Blaivas Michael, Brannam Larry, Fernandez Eleanor
Department of Emergency Medicine, Medical College of Georgia, Augusta, GA 30912-4007, USA.
Acad Emerg Med. 2003 Dec;10(12):1307-11. doi: 10.1111/j.1553-2712.2003.tb00002.x.
To determine whether a short-axis (SA) or long-axis (LA) ultrasound (US) approach to guidance for line placement results in faster vascular access for novice US users. Also, to assess if there was a difference in the number of skin penetrations and needle redirections between the two guidance techniques.
This was a prospective, randomized, observational study of emergency medicine (EM) residents at a Level I trauma center. A gelatin dessert and dietary fiber supplement mixture, providing a realistic US image, were placed inside a synthetic arm skin that is used for training phlebotomists and contains a rubber vein filled with red fluid at a depth of 1.5 cm. After a 30-minute tutorial on US-guided vascular access, EM residents were randomized to one of two groups. Group one attempted SA first and then the LA. Group two tried LA first followed by the SA. Time from skin break to vein cannulation, number of skin breaks and needle redirections, and difficulty of access on a 10-point Likert scale as reported by residents were recorded. Statistical analysis included paired Student's t-test with 95% confidence intervals (95% CIs).
Seventeen EM residents participated. The mean times to vein cannulation in SA and LA were 2.36 minutes (95% CI = 1.15 to 3.58) and 5.02 minutes (95% CI = 2.90 to 7.13), respectively (p = 0.03). The mean numbers of skin breaks for SA and LA were 4.18 (95% CI = 1.18 to 7.17) and 5.76 (95% CI = 1.83 to 9.69), respectively (p = 0.49). The mean numbers of needle redirections in the SA and LA were 13.71 (95% CI = 4.51 to 22.89) and 18.17 (95% CI = 7.95 to 28.40), respectively (p = 0.51). The mean difficulty scores for SA and LA were 3.99 (95% CI = 2.42 to 5.67) and 5.86 (95% CI = 4.32 to 7.40), respectively (p = 0.17).
Novice US users obtain vascular access faster with an SA approach on an inanimate model.
确定在新手超声使用者中，短轴（SA）或长轴（LA）超声引导行血管穿刺置管是否能更快实现血管通路建立。同时，评估两种引导技术在皮肤穿刺次数和进针方向调整次数上是否存在差异。
这是一项针对一级创伤中心急诊医学（EM）住院医师的前瞻性、随机、观察性研究。将一种能提供逼真超声图像的明胶甜点和膳食纤维补充剂混合物置于用于培训采血人员的合成手臂皮肤内，该皮肤内有一条位于1.5厘米深处、充满红色液体的橡胶静脉。在接受30分钟的超声引导血管穿刺培训后，EM住院医师被随机分为两组。第一组先尝试SA法，然后尝试LA法。第二组先尝试LA法，随后尝试SA法。记录从皮肤穿刺到静脉置管的时间、皮肤穿刺次数和进针方向调整次数，以及住院医师报告的10分制Likert量表上的穿刺难度。统计分析采用配对t检验及95%置信区间（95%CI）。
17名EM住院医师参与研究。SA法和LA法静脉置管的平均时间分别为2.36分钟（95%CI = 1.15至3.58）和5.02分钟（95%CI = 2.90至7.13）（p = 0.03）。SA法和LA法的平均皮肤穿刺次数分别为4.18次（95%CI = 1.18至7.17）和5.76次（95%CI = 1.83至9.69）（p = 0.49）。SA法和LA法的平均进针方向调整次数分别为13.71次（95%CI = 4.51至22.89）和18.17次（95%CI = 7.95至28.40）（p = 0.51）。SA法和LA法的平均难度评分分别为3.99分（95%CI = 2.42至5.67）和5.86分（95%CI = 4.32至7.40）（p = 0.17）。
在无生命模型上，新手超声使用者采用SA法能更快实现血管通路建立。
