Randomized, Prospective, Observational Simulation Study Comparing Residents� Needle-Guided vs. Free-Hand Ultrasound Techniques for Central Venous Catheter Access
R.D. Ball1 , N. E. Scouras1, 2, S. Orebaugh1, 3, J. Wilde4 and T. Sakai1, 5, 1 Department of Anesthesiology, University of Pittsburgh Medical Center, University of Pittsburgh, Liliane S. Kaufmann Building, 3471 Fifth Avenue Suite 910, Pittsburgh, PA 15213 USA. 2 American Anesthesiology, 3100 Spring Forest Road Suite 130, Raleigh, NV 27616, USA. 3 Division of Acute Interventional Perioperative Pain and Regional Anesthesia, Department of Anesthesiology, UPMC Southside/Mercy, 2000 Mary Street, Pittsburgh, PA 15203 USA. 4 University of Pittsburgh School of Medicine, University of Pittsburgh, M240 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261 USA. 5 Department of Anesthesiology, McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore, M469.11, 200 Lathrop Street, Pittsburgh, PA 15213 USA.
British Journal of Anaesthesia; November 2011
Summary and Methods
This study tested the hypothesis that a needle guided technique (NG) would allow faster central venous catheter placement, better success rates and fewer needle sticks than both the short-axis (S-FH) and long-axis (L-FH) free-handed methods. Additionally, the authors postulated the lack of control of needle depth under the short-axis (S-FH) approach contributes to inadvertent arterial puncture. Utilizing the needle guide technique would allow for better visualization of the needle tip during the procedure and could help circumvent this procedural risk.
Thirty-three anesthesia residents with equal levels of training participated in a prospective observational study at the Peter M. Winter Institute for Simulation, Education and Research at the University of Pittsburgh School of Medicine. Utilizing a central venous catheter (CVC) phantom, bedside ultrasound system and the Infiniti needle guide system, each resident performed a CVC insertion using three different techniques; short axis free-hand (S-FH), long axis free-hand (L-FH) and long axis needle guided.
Discussion and Results
The use of needle guided long-axis approach increased needle tip visualization by 276% when compared to the free-hand approaches. The success rate regardless of the technique was 100%.
In addition, no significant difference in procedure time was noted. Post-task surveys revealed positive feedback for the use of a needle guide including strong consideration to use the device in a clinical setting.
Conclusions
The authors reported study limitations including the lack of resident knowledge of the needle guide could have contributed to longer procedure times. Additionally, the venous catheter phantom does not react as human tissue. In a clinical setting, anatomical variances would exist based on patient body habitus. Finally, the time required task as the primary evaluation would not be reflective of a clinical setting.
The study's findings suggest the Infiniti needle guide:
- improved needle visualization in the long-axis versus free-hand technique
- demonstrated ease of usability and reliability of visualization of the needle
Author Commentary
�The visualization of the needle under ultrasound-guided techniques, including vascular access, regional nerve block and interventional radiology is a crucial component of patient safety. � �The needle guide permitted significantly more consistent visualization of the needle during the procedure, which suggested the needle guide's potential to improve patient safety by reducing the incidence of inadvertent punctures to adjacent structures.�
