Ultrasound-guided small vessel cannulation: long-axis approach is equivalent to short-axis in novice sonographers experienced with landmark-based cannulation

• Published in: The western journal of emergency medicine Vol. 15; no. 7; pp. 824 - 830
• Main Authors: Erickson, Catherine S, Liao, Michael M, Haukoos, Jason S, Douglass, Erica, DiGeronimo, Margaret, Christensen, Eric, Hopkins, Emily, Bender, Brooke, Kendall, John L
• Format: Journal Article
• Language: English
• Published: United States Department of Emergency Medicine, University of California, Irvine School of Medicine 01.11.2014
• Subjects: Catheterization, Peripheral - methods; Catheterization, Peripheral - nursing; Catheters, Indwelling; Clinical Competence; Emergency Medicine - education; Humans; Medical Errors - prevention & control; Phantoms, Imaging; Prospective Studies; Technology in Emergency Care; Time Factors; Ultrasonography, Interventional - nursing
• ISSN: 1936-900X; 1936-9018
• DOI: 10.5811/westjem.2014.9.22404

Our primary objective was to describe the time to vessel penetration and difficulty of long-axis and short-axis approaches for ultrasound-guided small vessel penetration in novice sonographers experienced with landmark-based small vessel penetration. This was a prospective, observational study of experienced certified emergency nurses attempting ultrasound-guided small vessel cannulation on a vascular access phantom. We conducted a standardized training, practice, and experiment session for each participant. Five long-axis and five short-axis approaches were attempted in alternating sequence. The primary outcome was time to vessel penetration. Secondary outcomes were number of skin penetrations and number of catheter redirections. We compared long-axis and short-axis approaches using multivariable regression adjusting for repeated measures, vessel depth, and vessel caliber. Each of 10 novice sonographers made 10 attempts for a total of 100 attempts. Median time to vessel penetration in the long-axis and short-axis was 11 (95% confidence interval [CI] 7-12) and 10 (95% CI 6-13) seconds, respectively. Skin penetrations and catheter redirections were equivalent and near optimal between approaches. The median caliber of cannulated vessels in the long-axis and short-axis was 4.6 (95% CI 4.1-5.5) and 5.6 (95% CI 5.1-6.2) millimeters, respectively. Both axes had equal success rates of 100% for all 50 attempts. In multivariable regression analysis, long-axis attempts were 32% (95% CI 11%-48%; p=0.009) faster than short-axis attempts. Novice sonographers, highly proficient with peripheral IV cannulation, can perform after instruction ultrasound-guided small vessel penetration successfully with similar time to vessel penetration in either the long-axis or short-axis approach on phantom models.