Ultrasound‐guided catheterisation of the subclavian vein: freehand vs needle‐guided technique

Abstract

SummaryThe objective of this prospective, randomised study was to examine the impact of a multi-angle needle guide for ultrasound-guided, in-plane, central venous catheter placement in the subclavian vein. One hundred and sixty patients were randomly allocated to two groups, freehand or needle-guided, and then 159 catheterisations were analysed. Cannulation of the first examined access site was successful in 96.9% of cases with no significant difference between groups. There were three arterial punctures and no other severe injuries. Catheter misplacements did not differ between the groups. Higher success rates within the first and second attempts in the needle-guided group were observed (p = 0.041 and p = 0.019, respectively).

The Value of Needle‐Guidance Technology in Ultrasound‐Guided Percutaneous Procedures Performed by Radiology Residents: A Comparison of Freehand, In‐Plane, Fixed‐Angle, and Electromagnetic Needle Tracking Techniques

“…Needle‐guidance technology, both IPFA and ENT, significantly improve radiology resident procedure time and accuracy, especially for lesions that are deep or require difficult approach. This is in accordance with previous literature showing improved procedure time and accuracy for attending physicians . Direct comparison of experienced attending physicians and residents is a potential avenue of future investigation.…”

“…Many of the previous studies of needle‐guidance technology have used small operator sample sizes of senior staff physicians . Several studies that have assessed needle‐guidance technology in the hands of novice proceduralists, including medical students and residents, did so using either an IPFA device for venous access or an out‐of‐plane, fixed‐angle device to place a needle into targets in a porcine model .…”

Evaluation of a Novel Out‐of‐Plane Needle Guide

“…We observed a statistically significant reduction in procedure times with the retreating‐stop needle guide, consistent with that observed with other styles of needle guides . We did not observe any reduction in accuracy and in fact noted a trend toward increased accuracy when used by participants with limited experience in ultrasound.…”

“…This approach allows the depth at which the needle will intersect the ultrasound plane to be known, and the user can select different depths by changing the angle of the guide. These guides have been shown to improve both the procedural time and success rate . Unfortunately, these variable‐angle guides are restricted to a limited number of depth settings and therefore are usually inadequate for regional anesthesia, although for large targets with predictable depths (such as venous structures), they remain widely used …”

“…[3][4][5][6] Unfortunately, these variable-angle guides are restricted to a limited number of depth settings and therefore are usually inadequate for regional anesthesia, although for large targets with predictable depths (such as venous structures), they remain widely used. [6][7][8][9] To address this shortcoming, manufacturers have also developed electromagnetic needle-tracking systems that display needle trajectory information on the ultrasound image. [10][11][12][13] Although these systems have shown clinical promise, they require proprietary ultrasound systems and needles.…”