Needle tip visualization during ultrasound-guided vascular access: short-axis vs long-axis approach
Needle tip visualization during ultrasound-guided vascular access: short-axis vs long-axis approach
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DOI：
10.1016/j.ajem.2008.11.022
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发表时间：
2010-03-01
影响因子：
3.6
通讯作者：
Blaivas, Michael
中科院分区：
文献类型：
--
作者：
Stone, Michael B.;Moon, Cynthia;Blaivas, Michael
目的：超声引导中心静脉置管术与地标技术相比，提高了成功率，减少了并发症。先前的研究表明，尽管实时超声引导，动脉和/或后静脉壁穿刺仍然发生。无法保持针尖的可视性可能导致这些并发症。本研究旨在确定超声引导血管通路的长轴或短轴途径是否能提高针尖的可见性。方法：一项前瞻性试验是在一级创伤中心进行的急诊医学住院医师。医学生和住院医师使用长轴和短轴方法将针插入血管通路组织幻象中。然后回顾在血管穿刺时获得的超声图像。主要结果测量是穿刺时针尖的可见性和成功穿刺血管的总时间。结果：所有受试者都能成功地从组织模体中获得模拟血液。长轴组平均穿刺时间14.8秒，短轴组平均穿刺时间12.4秒（P = 0.48）。长轴组穿刺血管时针尖可见性（24/ 39,62%）高于短轴组（9/ 39,23%）（P = 0.01）。结论：在模拟血管通路模型中，超声引导血管通路的长轴入路与血管穿刺时针尖的可见性提高有关。这种方法可能有助于减少超声引导中心静脉置管相关的并发症，应该在未来的研究中进行前瞻性评估。(C) 2010爱思唯尔公司版权所有。
Objectives: Ultrasound guidance for central venous catheterization improves success rates and decreases complications when compared to the landmark technique. Prior research has demonstrated that arterial and/or posterior vein wall puncture still occurs despite real-time ultrasound guidance. The inability to maintain visualization of the needle tip may contribute to these complications. This study aims to identify whether long-axis or short-axis approaches to ultrasound-guided vascular access afford improved visibility of the needle tip.Methods: A prospective trial was conducted at a level I trauma center with an emergency medicine residency. Medical students and residents placed needles into vascular access tissue phantoms using long-axis and short-axis approaches. Ultrasound images obtained at the time of vessel puncture were then reviewed. Primary outcome measures were visibility of the needle tip at the time of puncture and total time to successful puncture of the vessel.Results: All subjects were able to successfully obtain simulated blood from the tissue phantom. Mean time to puncture was 14.8 seconds in the long-axis group and 12.4 seconds in the short-axis group (P = .48). Needle tip visibility at the time of vessel puncture was higher in the long-axis group (24/39, 62%) as opposed to the short-axis group (9/39, 23%) (P = .01).Conclusions: In a simulated vascular access model, the long-axis approach to ultrasound-guided vascular access was associated with improved visibility of the needle tip during vessel puncture. This approach may help decrease complications associated with ultrasound-guided central venous catheterization and should be prospectively evaluated in future studies. (C) 2010 Elsevier Inc. All rights reserved.