Incidence of Posterior Vessel Wall Puncture During Ultrasound‐guided Vessel Cannulation in a Simulated Model

• Published in: Academic emergency medicine Vol. 17; no. 10; pp. 1138 - 1141
• Main Authors: Moon, Cynthia H., Blehar, David, Shear, Michael A., Uyehara, Paradis, Gaspari, Romolo J., Arnold, Jeremy, Cukor, Jeffrey
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-10-2010; Wiley Subscription Services, Inc
• Subjects: Carotid Artery Injuries - diagnostic imaging; Carotid Artery Injuries - epidemiology; Carotid Artery Injuries - etiology; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - instrumentation; Clinical Competence; Cohort Studies; Confidence Intervals; Coronary vessels; critical care; Education, Medical, Graduate - methods; Emergency medical care; emergency medicine; Emergency Medicine - education; Female; Humans; Incidence; Internship and Residency; Intubation; Jugular Veins - diagnostic imaging; Jugular Veins - injuries; Male; Manikins; Models, Anatomic; patient simulation; Punctures; shock; Simulation; Studies; Ultrasonic imaging; ultrasonography; Ultrasonography, Interventional
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/j.1553-2712.2010.00869.x

Objectives:  The incidence of posterior vessel wall puncture (PVWP) during central line placement with possible subsequent injury to structures lying behind the vein is unknown. At times the internal jugular vein lies immediately anterior to the carotid artery rather than lateral to it, leading to potential arterial puncture should the needle pass through the vein completely. The objective of this study is to evaluate the incidence of PVWP during simulated ultrasound (US)‐guided vessel cannulation.
Methods:  Enrolled subjects were emergency medicine resident and attending physicians. Subjects performed US‐guided venous access on simulated blood vessels within gelatin‐based US phantoms. While blinded to the purpose of the study, each subject performed successful cannulation of the vessel on separate phantoms, with wire placement confirmed by expert review of a follow‐up US. Each phantom was subsequently deconstructed to manually inspect for PVWP.
Results:  Thirty‐five subjects with a range of experience in the technique participated, each performing both transverse and long‐axis approaches for a total of 70 cannulations. The overall incidence of PVWP was 34% (95% confidence interval [CI] = 22.9% to 45.1%).
Conclusions:  This study found a high incidence of inadvertent PVWP during simulated US‐guided vessel cannulation in this model.
ACADEMIC EMERGENCY MEDICINE 2010; 17:1138–1141 © 2010 by the Society for Academic Emergency Medicine