Ultrasound-guided central venous vascular access—novel needle navigation technology compared with conventional method: A randomized study

Abstract

Purpose:

Central venous catheter insertion is a common procedure in the intensive care setting. However, complications persist despite real-time ultrasound guidance. Recent innovation in needle navigation technology using guided positioning system enables the clinician to visualize the needle’s real-time position and trajectory as it approaches the target. We hypothesized that the guided positioning system would improve performance time in central venous catheter insertion.

Methods:

A prospective randomized study was conducted in a single-center adult intensive care unit. In total, 100 patients were randomized into two groups. These patients underwent internal jugular vein central venous catheter cannulation with ultrasound guidance (short-axis scan, out-of-plane needling approach) in which one group adopted conventional method, while the other group was aided with the guided positioning system. Outcomes were measured by procedural efficacy (success rate, number of attempts, time to successful cannulation), complications, level of operators’ experience, and their satisfaction.

Results:

All patients had successful cannulation on the first attempt except for one case in the conventional group. The median performance time for the guided positioning system method was longer (25.5 vs 15.5 s; p = 0.01). And 86% of the operators had more than 3-year experience in anesthesia. One post-insertion hematoma occurred in the conventional group. Only 88% of the operators using the guided positioning system method were satisfied compared to 100% in the conventional group.

Conclusion:

Ultrasound-guided central venous catheter insertion via internal jugular vein was a safe procedure in both conventional and guided positioning system methods. The guided positioning system did not confer additional benefit but was associated with slower performance time and lower satisfaction level among the experienced operators.

Keywords

Central venous catheter internal jugular vein ultrasound guidance intensive care guided positioning system

Get full access to this article

View all access options for this article.

References

Jenssen

Brkljacic

Hocke

, et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS). Part VI—ultrasound-guided vascular interventions. Ultraschall Med 2016; 37: 473–476.

Bodenham Chair

Babu

Bennett

, et al. Association of Anaesthetists of Great Britain and Ireland: safe vascular access 2016. Anaesthesia 2016; 71: 573–585.

Tielens

Damen

Lerou

, et al. Ultrasound-guided needle handling using a guidance positioning system in a phantom. Anaesthesia 2014; 69: 24–31.

eZono. eZono 4000 and eZGuide ^® features, https://www.ezono.com/ezguide (accessed 9 September 2017).

Auyong

Yuan

Rymer

, et al. A randomized crossover study comparing a novel needle guidance technology for simulated internal jugular vein cannulation. Anesthesiology 2015; 123(3): 535–541.

Gadsden

Latmore

Levine

DM.

Evaluation of the eZono 4000 with eZGuide for ultrasound-guided procedures. Expert Rev Med Devices 2015; 12(3): 251–261.

Brass

Hellmich

Kolodziej

, et al. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database Syst Rev 2015; 1: CD006962.

Saugel

Scheeren

TWL

Teboul

J-L.

Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care 2017; 21: 225.

Troianos

Hartman

Glas

, et al. Special articles: guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Anesth Analg 2012; 114: 46–72.

10.

Blaivas

Brannam

Fernandez

Short-axis versus long-axis approaches for teaching ultrasound-guided vascular access on a new inanimate model. Acad Emerg Med 2003; 10: 1307–1311.

11.

Chittoodan

Breen

O’Donnell

, et al. Long versus short axis ultrasound guided approach for internal jugular vein cannulation: a prospective randomised controlled trial. Med Ultrason 2011; 13: 21–25.

12.

Kim

Min

Song

, et al. The effect of electromagnetic guidance system on early learning curve of ultrasound for novices. Korean J Anesthesiol 2016; 69: 15–20.

13.

Kopac

Chen

Tang

, et al. Comparison of a novel real-time SonixGPS needle-tracking ultrasound technique with traditional ultrasound for vascular access in a phantom gel model. J Vasc Surg 2013; 58(3): 735–741.

14.

Sander

Schick

Ecker

Novel navigated ultrasound compare with conventional ultrasound for vascular access: a prospective study in a gel phantom model. J Cardiothorac Vasc Anesth 2015; 29(5): 1261–1265.

15.

Johnson

Peiffer

Halmann

, et al. Ultrasound guided needle technique accuracy: prospective comparison of passive magnetic tracking versus unassisted echogenic needle localization. Reg Anesth Pain Med 2017; 42(2): 223–232.

16.

Dexheimer Neto

Roehrig

Morandi

, et al. Safety of a training program for ultrasound-guided internal jugular vein catheterization in critically ill patients. Rev Assoc Med Bras 2011; 57(4): 394–397.

17.

Nguyen

Prat

Bizien

Determination of the learning curve for ultrasound guided jugular venous catheter placement. Intensive Care Med 2013; 40(1): 66–73.

18.

Rossi

Rigamonti

Ticha

, et al. Percutaneous ultrasound-guided central venous catheters: the lateral in-plane technique for internal jugular vein access. J Vasc Access 2014; 15(1): 56–60.

19.

Pittiruti

La Greca

Cozza

, et al. Ultrasound guidance in central venous catheterization: the role of the experience of the physician. In: Proceedings of the 22nd postgraduate course in critical medicine on anaesthesia, pain, intensive care and emergency (A.P.I.C.E.) (ed Gullo

), Venice-Mestre, 9–11 November 2007.