The “Ski Lift”: A Technique to Maximize Needle Visualization with the Long‐axis Approach for Ultrasound‐guided Vascular Access

Schofer, Joel; Nomura, Jason T.; Bauman, Michael; Hyde, Robert J.; Schmier, Charles

doi:10.1111/j.1553-2712.2010.00784.x

Cited by 17 publications

(11 citation statements)

References 5 publications

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“…9 However, it is difficult to keep the needle in the same plane as the narrow US beam in the long-axis view during the procedure. 10 In this study, some participants reported that the OST-HMD facilitated the use of the long-axis view due to in-line positioning of the transducer, hands, and screen ( Figure 2).…”

Section: Discussionmentioning

confidence: 81%

“…Using an in‐plane needle approach with a long‐axis view of the vessel is superior to the short‐axis view for visualizing the entire subcutaneous portion of the needle, thus avoiding inadvertent puncture of distal structures . However, it is difficult to keep the needle in the same plane as the narrow US beam in the long‐axis view during the procedure . In this study, some participants reported that the OST‐HMD facilitated the use of the long‐axis view due to in‐line positioning of the transducer, hands, and screen (Figure ).…”

Section: Discussionmentioning

confidence: 94%

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Ultrasound‐guided central venous catheterization using an optical see‐through head‐mounted display: A pilot study

Kaneko

Sato

Takeshima

et al. 2016

J of Clinical Ultrasound

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 94%

Ultrasound‐guided central venous catheterization using an optical see‐through head‐mounted display: A pilot study

Kaneko

Sato

Takeshima

et al. 2016

J of Clinical Ultrasound

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“…Shofer and his colleagues indicate that using this approach, the LA approach has become the preferred method of visualization of vessels for central venous catheterization at their institution. 25 …”

Section: Discussionmentioning

confidence: 99%

Is Long-Axis View Superior to Short-Axis View in Ultrasound-Guided Central Venous Catheterization?*

Vogel

Haukoos

Erickson

et al. 2015

Critical Care Medicine

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Objective To evaluate whether using long axis (LA) or short axis (SA) view during ultrasound-guided internal jugular (IJ) and subclavian (SC) central venous catheterization (CVC) results in fewer skin breaks, decreased time to cannulation, and fewer posterior wall penetrations (PWP). Design Prospective, randomized crossover study. Setting Urban emergency department with approximate annual census of 60,000. Subjects Emergency medicine resident physicians at the Denver Health Residency in Emergency Medicine, a PGY 1-4 training program. Interventions Resident physicians blinded to the study hypothesis used ultrasound guidance to cannulate the IJ and SC of a human torso mannequin using the LA and SA views at each site. Measurements An ultrasound fellow recorded skin breaks, redirections, and time to cannulation. An experienced ultrasound fellow or attending used a convex 8–4 MHz transducer during cannulation to monitor the needle path and determine PWP. Generalized linear mixed models with a random subject effect were used to compare time to cannulation, number of skin breaks and redirections, and PWP of the LA and SA at each cannulation site. Results 28 resident physicians participated: 8 PGY-1, 8 PGY-2, 5 PGY-3, and 7 PGY-4. The median [interquartile range (IQR)] number of total IJ central venous catheters placed was 27 (IQR 9-42) and SC was 6 (IQR 2-20) catheters. The median number of previous ultrasound-guided IJ catheters was 25 (IQR 9-40), and ultrasound-guided SC catheters was 3 (IQR 0-5). The LA view was associated with a significant decrease in the number of redirections at the IJ and SC sites, relative risk (RR) 0.4 (95% confidence interval [CI] 0.2-0.9), and RR 0.5 (95% CI 0.3-0.7), respectively. There was no significant difference in the number of skin breaks between the LA and SA at the SC and IJ sites. The LA view for SC was associated with decreased time to cannulation; there was no significant difference in time between the SA and LA views at the IJ site. The prevalence of PWP was: IJ SA 25%, IJ LA 21%, SC SA 64%, and SC LA 39%. The odds of PWP were significantly less in the SC LA, odds ratio 0.3 (95% CI 0.1-0.9). Conclusions The LA view for the IJ was more efficient than the SA view with fewer redirections. The LA view for SC CVC was also more efficient with decreased time to cannulation and fewer redirections. The LA approach to SC CVC is also associated with fewer PWP. Using the LA view for SC CVC and avoiding PWP may result in fewer central venous catheter-related complications.

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“…On the contrary, the needle can not be visualized if it is not in the ultrasounic section. 21 This is the partial ultrasound volume phenomenon caused by the ultrasound section-thickness.…”

Section: Discussionmentioning

confidence: 99%

Modified Long-Axis In-Plane Ultrasound Versus Short-Axis Out-of-Plane Ultrasound For Radial Arterial Cannulation: A Prospective Randomized Controlled Trial

Wang

Zhang

Huang

et al. 2019

Preprint

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BACKGROUND Given a low first-pass success rate of the conventional SAX (short-axis) or LAX (long-axis) approach, ultrasound-guided radial artery cannulation in adults with radial artery diameter less than 2.2 mm may be still challenging. OBJECTIVE To assess the efficacy of modified long-axis in-plane(M-LAIP) versus short-axis out-of-plane (SAOP) or conventional palpation(C-P) approaches for ultrasound-guided radial artery cannulation. DESIGN A prospective, randomized and controlled trial. SETTING Operating room in a tertiary university hospital, from 1 July 2018 to 24 November 2018. PATIENTS A total of 201 patients (age 18 to 85 years, the diameter of the radial artery less 2.2 mm) were included. Patients with history of forearm surgery, ulnar artery occlusion, abnormal Allen test, etc, were excluded from this study. INTERVENTIONS All patients were randomized 1:1:1 to M-LAIP, SAOP or C-P. MAIN OUTCOME MEASURES The primary outcome was the cannulation success rate. Secondary outcomes included first location time and cannulation time, number of attempts. RESULTS The cannulation success rate was significantly higher in the M-LAIP group than in the SAOP group or C-P group (first success rate: 80.3% vs 53.8% or 33.8%; p =0.000; total success rate: 93.9% vs 78.5% or 50.8%; p =0.000). First location time (s) was significantly longer in the M-LAIP group compared with the SAOP group (31(28-35[12-44]) vs 15(14-17[10-21]); p =0.000) and the C-P group (31(28-35[12-44]) vs 12(8-13.5 [6-37]); p =0.000). However, the time of cannulation in the M-LAIP group (29(24-45[16-313])) was significantly shorter than that in the SAOP group (45(28.5-135.5[14-346]), p =0.002) and in the C-P group(138(27-308[12-363]), p =0.000). The number of attempts decreased in the M-LAIP group compared with SAOP or C-P group. CONCLUSION The M-LAIP procedure for ultrasound-guided radial artery cannulation can offer a higher success rate of the first-attempt and total cannulation, fewer attempts and less time of cannulation.

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The “Ski Lift”: A Technique to Maximize Needle Visualization with the Long‐axis Approach for Ultrasound‐guided Vascular Access

Cited by 17 publications

References 5 publications

Ultrasound‐guided central venous catheterization using an optical see‐through head‐mounted display: A pilot study

Ultrasound‐guided central venous catheterization using an optical see‐through head‐mounted display: A pilot study

Is Long-Axis View Superior to Short-Axis View in Ultrasound-Guided Central Venous Catheterization?*

Modified Long-Axis In-Plane Ultrasound Versus Short-Axis Out-of-Plane Ultrasound For Radial Arterial Cannulation: A Prospective Randomized Controlled Trial

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