Pulsed Doppler Sonography for the Guidance of Vein Puncture: A Prospective Study

Abstract

Blind deep venous puncture is an invasive procedure with risks of serious complications compromising the availability of veins for future punctures or endangering the patient's life. We designed a new hand-held pulsed Doppler probe for coaxial guidance of the puncture needle and a dedicated pulsed Doppler device displaying the depth of the measurement volume. We used this technique prospectively in two independent centers (the nephrology department and the intensive care unit) involving senior as well as junior staff members. Either the non-Doppler or the Doppler method were randomly selected for subclavian vein catheterization in 100 patients and for internal jugular vein catheterization in 30 patients. The success rate on the first attempt was 86.2% for the non-Doppler method versus 96.8% for the Doppler method (p = 0.03). The failure rate of the non-Doppler method used by junior staff members was 9.2%, reduced to 1.5% (p = 0.05) by secondary use of the Doppler method and/or help from a senior staff member (rescue procedure). Pulsed Doppler guidance reduced significantly the failure rate of venous punctures especially when used by seniors or by juniors after a training period.

The effectiveness and cost-effectiveness of ultrasound locating devices for central venous access: a systematic review and economic evaluation

“…Where this inexperience was defined, it was only in one study 35 where the operator had cannulated more than ten (but less than 30) patients with the ULD. Four more studies 6,34,37,38,41 recorded less than ten 2-D USguided cannulations prior to the trial, and in one of these, 6 the operators only had to demonstrate one successful cannulation, using the ULD, prior to the trial. Nine studies did not record the operators' ULD experience.…”

“…Six studies described the operators as having up to 5 years postgraduate experience, 25,27,35,37,38,41 eight as having more than 5 years, 5,10,26,28,[32][33][34]39 and two as varying in experience. 6,31 Four trials did not record the career experience of the operator. 11,24,36,40 In terms of experience in the use of the ULD, only one study 39 made a claim of expertise for the operator, although this was not quantified.…”

“…This will normally be only a few minutes, although failed insertions can take up to threequarters of an hour. 5,6 In an expensive ICU unit and using a highly qualified operator for example, the opportunity cost of a difficult insertion will be considerably more than a successful venepuncture achieved with the first pass of the venepuncture needle. Complications induced by the venepuncture may have only minor resource implications.…”

“…In three studies, 27,37,41 the operators were inexperienced both with ULD guidance and with the landmark method. In a further six studies, 6,25,26,34,35,38 the operators were inexperienced with ULD guidance and did not refer to their relative experience with the landmark method. Where this inexperience was defined, it was only in one study 35 where the operator had cannulated more than ten (but less than 30) patients with the ULD.…”

“…All the latter cases involved patients about to undergo cardiac surgery. In the adult trials, four studies 33,34,36,39 involved patients scheduled for cardiovascular/cardiothoracic surgery; five studies 24,28,32,35,38 concerned patients in ICU; two studied patients undergoing dialysis; 6,31 one studied patients in ICU or on dialysis;…”