Crum Todd, Adhikari Srikar, Lander Lina, Blaivas Michael
MS, Department of Emergency Medicine, University of Arizona Medical Center, PO Box 245057, Tucson, AZ 85724 USA.
J Ultrasound Med. 2014 Apr;33(4):623-8. doi: 10.7863/ultra.33.4.623.
The purpose of this study was to compare sonographically guided vascular access using standard and echo-enhanced needles in a variety of tissue-simulating vascular phantoms.
We conducted a prospective single-blinded observational study at an academic medical center. All participants performed real-time sonographically guided vascular access using both a standard 18-gauge needle and an echo-enhanced needle in both in-plane and out-of plane approaches on 3 different vascular access phantoms. The outcome measures included time to dye flash, first-pass success, visibility of the needle tip at the time of puncture, total number of attempts, number of redirections, and incidence of posterior wall penetration.
A total of 408 sonographically guided cannulations were performed by 34 participants. The time from needle stick to dye flash, first-pass success, and the total number of attempts were not significantly different between the two needles (P> .05). The tip of the needle was seen at the time of puncture in 79% of attempts with the standard needle (95% confidence interval [CI], 68%-86%) and in 86% of attempts with the echo-enhanced needle (95% CI, 76%-92%), although this difference was not significant (P= .103). The posterior wall was penetrated with the standard needle in 14% of attempts (95% CI, 9.6%-20%) and in 6% of attempts with the echo-enhanced needle (95% CI, 3.5%-11%), and the difference was significant (P < .02).
Echo-enhanced needles decreased the incidence of posterior wall punctures when compared to standard needles during sonographically guided vascular access. However, there were no significant differences in other sonographically guided vascular access metrics.
本研究旨在比较在各种组织模拟血管模型中，使用标准针和回声增强针在超声引导下进行血管穿刺的情况。
我们在一家学术医疗中心进行了一项前瞻性单盲观察性研究。所有参与者在3种不同的血管穿刺模型上，采用平面内和平面外进针方法，分别使用标准18号针和回声增强针进行实时超声引导下的血管穿刺。观察指标包括见回血时间、首次穿刺成功情况、穿刺时针尖的可视性、总穿刺次数、重新进针次数以及后壁穿刺发生率。
34名参与者共进行了408次超声引导下的插管操作。两种针在进针至见回血时间、首次穿刺成功情况和总穿刺次数方面无显著差异（P>0.05）。标准针穿刺时，79%的尝试中能看到针尖（95%置信区间[CI]，68%-86%）；回声增强针穿刺时，86%的尝试中能看到针尖（95%CI，76%-92%），尽管差异不显著（P=0.103）。标准针穿刺时后壁穿刺发生率为14%（95%CI，9.6%-20%），回声增强针穿刺时为6%（95%CI，3.5%-11%），差异有统计学意义（P<0.02）。
在超声引导下进行血管穿刺时，与标准针相比，回声增强针可降低后壁穿刺的发生率。然而，在其他超声引导下血管穿刺指标方面无显著差异。
