newborns. J Clin Monit Comput 2020; 34:607-614. [PMID: 32100161 DOI: 10.1007/s10877-020-00490-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 02/20/2020] [Indexed: 11/30/2022]
Abstract
Ultrasound-guided vascular access is a technique that can increase safety as well as technical and procedural success when performing invasive cardiovascular procedures. The aim of this study was to evaluate the effects of two cannulation techniques and vascular morphological properties on the success of femoral artery catheterisation in neonatal patients. We recruited 65 consecutive patients requiring femoral artery catheterisation and randomly divided them into two groups: Group 1, in-plane technique (n = 31) and Group 2, out-of-plane technique (n = 34). We compared the preparation duration, puncture duration, number of punctures, number of arterial punctures, number of unsuccessful interventions, hematoma incidence and vascular morphological characteristics between the groups. The mean age of Group 1 was 17.16 ± 7.04 days, and the mean age of Group 2 was 17.20 ± 7.40 days, with no difference observed between the groups (p > 0.05). Four patients in Group 1 and nine patients in Group 2 developed hematoma (p = 0.172). Hematoma was strongly correlated with the number of venous punctures (r = 0.632; p = 0.001) and the number of needle advancements (r = 0.415; p = 0.001). In terms of artery-vein position, patients whose artery overlapped the vein by > 50% required clearly longer artery cannulation durations than the other patients (p < 0.001). Although the in-plane technique has a steep learning curve, it was found superior in terms of procedure-related factors such as the number of trials, the incidence of hematoma and arterial puncture counts, as it offers advantages such as the ability to evaluate the lumen and a better control of the needle advancement direction.
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Affiliation(s)
- Omer Faruk Boran
- Department of Anesthesiology and Reanimation, Sütçü Imam University School of Medicine, C Blok Kat 5, Daire 11, 46100, Kahramanmaraş, Turkey.
| | - Aykut Urfalıoglu
- Department of Anesthesiology and Reanimation, Sütçü Imam University School of Medicine, C Blok Kat 5, Daire 11, 46100, Kahramanmaraş, Turkey
| | - Mahmut Arslan
- Department of Anesthesiology and Reanimation, Sütçü Imam University School of Medicine, C Blok Kat 5, Daire 11, 46100, Kahramanmaraş, Turkey
| | - Fatih Mehmet Yazar
- Department of General Surgery, Sütçü Imam University School of Medicine, Kahramanmaraş, Turkey
| | - Bora Bilal
- Department of Anesthesiology and Reanimation, Sütçü Imam University School of Medicine, C Blok Kat 5, Daire 11, 46100, Kahramanmaraş, Turkey
| | - Yavuz Orak
- Department of Anesthesiology and Reanimation, Sütçü Imam University School of Medicine, C Blok Kat 5, Daire 11, 46100, Kahramanmaraş, Turkey
| | - Erdinç Eroğlu
- Department of Cardiovascular Surgery, Sütçü Imam University School of Medicine, Kahramanmaraş, Turkey
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17
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Nam K, Jeon Y, Yoon S, Kwon SM, Kang P, Cho YJ, Kim TK. Ultrasound-guided radial artery cannulation using dynamic needle tip positioning versus conventional long-axis in-plane techniques in cardiac surgery patients: a randomized, controlled trial. Minerva Anestesiol 2020; 86:30-37. [DOI: 10.23736/s0375-9393.19.13646-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Spencer TR, Bardin-Spencer A. Ultrasound Guidance for Vascular Access Procedures by Qualified Vascular Access Specialists or Other Applicable Healthcare Clinicians. ACTA ACUST UNITED AC 2019. [DOI: 10.2309/j.java.2019.004.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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Abstract
Sonography is increasingly being used by nephrologists and the field of dialysis access is no exception. Advances in technology have allowed the addition of this universally available, portable, non-invasive tool to the nephrologist's armamentarium, which provides information on both morphology and physiology without the need for contrast or radiation. Ultrasound may be used across the spectrum of dialysis access, including central venous catheter placements, vascular mapping, regional anesthesia, creation, maintenance and assessment of hemodialysis access as well as assessment of the abdominal wall and peritoneal dialysis catheter placements. However, the lack of exposure in most training programs limits incorporation of routine use of ultrasounds in nephrology practice. As our specialty embarks on the ultrasound revolution, a two-pronged approach is essential to provide ample training opportunities while ensuring establishment of basic standards for training and competency.
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Affiliation(s)
- Vandana Dua Niyyar
- Division of Nephrology, Department of Medicine, Emory University, Atlanta, GA, USA
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20
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Spencer TR, Pittiruti M. Rapid Central Vein Assessment (RaCeVA): A systematic, standardized approach for ultrasound assessment before central venous catheterization. J Vasc Access 2018; 20:239-249. [PMID: 30286688 DOI: 10.1177/1129729818804718] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Ultrasound technology has revolutionized the practice of safer vascular access, for both venous and arterial cannulation. The ability to visualize underlying structures of the chest, neck, and upper/lower extremities provides for greater success, speed, and safety with all vascular access procedures. Ultrasound not only yields superior procedural advantages but also provides a platform to perform a thorough assessment of the vascular structures to evaluate vessel health, viability, size, and patency, including the location of other important and best avoided anatomical structures-prior to performing any procedures. Such assessment is best performed using a systematic and standardized approach, as the Rapid Central Vein Assessment, described in this study.
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Affiliation(s)
| | - Mauro Pittiruti
- 2 Department of Surgery, Catholic University Hospital "A.Gemelli", Roma, Italy
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21
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Transducer Disinfection for Evaluation and Insertion of Peripheral and Central Catheters for Vascular Access Teams and Clinicians. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.java.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Inagaki E, Farber A, Siracuse JJ, Mell MW, Rybin DV, Doros G, Kalish J. Routine Use of Ultrasound Guidance in Femoral Arterial Access for Peripheral Vascular Intervention Decreases Groin Hematoma Rates in High-Volume Surgeons. Ann Vasc Surg 2018; 51:1-7. [DOI: 10.1016/j.avsg.2018.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 11/17/2022]
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23
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McKay GFM, Weerasinghe A. Can we successfully teach novice junior doctors basic interventional ultrasound in a single focused training session? Postgrad Med J 2018; 94:259-262. [PMID: 29545458 DOI: 10.1136/postgradmedj-2018-135590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/19/2018] [Accepted: 03/03/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Ultrasonography is recognised as an invaluable imaging modality for assessing critically unwell patients and obtaining vascular access. Senior emergency medicine and anaesthetic clinicians will regularly use ultrasound-guided imaging to establish vascular access for unwell patients; however, junior doctors, who are routinely the first clinicians to review deteriorating patients, are not encouraged or required to develop basic ultrasound interventional skills and are therefore ill equipped to use ultrasonography. AIM To demonstrate that teaching basic interventional ultrasound skills to novice junior doctors in a single focused session is an achievable outcome. METHOD We reviewed the success of the 'Junior doctor Ultrasound Training' (JUST) course in teaching basic interventional ultrasound skills to junior clinicians. We collated information from 237 JUST delegates. We surveyed candidates' prior ultrasound experience and retrospectively analysed their level 2 Kirkpatrick formative assessment outcome following the JUST course. RESULTS The overwhelming majority of doctors had no prior ultrasound experience (>95%). 99% (235) of candidates performed ultrasound to an acceptable standard to pass the formative assessment. 73% (174) achieved the course outcomes independent of faculty prompting. 1% (2) candidates failed the formative assessment. CONCLUSION Basic ultrasound competency is an achievable educational outcome for the overwhelming majority of novice junior doctors. Our findings add to growing evidence that early ultrasound tuition can be both valuable and economical for training clinicians. By arming junior doctors with a relevant and versatile skill set, we can provide opportunity for clinicians to develop their expertise and prepare for the future challenges of clinical medicine.
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Affiliation(s)
| | - Asoka Weerasinghe
- Emergency Department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.,Accident and Emergency Medicine, Dewsbury and District Hospital, Dewsbury, UK
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Liu C, Mao Z, Kang H, Hu X, Jiang S, Hu P, Hu J, Zhou F. Comparison between the long-axis/in-plane and short-axis/out-of-plane approaches for ultrasound-guided vascular catheterization: an updated meta-analysis and trial sequential analysis. Ther Clin Risk Manag 2018; 14:331-340. [PMID: 29503552 PMCID: PMC5824754 DOI: 10.2147/tcrm.s152908] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background A long-axis in-plane (LA-IP) approach and a short-axis out-of-plane (SA-OOP) approach are the two main approaches used in ultrasound (US)-guided vascular catheterization. However, the efficacy and safety of these approaches remain controversial. Therefore, we performed this meta-analysis to compare the two techniques in vascular catheterization. Materials and methods Relevant studies were searched in PubMed, Embase, and the Cochrane Library databases from database inception until August 2017. Randomized controlled trials comparing a long-axis approach with a short-axis approach for US-guided vascular cannulation were selected. The RevMan software was used to analyze the results, and trial sequential analysis (TSA) was further applied to determine whether the currently available evidence was sufficient and conclusive. Results Eleven studies met the inclusion criteria. Overall, 1,210 patients were included. The total success rate was similar between the SA-OOP and LA-IP approaches for US-guided vascular catheterization (risk ratio [RR], 1.01; 95% CI, 0.99–1.04; P=0.35; I2=48%). In the radial artery (RA; RR, 1.00; 95% CI, 0.96–1.05; P=0.88; I2=49%) and internal jugular vein (IJV; RR, 1.00; 95% CI, 0.98–1.02; P=0.99; I2=0%) subgroups, the total success rate was also similar and was confirmed by the TSA. For populations with subclavian vein (SCV) and axillary vein catheterization, the SA-OOP approach showed a benefit for first-attempt success rate. No significant differences in first-attempt success rate, cannulation times, or complications were found between the two approaches. Conclusion Despite a similar total success rate between the SA-OOP approach and the LA-IP approach when used for RA and IJV catheterization (as confirmed by TSA), further robust well-designed trials are warranted to evaluate other outcomes. There is insufficient evidence to definitively state that the SA-OOP approach was superior to the LA-IP approach when used for SCV and axillary vein catheterization. High-quality trials are needed to confirm or refute this finding.
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Affiliation(s)
- Chao Liu
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Zhi Mao
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Hongjun Kang
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Xin Hu
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Shengmao Jiang
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Pan Hu
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Jie Hu
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Feihu Zhou
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
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Shin SY, Kim H, Choi YS, Kim SW. Usefulness of Doppler waveform analysis before performing a complex procedure using femoral venous access. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:157-159. [PMID: 29159810 DOI: 10.1002/jcu.22564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 01/09/2017] [Accepted: 02/05/2017] [Indexed: 06/07/2023]
Abstract
Ultrasonography is a well-defined and widely accepted technique in the settings of interventional procedures requiring peripheral venous access, either for the confirmation of the vein patency (with the compression test) or for guiding needle insertion. This report describes a case of unsuccessful guidewire passage through the right iliac vein in spite of successful ultrasonography-guided puncture of the femoral vein. On repeat duplex ultrasonography, the Doppler waveform showed a continuous pattern without respiratory phasicity, which was consistent with proximal venous occlusion. Venous Doppler signal waveform analysis can be helpful for ensuring downstream patency when planning long-distance catheterization via femoral venous access.
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Affiliation(s)
- Seung Yong Shin
- Department of Cardiology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Hyangkyoung Kim
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Yoo Shin Choi
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Sang Wook Kim
- Department of Cardiology, College of Medicine, Chung-Ang University, Seoul, Korea
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Yamagami Y, Ueki S, Matoba K, Makimoto K. Effectiveness of ultrasound-guided peripheral intravenous cannulation in pediatric patients aged under three years: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:35-38. [PMID: 29324553 DOI: 10.11124/jbisrir-2017-003395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION The objective of this systematic review is to identify, evaluate and synthesize evidence of effectiveness on ultrasound-guided peripheral intravenous cannulation in pediatric patients aged under three years.Specially, the review question is: In pediatric patients aged under three years, what is the effect of ultrasound-guided peripheral intravenous cannulation on the first attempt and on the overall success rate, time to cannulation and number of attempts for successful cannulation compared with the traditional blind approach?
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Affiliation(s)
- Yuki Yamagami
- Graduate School of Medicine, Osaka University, Osaka, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
- The Japan Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Shingo Ueki
- Graduate School of Medicine, Osaka University, Osaka, Japan
- The Japan Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
- Faculty of Nursing, Mukogawa Women's University, Nishinomiya, Japan
| | - Kei Matoba
- Graduate School of Medicine, Osaka University, Osaka, Japan
- Faculty of Health Science, Osaka Aoyama University, Osaka, Japan
| | - Kiyoko Makimoto
- The Japan Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
- School of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
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Hanada S, Van Winkle MT, Subramani S, Ueda K. Dynamic ultrasound-guided short-axis needle tip navigation technique vs. landmark technique for difficult saphenous vein access in children: a randomised study. Anaesthesia 2017; 72:1508-1515. [DOI: 10.1111/anae.14082] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 12/29/2022]
Affiliation(s)
- S. Hanada
- Department of Anesthesia; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | | | - S. Subramani
- Department of Anesthesia; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - K. Ueda
- Department of Anesthesia; University of Iowa Hospitals and Clinics; Iowa City IA USA
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28
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A randomized study of training with large versus small vessel size on successful ultrasound-guided peripheral venous access. J Vasc Access 2017; 18:163-166. [PMID: 28165578 DOI: 10.5301/jva.5000645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2016] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Our objective was to investigate whether training on phantoms with smaller or larger vessels would improve success rate in novice medical students learning this skill. METHODS Medical students who participated in a voluntary, extracurricular ultrasound training day were asked to participate in the study as part of their procedural training. They were given a standardized education and demonstration of how to use ultrasound to place a peripheral intravenous (IV) catheter. They were then randomized to practice three times on homemade phantom models with either a 5-mm or a 2.5-mm diameter simulated vessel. Afterwards, they were observed attempting to place an ultrasound-guided IV on a 5-mm diameter vessel. Successful cannulation rates was the primary outcome. RESULTS Fifty-one students from five institutions were included in the analysis. No significant difference in success rate, time to cannulation, number of sticks, or number of redirects was seen between the group who trained on the phantoms with the smaller vessels versus those who trained on the phantoms with the larger vessel. A trend towards significance was seen for success rate and number of redirects, favoring the group trained on the smaller vessels, but this did not reach significance. CONCLUSION In our small sample, there was no difference in success rate of novice students trained in ultrasound-guided peripheral IV access using either a smaller or a larger vessel phantom. Future work should focus on elucidating other aspects of training in ultrasound-guided procedures and should attempt a similar study with a larger sample size.
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29
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Goswami D, Borle A. Preplacement check of complete central venous pressure catheter assembly: Should it be made routine? J Anaesthesiol Clin Pharmacol 2017; 33:273-274. [PMID: 28781468 PMCID: PMC5520615 DOI: 10.4103/0970-9185.173376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kashif M, Hashmi H, Jadhav P, Khaja M. A Missing Guide Wire After Placement of Peripherally Inserted Central Venous Catheter. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:925-928. [PMID: 27920421 PMCID: PMC5142581 DOI: 10.12659/ajcr.901046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Central venous catheterization is a common tool used in critically ill patients to monitor central venous pressure and administer fluids and medications such as vasopressors. Here we present a case of a missing guide wire after placement of peripherally inserted central catheter (PICC), which was incidentally picked up by bedside ultrasound in the intensive care unit. CASE REPORT A 50-year-old Hispanic male was admitted to the intensive care unit for alcohol intoxication. He was managed for septic shock and required placement of a peripherally inserted central line in his left upper extremity for antibiotics and vasopressor administration. A bedside ultrasound performed by the intensivist to evaluate upper extremity swelling revealed a foreign body in the left arm. Percutaneous procedure by Interventional radiologist was required for retrieval of the guidewire. CONCLUSIONS Guide wire related complications are rarely reported, but are significantly associated with mortality and morbidity. The use of ultrasound guidance placement of PICC lines decreases the risk of complications, provides better optimal vein selection, and enhances success.
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Affiliation(s)
- Muhammad Kashif
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Hafiz Hashmi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Preeti Jadhav
- Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Misbahuddin Khaja
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
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31
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Blanco P. Ultrasound-guided vascular cannulation in critical care patients: A practical review. Med Intensiva 2016; 40:560-571. [PMID: 28340911 DOI: 10.1016/j.medin.2016.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 01/15/2023]
Abstract
Vascular cannulation is common practice in critical care, and is traditionally performed using the landmark technique - though failures and complications are not uncommon. In this regard, ultrasound guided vascular cannulation (USGVC) has been shown to improve the procedure success rate and reduce its associated complications. This review addresses the fundamental aspects of USGVC and discusses some training issues related to this technique which is currently regarded as essential for intensivists.
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Affiliation(s)
- P Blanco
- Intensive Care Physician, Intensive Care Unit, Clínica Cruz Azul, 2651, 60 St., Necochea 7630, Argentina.
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Dietrich CF, Horn R, Morf S, Chiorean L, Dong Y, Cui XW, Atkinson NSS, Jenssen C. Ultrasound-guided central vascular interventions, comments on the European Federation of Societies for Ultrasound in Medicine and Biology guidelines on interventional ultrasound. J Thorac Dis 2016; 8:E851-E868. [PMID: 27747022 DOI: 10.21037/jtd.2016.08.49] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Central venous access has traditionally been performed on the basis of designated anatomical landmarks. However, due to patients' individual anatomy and vessel pathology and depending on individual operators' skill, this landmark approach is associated with a significant failure rate and complication risk. There is substantial evidence demonstrating significant improvement in effectiveness and safety of vascular access by realtime ultrasound (US)-guidance, as compared to the anatomical landmark-guided approach. This review comments on the evidence-based recommendations on US-guided vascular access which have been published recently within the framework of Guidelines on Interventional Ultrasound (InVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) from a clinical practice point of view.
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Affiliation(s)
- Christoph F Dietrich
- Medical Department, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany;; Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Rudolf Horn
- Notfallstation, Kantonsspital Glarus, Glarus, Switzerland
| | - Susanne Morf
- Intensivmedizin Kantonsspital Graubünden, Chur, Switzerland
| | - Liliana Chiorean
- Department of Medical Imaging, des Cévennes Clinic, Annonay, France
| | - Yi Dong
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Xin-Wu Cui
- Medical Department, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany;; Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Nathan S S Atkinson
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg, Wriezen, Germany
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Jung CF, Breaud AH, Sheng AY, Byrne MW, Muruganandan KM, Dhanani M, Leo MM. Delphi method validation of a procedural performance checklist for insertion of an ultrasound-guided peripheral intravenous catheter. Am J Emerg Med 2016; 34:2227-2230. [PMID: 27645813 DOI: 10.1016/j.ajem.2016.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Christine F Jung
- Department of Emergency Medicine, Boston Medical Center, Boston, MA
| | - Alan H Breaud
- Department of Emergency Medicine, Boston Medical Center, Boston, MA
| | - Alexander Y Sheng
- Department of Emergency Medicine, Boston Medical Center, Boston, MA; Boston University School of Medicine, Boston, MA
| | - Mark W Byrne
- Department of Emergency Medicine, Boston Medical Center, Boston, MA; Boston University School of Medicine, Boston, MA
| | - Krithika M Muruganandan
- Department of Emergency Medicine, Boston Medical Center, Boston, MA; Boston University School of Medicine, Boston, MA
| | - Muhammad Dhanani
- Division of General Internal Medicine, Department of Medicine, Mount Auburn Hospital, Cambridge, MA; Harvard Medical School, Boston, MA
| | - Megan M Leo
- Department of Emergency Medicine, Boston Medical Center, Boston, MA; Boston University School of Medicine, Boston, MA.
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Czyzewska D, Ustymowicz A, Klukowski M. [Application of ultrasonography in central venous catheterization; access sites and procedure techniques]. Med Clin (Barc) 2016; 147:116-20. [PMID: 27157792 DOI: 10.1016/j.medcli.2016.02.032] [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: 02/08/2016] [Accepted: 02/22/2016] [Indexed: 11/26/2022]
Abstract
Central venous catheterization is commonly performed in clinical practice. Traditional procedural technique is based on anatomical landmarks, but is associated with a high risk of failure and complications. To decrease their incidence European and American societies recommend application of ultrasonography. Preliminary ultrasonographic examination allows for assessment of local anatomical relations as well as vessel morphology (diameter, patency), while real-time ultrasonography increases chances of successful needle insertion. This paper presents the most common venous access sites and procedure techniques.
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Affiliation(s)
- Dorota Czyzewska
- Department of Diagnostic Imaging, Independent Public Provincial Hospital of J. Sniadecki, Bialystok, Polonia.
| | - Andrzej Ustymowicz
- Department of Radiology, Medical University of Bialystok, Bialystok, Polonia
| | - Mark Klukowski
- Department of Pediatrics, Gastroenterology, and Allergology, Medical University of Bialystok, Bialystok, Polonia
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35
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Short-axis/out-of-plane or long-axis/in-plane ultrasound-guided arterial cannulation in children. Eur J Anaesthesiol 2016; 33:522-7. [DOI: 10.1097/eja.0000000000000453] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Jaffer U, Normahani P, Singh P, Aslam M, Standfield NJ. Randomized study of teaching ultrasound-guided vascular cannulation using a phantom and the freehand versus needle guide-assisted puncture techniques. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:469-477. [PMID: 25704049 DOI: 10.1002/jcu.22263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 09/15/2014] [Accepted: 11/16/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE The task of ultrasound-guided vessel cannulation can be technically difficult. Needle guides have been designed to facilitate vessel puncture. We aimed to identify and compare the learning curves of participants performing vessel puncture with conventional freehand (FH) and needle guide-assisted (NG) techniques. METHODS Thirty-six participants were randomly allocated to either the FH or the NG group. They were asked to consecutively perform as many as 30 vessel punctures on a simulated phantom model. Quantitative metrics (time taken and number of skin and posterior-wall punctures) were recorded and compared between the two groups. The cumulative sum and moving F-test statistical methods were used to delineate the learning curves. RESULTS There was a significantly lower rate of posterior-wall punctures in the NG group than in the FH group (15% versus 26%; p < 0.0001). Participants in the NG group also performed significantly fewer skin punctures than did those in the FH group (mean, 405 versus 515; p < 0.0001). Cumulative sum statistical method analysis showed that participants in the NG group surmounted the learning curve earlier (13 attempts; interquartile range, 10.3-17.0) than did those in the FH group (19 attempts; interquartile range, 15.0-27.5). The number of attempts to surmount the learning curve was significantly less for the FH group (7.2 versus 16 attempts; p = 0.007) when using the moving F-test. CONCLUSIONS The NG puncture allows a greater number of trainees to cross the learning threshold and offers the advantages of fewer posterior-wall punctures and skin punctures. The use of NG puncture may result in a shorter path to proficiency, allowing trainees to attempt needle puncture earlier and with a greater degree of safety.
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Affiliation(s)
- Usman Jaffer
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Pasha Normahani
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Prashant Singh
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Mohammed Aslam
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Nigel J Standfield
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
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Congenital Anomalies of Superior Vena Cava and their Implications in Central Venous Catheterization. J Vasc Access 2015; 16:265-8. [DOI: 10.5301/jva.5000371] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 11/20/2022] Open
Abstract
Congenital anomalies of superior vena cava (SVC) are generally discovered incidentally during central venous catheter (CVC) insertion, pacemaker electrode placement, and cardiopulmonary bypass surgery. Persistent left SVC (PLSVC) is a rare (0.3%) anomaly in healthy subjects, usually asymptomatic, but when present and undiagnosed, it may be associated with difficulties and complications of CVC placement. In individuals with congenital heart anomalies, its prevalence may be up to 10 times higher than in the general population. In this perspective, awareness of the importance of the incidental finding of PLSV during CVC placement is crucial. To improve knowledge of this rare but potentially dangerous condition, we describe the embryological origin of SVC, its normal anatomy, and possible congenital anomalies of the venous system and of the heart, including the presence of a right to left cardiac shunt. Diagnosis of PLSVC as well as the clinical complications and technical impact of SVC congenital anomalies for CVC placement are emphasized.
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Moore CL. Ultrasound first, second, and last for vascular access. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1135-1142. [PMID: 24958398 DOI: 10.7863/ultra.33.7.1135] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Vascular access is the most commonly performed invasive procedure in medicine. For more than 20 years, ultrasound has been shown to improve the success and decrease complications of central venous access; however, it is still not universally used for this procedure. Ultrasound may also be used to facilitate difficult peripheral vascular access, potentially avoiding other more invasive procedures such as central or intraosseus vascular access. This article reviews some of the indications and evidence for ultrasound-guided vascular access, provides tips for successful ultrasound guidance, and discusses barriers to adoption.
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Affiliation(s)
- Christopher L Moore
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut USA.
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