Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-26T06:23:09.609Z Has data issue: false hasContentIssue false
  • English
  • Français

The wire is really easy to see (WIRES): sonographic visualization of the guidewire by novices

Published online by Cambridge University Press:  04 March 2015

James H. Moak ,
John S. Rajkumar  and
William A. Woods
James H. Moak*
Affiliation:
Department of Emergency Medicine, University of Virginia, Charlottesville, VA
John S. Rajkumar
Affiliation:
Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY
William A. Woods
Affiliation:
Department of Emergency Medicine, University of Virginia, Charlottesville, VA
*
University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908-0699; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

To determine whether novices can distinguish between properly and improperly placed guidewires in a vascular access model after only minimal training.

Methods:

This was a prospective study involving trainees with no previous training in sonographic guidewire visualization. A vascular access model was created with guidewires positioned inside or adjacent to simulated veins. Subjects were taught to scan each wire to determine its location. Afterward, participants scanned a test model of five vein-wire pairs and recorded their answers as “inside,” “outside,” or “unsure.” The test characteristics of sonographic guidewire localization were determined using actual wire location as the criterion standard.

Results:

Forty trainees (21 emergency medicine residents, 19 medical students) participated, and each examined five simulated veins. There were 156 true positives (intravascular wire correctly identified), 38 true negatives (extravascular wire correctly identified), 2 false negatives, 2 false positives, and 2 cases in which the participant marked “not sure,” which were reclassified as false negatives. Test characteristics were sensitivity 97.5% (95% CI 93.3–99.2) and specificity 95.0% (95% CI 81.8–99.1). The overall accuracy was 97.0%.

Conclusions:

Sonographic guidewire visualization, a step recommended for ensuring proper vessel cannulation during central venous access, can be accomplished by novices with a high degree of accuracy.

Keywords

arterial puncturecomplicationsguidewireultrasonographyvascular access
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 1 , January 2013 , pp. 18 - 23
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

REFERENCES

1.Karakitsos, D, Labropoulos, N, De Groot, E, et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care 2006;10:R162, doi:10.1186/cc5101.CrossRefGoogle ScholarPubMed
2.Leung, J, Duffy, M, Finckh, A. Real-time ultrasonographically-guided internal jugular vein catheterization in the emergency department increases success rates and reduces complications: a randomized, prospective study. Ann Emerg Med 2006;48:540–7, doi:10.1016/j.annemergmed.2006.01.011.CrossRefGoogle ScholarPubMed
3.Milling, TJ Jr, Rose, J, Briggs, WM, et al. Randomized, controlled clinical trial of point-of-care limited ultrasonography assistance of central venous cannulation: the Third Sonography Outcomes Assessment Program (SOAP-3) Trial. Crit Care Med 2005;33:1764–9, doi:10.1097/01.CCM.0000171533.92856.E5.Google Scholar
4.Stone, MB, Hern, HG. Inadvertent carotid artery cannulation during ultrasound guided central venous catheterization. Ann Emerg Med 2007;49:720, doi:10.1016/j.annemergmed.2006.11.030.CrossRefGoogle ScholarPubMed
5.Domino, KB, Bowdle, TA, Posner, KL, et al. Injuries and liability related to central vascular catheters: a closed claims analysis. Anesthesiology 2004;100:1411–8, doi:10.1097/00000542-200406000-00013.CrossRefGoogle ScholarPubMed
6.Guilbert, MC, Elkouri, S, Bracco, D, et al. Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm. J Vasc Surg 2008;48:918–25;discussion 925, doi:10.1016/j.jvs.2008.04.046.Google Scholar
7.Singhal, M, Gupta, V, Singh, P, et al. Iatrogenic lifethreatening pseudoaneurysms of extracranial internal carotid artery after fine-needle aspiration of cervical lymph nodes: report of two cases in children. Cardiovasc Intervent Radiol 2009;32:1260–3, doi:10.1007/s00270-009-9506-x.Google Scholar
8.Siu, DY, Wong, GK, Ho, SS, et al. Iatrogenic carotid-jugular fistula. Hong Kong Med J 2009;15:313–4.Google ScholarPubMed
9.Moak, JH, Lyons, MS, Wright, SW, et al. Needle and guidewire visualization in ultrasound-guided internal jugular vein cannulation. Am J Emerg Med 2011;29:432–6, doi:10.1016/j.ajem.2010.01.004.CrossRefGoogle ScholarPubMed
10.Stone, MB, Nagdev, A, Murphy, MC, et al. Ultrasound detection of guidewire position during central venous catheterization. Am J Emerg Med 2010;28:82–4, doi:10.1016/j.ajem.2008.09.019.Google Scholar
11.Gillman, LM, Blaivas, M, Lord, J, et al. Ultrasound confirmation of guidewire position may eliminate accidental arterial dilatation during central venous cannulation. Scand J Trauma Resusc Emerg Med 2010;18:39, doi:10.1186/1757-7241-18-39.CrossRefGoogle ScholarPubMed
12.Kendall, JL, Faragher, JP. Ultrasound-guided central venous access: a homemade phantom for simulation. CJEM 2007;9:371–3.CrossRefGoogle ScholarPubMed
13.Arndt, GA, Felton, T, Finucane, B, et al. Confirmation of internal jugular vein cannulation: the Finucane technique. Can J Anaesth 1993;40:1220–1, doi:10.1007/BF03009616.Google Scholar
14.Afonso, N, Amponsah, D, Yang, J, et al. Adding new tools to the black bag—introduction of ultrasound into the physical diagnosis course. J Gen Intern Med 2010;25:1248–52, doi:10.1007/s11606-010-1451-5.Google Scholar