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      Homemade phantoms improve ultrasound-guided vein cannulation confidence and procedural performance on patients

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          ABSTRACT

          BACKGROUND:

          Ultrasound-guided vein cannulation is an essential skill in emergency medicine. Prohibitive costs of commercial ultrasound phantoms limit the ability to adequately train residents. We assess the clinical utility of homemade phantoms for medical education.

          METHODS:

          Eighteen emergency medicine residents each performed 10 ultrasound-guided IV attempts on patients, half of the attempts before and half after a training course using two homemade ultrasound phantoms with 14 total Penrose drains. We conducted a prospective feasibility study using pre- and post-training surveys comparing confidence and success rates of IV cannulation attempts on patients.

          RESULTS:

          Residents demonstrated an improvement in successful ultrasound-guided peripheral vein cannulations from an average of 47.8% during the first five attempts to 71.1% in the last five attempts. No benefit was noted from the first to the fifth attempts, nor from the six to the tenth attempts, suggesting minimal benefit from experience early on. Residents reported increased confidence in performing ultrasound-guided venous cannulation on patients, identifying the correct probe, adjusting gain and depth, visualizing veins in short and long axis, differentiating arteries from veins, and vein cannulation on a phantom model.

          CONCLUSION:

          Homemade ultrasound phantoms are cost effective, increase confidence, and improve emergency medicine residents’ ability to perform ultrasound-guided vein cannulation.

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          Most cited references26

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          Ultrasonic locating devices for central venous cannulation: meta-analysis.

          To assess the evidence for the clinical effectiveness of ultrasound guided central venous cannulation. 15 electronic bibliographic databases, covering biomedical, science, social science, health economics, and grey literature. Systematic review and meta-analysis of randomised controlled trials. Populations Patients scheduled for central venous access. INTERVENTION REVIEWED: Guidance using real time two dimensional ultrasonography or Doppler needles and probes compared with the anatomical landmark method of cannulation. Risk of failed catheter placement (primary outcome), risk of complications from placement, risk of failure on first attempt at placement, number of attempts to successful catheterisation, and time (seconds) to successful catheterisation. 18 trials (1646 participants) were identified. Compared with the landmark method, real time two dimensional ultrasound guidance for cannulating the internal jugular vein in adults was associated with a significantly lower failure rate both overall (relative risk 0.14, 95% confidence interval 0.06 to 0.33) and on the first attempt (0.59, 0.39 to 0.88). Limited evidence favoured two dimensional ultrasound guidance for subclavian vein and femoral vein procedures in adults (0.14, 0.04 to 0.57 and 0.29, 0.07 to 1.21, respectively). Three studies in infants confirmed a higher success rate with two dimensional ultrasonography for internal jugular procedures (0.15, 0.03 to 0.64). Doppler guided cannulation of the internal jugular vein in adults was more successful than the landmark method (0.39, 0.17 to 0.92), but the landmark method was more successful for subclavian vein procedures (1.48, 1.03 to 2.14). No significant difference was found between these techniques for cannulation of the internal jugular vein in infants. An indirect comparison of relative risks suggested that two dimensional ultrasonography would be more successful than Doppler guidance for subclavian vein procedures in adults (0.09, 0.02 to 0.38). Evidence supports the use of two dimensional ultrasonography for central venous cannulation.
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            Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on Central Venous Access.

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              Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature.

              To evaluate the effect of real-time ultrasound guidance using a regular or Doppler ultrasound technique for placement of central venous catheters. We searched for published and unpublished research using MEDLINE, citation review of relevant primary and review articles, conference abstracts, personal files, and contact with expert informants. From a pool of 208 randomized, controlled trials of venous and arterial catheter management, eight published randomized, controlled trials were identified. In duplicate, independently, we abstracted data on the population, intervention, outcome, and methodologic quality. Ultrasound guidance significantly decreases internal jugular and subclavian catheter placement failure (relative risk 0.32; 95% confidence interval 0.18 to 0.55), decreases complications during catheter placement (relative risk 0.22; 95% confidence interval 0.10 to 0.45), and decreases the need for multiple catheter placement attempts (relative risk 0.60; 95% confidence interval 0.45 to 0.79) when compared with the standard landmark placement technique. When used for vessel location and catheter placement real-time, ultrasound guidance or Doppler ultrasound guidance improves success rates and decreases the complications associated with internal jugular and subclavian venous catheter placement.
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                Author and article information

                Journal
                Ulus Travma Acil Cerrahi Derg
                Ulus Travma Acil Cerrahi Derg
                Turkish Journal of Trauma & Emergency Surgery
                Kare Publishing (Turkey )
                1306-696X
                1307-7945
                September 2022
                01 September 2022
                : 28
                : 9
                : 1312-1316
                Affiliations
                [1 ]Department of Emergency Medicine, Gaziantep University Faculty of Medicine, Gaziantep- Türkiye
                [2 ]Department of General Surgery, Beaumont Health, Royal Oak, MI- USA
                [3 ]St. George School of Medicine, Grenada- West Indies
                [4 ]Department of Emergency Medicine, Western Michigan University School of Medicine, Kalamazoo, MI- USA
                Author notes
                Address for correspondence: Mustafa Sabak, M.D. Gaziantep Üniversitesi Tıp Fakültesi, Acil Tıp Anabilim Dalı, 27310 Gaziantep, Türkiye Tel: +90 342 - 360 60 60 / 77130 E-mail: mustafasabak@ 123456hotmail.com
                Article
                TJTES-28-1312
                10.14744/tjtes.2022.74712
                10315958
                36043933
                59a63f9a-3f5e-46a3-bf9b-103210087566
                Copyright © 2022 Turkish Journal of Trauma and Emergency Surgery

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

                History
                : 26 March 2022
                : 23 July 2022
                Categories
                Original Article

                emergency,phantom,training,ultrasound,vein
                emergency, phantom, training, ultrasound, vein

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