A comparison of longitudinal and transverse approaches to ultrasound-guided axillary vein cannulation
| Autor: | Michael D. Witting, Sarah K. Sommerkamp, Deanna R. Ford, Brian D. Euerle, Michael G. Allison, Victoria M. Romaniuk |
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| Rok vydání: | 2013 |
| Předmět: |
Models
Anatomic Catheterization Central Venous medicine.medical_specialty Time Factors Attitude of Health Personnel Imaging phantom Interquartile range Physicians Surveys and Questionnaires medicine Humans Axillary Vein Ultrasonography Interventional Cross-Over Studies business.industry Ultrasound General Medicine Torso Crossover study Confidence interval Surgery Transverse plane medicine.anatomical_structure Emergency Medicine Clinical Competence Radiology business Axillary vein |
| Zdroj: | The American Journal of Emergency Medicine. 31:478-481 |
| ISSN: | 0735-6757 |
| DOI: | 10.1016/j.ajem.2012.09.015 |
| Popis: | Objective The axillary vein is an easily accessible vessel that can be used for ultrasound-guided central vascular access and offers an alternative to the internal jugular and subclavian veins. The objective of this study was to identify which transducer orientation, longitudinal or transverse, is better for imaging the axillary vein with ultrasound. Methods Emergency medicine physicians at an inner-city academic medical center were asked to cannulate the axillary vein in a torso phantom model. They were randomized to start with either the longitudinal or transverse approach and completed both sequentially. Participants answered questionnaires before and after the cannulation attempts. Measurements were taken regarding time to completion, success, skin punctures, needle redirections, and complications. Results Fifty-seven operators with a median experience of 85 ultrasound procedures (interquartile range, 26-120) participated. The frequency of first-attempt success was 39 (0.69) of 57 for the longitudinal method and 21 (0.37) of 57 for the transverse method (difference, 0.32; 95% confidence interval [CI], 0.12-0.51 [ P = .001]); this difference was similar regardless of operator experience. The longitudinal method was associated with fewer redirections (difference, 1.8; 95% CI, 0.8-2.7 [ P = .0002]) and skin punctures (difference, 0.3; 95% CI, −2 to +0.7 [ P = .07]). Arterial puncture occurred in 2 of 57 longitudinal and 7 of 57 transverse attempts; no pleural punctures occurred. For successful attempts, the time spent was 24 seconds less for the longitudinal method (95% CI, 3-45 [ P = .02]). Conclusions The longitudinal method of visualizing the axillary vein during ultrasound-guided venous access is associated with greater first-attempt success, fewer needle redirections, and a trend of fewer arterial punctures compared with the transverse orientation. |
| Databáze: | OpenAIRE |
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