Ricerca sul reperimento di accesso vascolare su fantoccio. Sarebbe interessante verificare che tipo di fantoccio fosse perchè se fosse con superficie piana sarebbe uguale la difficoltà nella tecnica d'incannulamento mentre se fosse stato cilindrico, tecnica in asse corto vs quella in asse lungo, avrebbero difficoltà diverse come sanno i colleghi che impiantano.
Ottimale sarebbe stata una ricerca del genere sul campo con tutte le variabili del caso.
West J Emerg Med. 2014 Nov;15(7):824-30. doi: 10.5811/westjem.2014.9.22404. Epub 2014 Oct 21.
Ultrasound-guided small vessel cannulation: long-axis approach is equivalent to short-axis in novice sonographers experienced with landmark-based cannulation.
Erickson CS1, Liao MM2, Haukoos JS3, Douglass E2, DiGeronimo M2, Christensen E4, Hopkins E4, Bender B4, Kendall JL2.
- 1Oregon Health and Science University, Department of Emergency Medicine, Portland, Oregon.
- 2Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado ; University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado.
- 3Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado ; University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado ; Colorado School of Public Health, Department of Epidemiology, Aurora, Colorado.
- 4Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado.
Abstract
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 short-axis 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.- PMID:
- 25493126
- [PubMed - in process]
- PMCID:
- PMC4251227
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