Dynamic Needle Tip Positioning – Ultrasound Guidance for Peripheral Vascular Access. A Randomized, Controlled and Blinded Study in Phantoms Performed by Ultrasound Novices

Abstract

Purpose: The application of ultrasound-guidance for peripheral venous access is gaining popularity. It is possible to produce a short axis or a long axis sonographic view of the target vessel and apply an out-of-plane or in-plane needle tip approach. Our aim was to present the dynamic needle tip positioning technique and to estimate which approach is the most accurate for inserting the needle tip into the center of the target vessel.

Materials and Methods: Fiftynine novices in ultrasound-guided peripheral vascular access participated. (A) a short axis view combined with an out-of-plane needle tip approach using dynamic needle tip positioning was compared to (B) a long axis view combined with an in-plane needle tip approach to a target vessel embedded in a gelatine phantom.

Results: The success rate of method (A) was significantly higher than method (B) (97 % versus 81 %). The distance between the center of the target vessel and the final needle tip position was significantly shorter for method (A) compared to method (B).

Conclusion: The combined short axis and out-of-plane technique using dynamic needle tip positioning had a higher success rate and a shorter distance between the center of the target vessel and the needle tip compared to the combined long axis and in-plane technique.

Zusammenfassung

Ziel: Die Anwendung einer Ultraschallkontrolle beim peripheren Gefäßzugang wird immer beliebter. Es ist möglich, einen sonografischen Kurz- oder Längsachsenblick des Zielgefäßes zu erhalten und für den Zugang der Nadelspitze eine Methode außerhalb und in der Ebene anzuwenden. Unser Ziel war es, die Technik der dynamischen Nadelspitzen-Positionierung vorzustellen und zu bewerten, welche Methode für die Einführung der Nadelspitze in das Zentrum des Zielgefäßes die genaueste ist.

Material und Methoden: Es nahmen 59 Anfänger in Bezug auf den ultraschallgestützten peripheren Gefäßzugangs teil. An einem Zielgefäß, das in ein Gelantine-Phantom eingebettet war, wurde (A) der Kurzachsenblick mit Nadelspitzenzugang außerhalb der Ebene (out-of-plane) mittels dynamischer Nadelspitzen-Positionierung mit (B) dem Längsachsenblick in Kombination mit dem Nadelspitzenzugang in der Ebene (in-plane) verglichen.

Ergebnisse: Die Erfolgsquote von Methode (A) war deutlich höher als die von Methode (B) (97 % im Vergleich zu 81 %). Die Entfernung zwischen dem Zentrum des Zielgefäßes und der Endposition der Nadelspitze war bei Methode (A) deutlich geringer.

Schlussfolgerung: Die Kombination von Kurzachsen- und Out-of-plane-Technik unter Verwendung der dynamischen Nadelspitzen-Positionierung führte zu einer höheren Erfolgsquote und einer geringeren Entfernung zwischen dem Zentrum des Zielgefäßes und der Nadelspitze als die Kombination von Längsachsen- und In-plane-Technik.

Key words

vascular - veins - interventional procedures - ultrasound 2 D - catheters

• References

• 1 Atkinson P, Boyle A, Robinson S et al. Should ultrasound guidance be used for central venous catheterisation in the emergency department?. Emerg Med J 2005; 22: 158-164
• 2 Hind D, Calvert N, McWilliams R et al. Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ 2003; 327: 361
• 3 Karakitsos D, Labropoulos N, De Groot E et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care 2006; 10: R162
• 4 Leung J, Duffy M, Finckh A. Real-time ultrasonographically-guided internal jugular vein catheterization in the emergency department increases success rates and reduces complications: a randomized, prospective study. Ann Emerg Med 2006; 48: 540-547
• 5 Milling Jr TJ , Rose J, Briggs WM et al. Randomized, controlled clinical trial of point-of-care limited ultrasonography assistance of central venous cannulation: the Third Sonography Outcomes Assessment Program (SOAP-3) Trial. Crit Care Med 2005; 33: 1764-1769
• 6 Teichgräber UK, Benter T, Schultz HJ et al. Ultrasonographically guided puncture technique for central venous vessels as a one-person technique. Ultraschall in Med 2000; 21: 132-136
• 7 Böck U, Möllhoff T, Förster R. Ultrasonography guided versus anatomically oriented puncture of the internal jugular vein for central venous catheterization. Ultraschall in Med 1999; 20: 98-103
• 8 Aschwanden M, Thalhammer C, Schaub S et al. Common carotid dissection after central venous catheterisation. Ultraschall in Med 2008; 29: 571-574
• 9 Brannam L, Blaivas M, Lyon M et al. Emergency nurses’ utilization of ultrasound guidance for placement of peripheral intravenous lines in difficult-access patients. Acad Emerg Med 2004; 11: 1361-1363
• 10 Costantino TG, Kirtz JF, Satz WA. Ultrasound-guided peripheral venous access vs. the external jugular vein as the initial approach to the patient with difficult vascular access. J Emerg Med 2010; 39: 462-467
• 11 Gregg SC, Murthi SB, Sisley AC et al. Ultrasound-guided peripheral intravenous access in the intensive care unit. J Crit Care 2010; 25: 514-519
• 12 Keyes LE, Frazee BW, Snoey ER et al. Ultrasound-guided brachial and basilic vein cannulation in emergency department patients with difficult intravenous access. Ann Emerg Med 1999; 34: 711-714
• 13 Doniger SJ, Ishimine P, Fox JC et al. Randomized controlled trial of ultrasound-guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients. Pediatr Emerg Care 2009; 25: 154-159
• 14 Adhikari S, Blaivas M, Morrison D et al. Comparison of infection rates among ultrasound-guided versus traditionally placed peripheral intravenous lines. J Ultrasound Med 2010; 29: 741-747
• 15 Sterio DC. The unbiased estimation of number and sizes of arbitrary particles using the disector. J Microsc 1984; 134: 127-136
• 16 Goldstein JR. Ultrasound-Guided Peripheral Venous Access. Israeli Journal of Emergency Medicine 2006; 6: 46
• 17 Blaivas M, Brannam L, Fernandez E. Short-axis versus long-axis approaches for teaching ultrasound-guided vascular access on a new inanimate model. Acad Emerg Med 2003; 10: 1307-1311
• 18 Stone MB, Moon C, Sutijono D et al. Needle tip visualization during ultrasound-guided vascular access: short-axis vs long-axis approach. Am J Emerg Med 2010; 28: 343-347
• 19 Knudsen PJ, Vigsnaes JS, Rasmussen R et al. Terminal ballistics of 7.62 mm NATO bullets: experiments in ordnance gelatin. Int J Legal Med 1995; 108: 62-67
• 20 Bude RO, Adler RS. An easily made, low-cost, tissue-like ultrasound phantom material. J Clin Ultrasound 1995; 23: 271-273
• 21 Kendall JL, Faragher JP. Ultrasound-guided central venous access: a homemade phantom for simulation. CJEM 2007; 9: 371-373
• 22 Witting MD, Schenkel SM, Lawner BJ et al. Effects of vein width and depth on ultrasound-guided peripheral intravenous success rates. J Emerg Med 2010; 39: 70-75
• 23 French JL, Raine-Fenning NJ, Hardman JG et al. Pitfalls of ultrasound guided vascular access: the use of three/four-dimensional ultrasound. Anaesthesia 2008; 63: 806-813
• 24 Blaivas M, Adhikari S. An unseen danger: frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance. Crit Care Med 2009; 37: 2345-2349 ; quiz 2359
• 25 Chapman GA, Johnson D, Bodenham AR. Visualisation of needle position using ultrasonography. Anaesthesia 2006; 61: 148-158