Boniface Keith S, LeSaux Maxine A, Mandoorah Sohaib, Patel Amit, Neander Kai L, Shokoohi Hamid
1 Department of Emergency Medicine, The George Washington University Medical Center, Washington, DC, USA.
2 Children's National Medical Center, The George Washington University Medical Center, Washington, DC, USA.
J Vasc Access. 2018 Sep;19(5):441-445. doi: 10.1177/1129729818758228. Epub 2018 Mar 12.
We evaluated the performance of an encapsulated guidewire designed for single-handed use with ultrasound-guided vascular access (SonoStik) with Seldinger technique, as compared with conventional intravenous catheters placed under ultrasound guidance in healthy subjects.
This is a prospective cohort trial in healthy subjects in which each subject served as his/her own control by having a SonoStik ultrasound intravenous cannulation placed in one arm and a conventionally placed, standard ultrasound intravenous cannulation placed in the other arm. The basilic vein was used because it is a non-visible and non-palpable vein. Emergency department technicians with extensive experience in ultrasound-guided intravenous access performed the procedures. The first-attempt success rate of intravenous-guided intravenous by using the SonoStik was compared to the standard ultrasound intravenous cannulation in adult healthy subjects. The secondary outcomes including time of procedure, technicians' and subjects' satisfaction, and complications were compared in both arms of the study.
A total of 24 volunteers with a mean age of 22.7 years were enrolled. Four emergency department technicians with extensive prior experience with ultrasound-guided intravenous access but with no prior experience using the SonoStik device performed the procedures. The first-attempt success was 83.3% with the use of SonoStik ultrasound intravenous cannulation compared to 95.8% with the standard ultrasound intravenous cannulation. There was a mean of 1.14 insertions per each successful placement in the SonoStik group compared to 1.04 insertions by using the standard catheters (mean differences = -0.1; 95% confidence interval = -0.6 to 0.4). There were no complications in either SonoStik or the standard ultrasound intravenous cannulation group. The mean time of insertion using SonoStik was slightly longer compared to standard ultrasound intravenous cannulation (143.3 vs 109.7 s).
This study demonstrated that emergency department technicians skilled in ultrasound-guided intravenous access could successfully place SonoStik 83.3% of the time in vessels that were unable to be palpated or visualized. Compared to standard ultrasound intravenous cannulation, the odds ratio of successful cannulation with SonoStik was 0.91 (95% confidence interval = 0.04-17.5). In all cases, the time required to successfully insert SonoStik was less than 4 min from tourniquet application to catheter advancement to hub, with a mean time of less than 2.5 min.
我们评估了一种专为单手使用超声引导血管穿刺（SonoStik）并采用塞丁格技术而设计的封装导丝的性能，将其与在健康受试者中超声引导下放置的传统静脉导管进行比较。
这是一项针对健康受试者的前瞻性队列试验，其中每个受试者通过在一只手臂上进行SonoStik超声静脉置管，在另一只手臂上进行传统放置的标准超声静脉置管，作为自身对照。选用贵要静脉是因为它是一条不可见且不可触及的静脉。由在超声引导静脉穿刺方面有丰富经验的急诊科技术人员进行操作。将成年健康受试者中使用SonoStik进行静脉引导静脉穿刺的首次尝试成功率与标准超声静脉置管进行比较。研究的两个组均比较了包括操作时间、技术人员和受试者满意度以及并发症等次要结果。
共招募了24名平均年龄为22.7岁的志愿者。四名在超声引导静脉穿刺方面有丰富经验但此前没有使用SonoStik设备经验的急诊科技术人员进行了操作。使用SonoStik超声静脉置管的首次尝试成功率为83.3%，而标准超声静脉置管的成功率为95.8%。SonoStik组每次成功置管的平均插入次数为1.14次，而使用标准导管为1.04次（平均差异=-0.1；95%置信区间=-0.6至0.4）。SonoStik组和标准超声静脉置管组均未出现并发症。与标准超声静脉置管相比，使用SonoStik的平均插入时间略长（143.3秒对109.7秒）。
本研究表明，熟练掌握超声引导静脉穿刺的急诊科技术人员在无法触及或可视化的血管中，使用SonoStik的成功置管率为83.3%。与标准超声静脉置管相比，使用SonoStik成功置管的优势比为0.91（95%置信区间=0.04-17.5）。在所有情况下，从应用止血带到导管推进至接头成功插入SonoStik所需的时间少于4分钟，平均时间少于2.5分钟。
