Ultrasound-guided oblique approach for peripheral venous access in a phantom model

Abstract

BackgroundUltrasound (US) vascular guidance is traditionally performed in transverse (T) and longitudinal (L) axes, each with drawbacks. We hypothesized that the introduction of a novel oblique (O) approach would improve the success of US-guided peripheral venous access. We examined emergency physician (EP) performance using the O approach in a gel US phantom.MethodsIn a prospective, case control study, EPs were enrolled from four levels of physician experience including postgraduate years one to three (PGY1, PGY2, PGY3) and attending physicians. After a brief training session, each participant attempted vessel aspiration using a linear probe in T, L, and O axes on a gel US phantom. Time to aspiration and number of attempts to aspiration were recorded. The approach order was randomized, and descriptive statistics were used.ResultsTwenty-four physicians participated. The first-attempt success rate was lower for O, 45.83%, versus 70.83% for T (p = 0.03) and 83.33% for L (p = 0.01). The average time to aspiration was 12.5 s (O) compared with 9.47 s (T) and 9.74 s (L), respectively. There were no significant differences between all four groups in regard to total amount of time and number of aspiration attempts; however, a trend appeared revealing that PGY3 and attending physicians tended to aspirate in less time and by fewer attempts in all three orientations when compared with the PGY2 and PGY1 physicians.ConclusionIn this pilot study, US-guided simulated peripheral venous access using a phantom gel model in a mixed user group showed that the novel oblique approach was not initially more successful versus T and L techniques.

Focused Simulation Training: Emergency Department Nurses’ Confidence and Comfort Level in Performing Ultrasound-Guided Vascular Access

“…Different approaches to perform ultrasound-guided vascular access have been studied (29–––31). In a study done by Blaivas et al, novice sonographers were able to perform ultrasound-guided vascular access faster with out-of-plane technique (transverse image of the vein by placing long axis of the probe perpendicular to long axis of the vein) compared with in-plane technique (longitudinal image of the vein by placing the long axis of the probe parallel to long axis of the vein) (32).…”

Education in the placement of ultrasound-guided peripheral venous catheters: a systematic review

“…Fourteen educational programs included video material of the procedure [ 12 – 14 , 22 – 32 ] and five included live demonstrations of the procedure [ 22 , 23 , 29 , 33 , 34 ]. Inter-study duration variations in the training sessions were seen from the shortest of 5 min to the longest of 9 h [ 35 , 36 ]. In general, the duration of the training was between two to 4 h (Additional file 3 ).…”

“…In other studies, the living subjects were healthy persons ( n = 2). The phantoms used in studies were commercially available ( n = 10) [ 13 , 23 , 34 , 35 , 38 , 40 , 44 – 47 ], homemade ( n = 5) [ 26 , 37 , 39 , 48 , 49 ], or a mixture of both types of phantoms [ 50 ]. One study did not specify the type of phantom they used [ 51 ].…”

Evaluation of the eZono 4000 with eZGuide for ultrasound-guided procedures

“…A deliberate oblique orientation (i.e., between 0 and 90 degrees with respect to the plane of the beam) in the absence of needle guidance is not ideal, as inferences about the needle position in two perpendicular planes must now be made, rather than just one [41]. This makes the estimation of needle and needle tip position far more complex, possibly leading to an increased risk of injury.…”