TY - JOUR
T1 - Ultrasound-guided small vessel cannulation
T2 - Long-axis approach is equivalent to short-axis in novice sonographers experienced with landmark-based cannulation
AU - Erickson, Catherine S.
AU - Liao, Michael M.
AU - Haukoos, Jason S.
AU - Douglass, Erica
AU - DiGeronimo, Margaret
AU - Christensen, Eric
AU - Hopkins, Emily
AU - Bender, Brooke
AU - Kendall, John L.
PY - 2014
Y1 - 2014
N2 - Introduction: Our primary objective was to describe the time to vessel penetration and difficulty of long-axis and short-axis approaches for ultrasound-guided small vessel penetration in novice sonographers experienced with landmark-based small vessel penetration.Methods: This was a prospective, observational study of experienced certified emergency nurses attempting ultrasound-guided small vessel cannulation on a vascular access phantom. We conducted a standardized training, practice, and experiment session for each participant. Five long-axis and five short-axis approaches were attempted in alternating sequence. The primary outcome was time to vessel penetration. Secondary outcomes were number of skin penetrations and number of catheter redirections. We compared long-axis and short-axis approaches using multivariable regression adjusting for repeated measures, vessel depth, and vessel caliber.Results: Each of 10 novice sonographers made 10 attempts for a total of 100 attempts. Median time to vessel penetration in the long-axis and short-axis was 11 (95% confidence interval [CI] 7-12) and 10 (95% CI 6-13) seconds, respectively. Skin penetrations and catheter redirections were equivalent and near optimal between approaches. The median caliber of cannulated vessels in the long-axis and short-axis was 4.6 (95% CI 4.1-5.5) and 5.6 (95% CI 5.1-6.2) millimeters, respectively. Both axes had equal success rates of 100% for all 50 attempts. In multivariable regression analysis, long-axis attempts were 32% (95% CI 11%-48%; p=0.009) faster than shortaxis attempts.Conclusion: Novice sonographers, highly proficient with peripheral IV cannulation, can perform after instruction ultrasound-guided small vessel penetration successfully with similar time to vessel penetration in either the long-axis or short-axis approach on phantom models.
AB - Introduction: Our primary objective was to describe the time to vessel penetration and difficulty of long-axis and short-axis approaches for ultrasound-guided small vessel penetration in novice sonographers experienced with landmark-based small vessel penetration.Methods: This was a prospective, observational study of experienced certified emergency nurses attempting ultrasound-guided small vessel cannulation on a vascular access phantom. We conducted a standardized training, practice, and experiment session for each participant. Five long-axis and five short-axis approaches were attempted in alternating sequence. The primary outcome was time to vessel penetration. Secondary outcomes were number of skin penetrations and number of catheter redirections. We compared long-axis and short-axis approaches using multivariable regression adjusting for repeated measures, vessel depth, and vessel caliber.Results: Each of 10 novice sonographers made 10 attempts for a total of 100 attempts. Median time to vessel penetration in the long-axis and short-axis was 11 (95% confidence interval [CI] 7-12) and 10 (95% CI 6-13) seconds, respectively. Skin penetrations and catheter redirections were equivalent and near optimal between approaches. The median caliber of cannulated vessels in the long-axis and short-axis was 4.6 (95% CI 4.1-5.5) and 5.6 (95% CI 5.1-6.2) millimeters, respectively. Both axes had equal success rates of 100% for all 50 attempts. In multivariable regression analysis, long-axis attempts were 32% (95% CI 11%-48%; p=0.009) faster than shortaxis attempts.Conclusion: Novice sonographers, highly proficient with peripheral IV cannulation, can perform after instruction ultrasound-guided small vessel penetration successfully with similar time to vessel penetration in either the long-axis or short-axis approach on phantom models.
KW - Long axis
KW - Peripheral intravenous cannulation
KW - Short axis
KW - Ultrasound guidance
UR - http://www.scopus.com/inward/record.url?scp=84913554977&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84913554977&partnerID=8YFLogxK
U2 - 10.5811/westjem.2014.9.22404
DO - 10.5811/westjem.2014.9.22404
M3 - Article
C2 - 25493126
AN - SCOPUS:84913554977
SN - 1936-900X
VL - 15
SP - 824
EP - 830
JO - Western Journal of Emergency Medicine
JF - Western Journal of Emergency Medicine
IS - 7
ER -