A Crossover Study Comparing In-Plane and Out-of-Plane Approaches for Simulated Ultrasound-Guided Central Venous Cannulation on Phantom Models by Anaesthesiology Trainees
Two Approaches of Simulated Central Vein Cannulation
Abstract
This prospective crossover study compared the incidence of posterior vessel wall puncture between two approaches during ultrasound-guided simulated central venous cannulation by anaesthesiology trainees. Each phantom model, simulating a central vein and artery, was cannulated by 37 anaesthesiology trainees under ultrasound-guidance using the in-plane approach (IPA) and out-of-plane approach (OPA). Total procedural time and the time taken from starting image scanning until commencing puncture, was recorded. The number of attempts required to achieve successful venous cannulation was noted. Finally, the models were examined for posterior venous wall and arterial puncture. Total procedural time was shorter with the OPA (26.5 vs 50.3 seconds, p=0.001). The time taken from starting image scanning until commencing puncture was shorter for the OPA (2.2 vs 12.3 seconds, p<0.0001). The IPA resulted in significantly more attempts for cannulation. Twenty and eleven participants were successful within the first pass using the OPA and IPA, respectively (p=0.034). There was no difference in the incidence of posterior vessel wall puncture between these two techniques. The OPA resulted in less arterial puncture compared to the IPA (2 vs 9, p=0.022). The incidence of posterior vessel wall puncture between the IPA and OPA during ultrasound-guided simulated central venous cannulation by anaesthesiology trainees was comparable.
Keywords :
in-plane,
out-of-plane,
simulation,
trainee,
ultrasound-guided cannulation,
Abstrak
Kajian bersilang kumpulan ini dijalankan untuk membandingkan insiden penembusan dinding belakang vena fantom di antara teknik ‘in-plane’ (IPA) dan ‘out-of-plane’ (OPA) semasa pemasangan kateter vena pusat dengan panduan ultrasound di kalangan doktor pelatih bius. Model fantom sebagai model simulasi vena dan arteri pusat dicucuk oleh 37 orang doktor pelatih bius menggunakan kedua-dua teknik tersebut. Jumlah keseluruhan masa prosedur dan masa yang diambil dari permulaan pengimbasan imej sehingga permulaan penusukan jarum dicatat. Bilangan nombor percubaan sehingga vena berjaya ditusuk juga dikira. Akhirnya, semua model diperiksa untuk kejadian penembusan dinding belakang vena dan penembusan arteri. Jumlah kesuluruhan masa prosedur adalah lebih singkat untuk teknik OPA (26.5 vs 50.3 saat, p=0.001). Masa yang diambil dari permulaan pengimbasan imej sehingga permulaan pencucukan jarum adalah lebih singkat untuk teknik OPA (2.2 vs 12.3 saat, p<0.0001). Teknik IPA memerlukan percubaan penembusan lebih banyak yang ketara. Dua puluh dan sebelas peserta berjaya dalam percubaan pertama untuk teknik-teknik OPA dan IPA, masing-masing (p=0.034). Tiada perbezaan wujud dalam kejadian penembusan dinding belakang vena di antara kedua-dua teknik. Teknik OPA melibatkan kurang penembusan arteri berbanding dengan teknik IPA (2 vs 9, p=0.022). Kejadian penembusan dinding belakang vena pusat semasa panduan ultrasound dengan menggunakan teknik IPA dan OPA di kalangan doktor pelatih bius adalah setara.
Kata Kunci :
pelatih,
penembusan salur darah bawah panduan ultrasound,
simulasi,
“in-plane”,
“out-of-plane”,
Correspondance Address
Dr. Muhammad Maaya. Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-9145 7359 Email: muhammad@ppukm.ukm.edu.my/ mm0427@gmail.com
