Training novice in ultrasound-guided venipuncture: A randomized controlled trial comparing out-of-plane needle-guided versus free-hand ultrasound techniques on a simulator

2020 ◽  
pp. 112972982096291
Author(s):  
Julien Raft ◽  
Danièle Dupanloup ◽  
Isabelle Clerc-Urmès ◽  
Cédric Baumann ◽  
Philippe Richebé ◽  
...  
Keyword(s):  
Learning Curve ◽  
Guide Wire ◽  
Controlled Trial ◽  
Randomized Study ◽  
Group Versus ◽  
Medical Procedure ◽  
Success Rates ◽  
Intravenous Access ◽  
Out Of Plane ◽  
Peripheral Intravenous Access

Background: Peripheral intravenous access is a common medical procedure, however, it can be difficult to perform in some patients. Success rates have proved greater with ultrasound guidance. Peripheral intravenous access using ultrasound requires specific training, especially for new ultrasound users. To overcome these difficulties, guidance devices on ultrasound probes are able to control the angle of penetration into tissues. We hypothesized that, and particularly for new ultrasound users, the use of a needle guide (NG) paired with the out-of-plane approach would facilitate puncture of a simulation model of vessel more effectively than similar free hand (FH) techniques. Methods: A prospective controlled randomized study was conducted of new ultrasound users using a guide wire introducer needle on gelatine phantom. After a 30-min lecture, one group performed the FH technique and the other group performed the NG technique both in an out-of-plane approach. The main criterion was the number of attempts before success of catheterization of this model of vessel. Results: Thirty-four nurse anesthetist students participated in the study. The number of attempts before success using the NG technique was significantly lower: 3.7 (±0.9) in the NG group versus 6.7 (±3.3) in the FH group ( p = 0.01). In the NG group, 100% of the participants achieved success after the sixth attempt. In the FH group, only 81.25% ( n = 13/16) reached success. Conclusion: NG technique has been proved to have a steeper learning curve compared with the FH technique. A study on a learning curve in clinical practice is needed to confirm these results.

Prospective, randomized controlled comparison of a flash-tip catheter and a traditional intravenous catheter in an urban emergency department

2018 ◽  
Vol 19 (4) ◽  
pp. 387-391 ◽  
Author(s):  
Siamak Moayedi ◽  
Michael Witting ◽  
Jon Mark Hirshon ◽  
Nicholas George ◽  
Alise Burke ◽  
...  
Keyword(s):  
Emergency Department ◽  
New Jersey ◽  
Controlled Trial ◽  
Success Rates ◽  
Blood Contamination ◽  
Becton Dickinson ◽  
Intravenous Access ◽  
Randomized Controlled ◽  
Peripheral Intravenous Access ◽  
Urban Emergency Department

Introduction: Safe and efficient intravenous access is paramount to the practice of emergency medicine. We compared the first-stick success rates and blood spillage of two peripheral intravenous catheters in a busy urban emergency department. Methods: In this randomized controlled trial, we assigned emergency department patients requiring peripheral intravenous access to use of either a flash-tip catheter (SurFlash Plus, Terumo Medical Corporation, Somerset, New Jersey) or a widely used control catheter (Insyte Autoguard; Becton, Dickinson and Company, Franklin Lakes, New Jersey). We compared frequency of first-stick success and blood contamination between catheters using chi-squared analysis. Results: We enrolled 600 patients, randomizing 309 to the flash-tip catheter and 291 to the control catheter. The first-stick success rate of each device was 79%. Blood contamination, defined as spillage of blood on the patient’s skin, bedding, or the inserter, occurred in 8 of 309 cases (2.6%) with the flash-tip catheter versus 92 of 291 cases (31.6%) for the control catheter. Conclusion: The two catheters tested in this study had comparable rates of first-stick success, but the flash-tip catheter was associated with significantly less blood contamination during insertion attempts.

scholarly journals Effectiveness of a phantom based learning model for medical students to achieve ultrasound-guided vascular access – a prospective study

2020 ◽  
Author(s):  
Philippe Jagoda ◽  
Jonas Stroeder ◽  
Arno Buecker ◽  
Joshua Gawlitza ◽  
Felix Frenzel ◽  
...  
Keyword(s):  
Medical Students ◽  
Learning Curve ◽  
Prospective Study ◽  
Vascular Access ◽  
Guide Wire ◽  
Practical Training ◽  
Success Rates ◽  
Ultrasound Guided ◽  
Access Methods ◽  
Phantom Model

Abstract Background: This prospective study evaluated the learning curve of inexperienced medical students in successfully establishing an ultrasound guided vessel access. Methods: Medical students (n=11) with no experience in ultrasound imaging were asked to perform an ultrasound- guided vessel access simulated by a gelatin based phantom model. Success rates and time of procedures were measured. Afterwards, every student underwent peer-teaching with both theoretical information given and practical training skills applied. Then, every student had to perform the very same procedure again and results were compared in a prior- to post-teaching scenario with paired t-test. Results: After theoretical and practical teaching lessons all students were able to successfully establish an ultrasound-guided vascular access. Prior to teaching sessions, only 4 out of 11 students managed to successfully perform the procedure. Success rate rose from 36.4% to 100%. Mean number of attempts were 2.5 +- 1.3 before, and 1.2 +- 0.4 after teaching (p < 0.05). Overall time to successful guide wire placement improved from 291+-8 seconds to 151+-37 seconds (p<0.05). Conclusions: In a gelatin based phantom model for ultrasound-guided vascular access medical students demonstrate significantly improved practical puncture skills and thus a steep learning curve.

Short- vs long-axis approach to ultrasound-guided peripheral intravenous access: a prospective randomized study

2011 ◽  
Vol 29 (9) ◽  
pp. 1194-1197 ◽  
Author(s):  
Simon A. Mahler ◽  
Hao Wang ◽  
Chadwick Lester ◽  
Janice Skinner ◽  
Thomas C. Arnold ◽  
...  
Keyword(s):  
Randomized Study ◽  
Prospective Randomized Study ◽  
Ultrasound Guided ◽  
Intravenous Access ◽  
Peripheral Intravenous Access

Efficacy of VeinViewer in pediatric peripheral intravenous access: a randomized controlled trial

2012 ◽  
Vol 171 (7) ◽  
pp. 1121-1125 ◽  
Author(s):  
Min Joung Kim ◽  
Joon Min Park ◽  
Nuga Rhee ◽  
Sang Mo Je ◽  
Seong Hee Hong ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Intravenous Access ◽  
Randomized Controlled ◽  
Peripheral Intravenous Access

Clinical use of electrical stimulation with the Veinplicity®device and its effect on the first attempt success rate of peripheral intravenous cannulation: A non-randomized clinical trial

2019 ◽  
Vol 20 (6) ◽  
pp. 621-629 ◽  
Author(s):  
Fredericus HJ van Loon ◽  
Freek JP Willekens ◽  
Marc P Buise ◽  
Hendrikus HM Korsten ◽  
Arthur RA Bouwman ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Success Rate ◽  
Intervention Group ◽  
Control Group ◽  
Success Rates ◽  
Moderate Risk ◽  
Intravenous Access ◽  
Group 2 ◽  
Peripheral Intravenous Access ◽  
Group 1

Background:Peripheral intravenous cannulation is one of the most frequently performed medical procedures. Venodilation, which can be achieved with different techniques, is an important factor for first attempt success. The objective of this study was to compare the first attempt success rates upon peripheral intravenous cannulation after applying a tourniquet, with venous dilation by electrical stimulation using the Veinplicity®device, or a combination of both techniques, in participants at moderate risk of a difficult peripheral intravenous access.Methods:This non-randomized clinical trial was carried out in adult patients divided into three parallel study groups, consisting of cannulation with a tourniquet (control group), cannulation after electrical stimulation without using a tourniquet (intervention group 1), and cannulation after applying electrical stimulation followed by the application of a tourniquet on the selected upper extremity (intervention group 2). The primary outcome was the first attempt success rate of peripheral intravenous catheter placement.Results:In all, 141 participants were included in this study, with an overall success rate of 86%. Success rates of 78%, 88%, and 92% were observed in the control group, intervention group 1, and intervention group 2, respectively ( p = 0.25, χ2 = 2.771, df = 2). A higher first attempt success rate was detected in participants in intervention group 2, when compared to the control group ( p = 0.04, χ2 = 4.63, df = 1).Conclusion:Increase in first attempt success was clinically relevant when electrical stimulation with the Veinplicity®device was combined with the application of a tourniquet in participants at moderate risk of a difficult peripheral intravenous access.

scholarly journals Impact of an Electronic App on Resident Responses to Simulated In-Flight Medical Emergencies: Randomized Controlled Trial

10.2196/10955 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e10955 ◽  
Author(s):  
Nur-Ain Nadir ◽  
Courtney J Cook ◽  
Raymond E Bertino ◽  
Marc D Squillante ◽  
Cameron Taylor ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Rating Scales ◽  
Controlled Trial ◽  
Randomized Study ◽  
Control Group ◽  
Global Rating ◽  
Shortness Of Breath ◽  
Care Providers ◽  
Success Rates ◽  
Medical Emergencies

Background Health care providers are often called to respond to in-flight medical emergencies, but lack familiarity with expected supplies, interventions, and ground medical control support. Objective The objective of this study was to determine whether a mobile phone app (airRx) improves responses to simulated in-flight medical emergencies. Methods This was a randomized study of volunteer, nonemergency resident physician participants who managed simulated in-flight medical emergencies with or without the app. Simulations took place in a mock-up cabin in the simulation center. Standardized participants played the patient, family member, and flight attendant roles. Live, nonblinded rating was used with occasional video review for data clarification. Participants participated in two simulated in-flight medical emergencies (shortness of breath and syncope) and were evaluated with checklists and global rating scales (GRS). Checklist item success rates, key critical action times, GRS, and pre-post simulation confidence in managing in-flight medical emergencies were compared. Results There were 29 participants in each arm (app vs control; N=58) of the study. Mean percentages of completed checklist items for the app versus control groups were mean 56.1 (SD 10.3) versus mean 49.4 (SD 7.4) for shortness of breath (P=.001) and mean 58 (SD 8.1) versus mean 49.8 (SD 7.0) for syncope (P<.001). The GRS improved with the app for the syncope case (mean 3.14, SD 0.89 versus control mean 2.6, SD 0.97; P=.003), but not the shortness of breath case (mean 2.90, SD 0.97 versus control mean 2.81, SD 0.80; P=.43). For timed checklist items, the app group contacted ground support faster for both cases, but the control group was faster to complete vitals and basic exam. Both groups indicated higher confidence in their postsimulation surveys, but the app group demonstrated a greater increase in this measure. Conclusions Use of the airRx app prompted some actions, but delayed others. Simulated performance and feedback suggest the app is a useful adjunct for managing in-flight medical emergencies.

scholarly journals A Chatbot Versus Physicians to Provide Information for Patients With Breast Cancer: Blind, Randomized Controlled Noninferiority Trial (Preprint)

2019 ◽  
Author(s):  
Jean-Emmanuel Bibault ◽  
Benjamin Chaix ◽  
Arthur Guillemassé ◽  
Sophie Cousin ◽  
Alexandre Escande ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Controlled Trial ◽  
Group Versus ◽  
Conversational Agent ◽  
Success Rates ◽  
Breast Cancer Patients ◽  
Conversational Agents ◽  
Randomized Controlled ◽  
Eortc Qlq

BACKGROUND The data regarding the use of conversational agents in oncology are scarce. OBJECTIVE The aim of this study was to verify whether an artificial conversational agent was able to provide answers to patients with breast cancer with a level of satisfaction similar to the answers given by a group of physicians. METHODS This study is a blind, noninferiority randomized controlled trial that compared the information given by the chatbot, Vik, with that given by a multidisciplinary group of physicians to patients with breast cancer. Patients were women with breast cancer in treatment or in remission. The European Organisation for Research and Treatment of Cancer Quality of Life Group information questionnaire (EORTC QLQ-INFO25) was adapted and used to compare the quality of the information provided to patients by the physician or the chatbot. The primary outcome was to show that the answers given by the Vik chatbot to common questions asked by patients with breast cancer about their therapy management are at least as satisfying as answers given by a multidisciplinary medical committee by comparing the success rate in each group (defined by a score above 3). The secondary objective was to compare the average scores obtained by the chatbot and physicians for each INFO25 item. RESULTS A total of 142 patients were included and randomized into two groups of 71. They were all female with a mean age of 42 years (SD 19). The success rates (as defined by a score &gt;3) was 69% (49/71) in the chatbot group versus 64% (46/71) in the physicians group. The binomial test showed the noninferiority (<italic>P</italic>&lt;.001) of the chatbot’s answers. CONCLUSIONS This is the first study that assessed an artificial conversational agent used to inform patients with cancer. The EORTC INFO25 scores from the chatbot were found to be noninferior to the scores of the physicians. Artificial conversational agents may save patients with minor health concerns from a visit to the doctor. This could allow clinicians to spend more time to treat patients who need a consultation the most. CLINICALTRIAL Clinicaltrials.gov NCT03556813, https://tinyurl.com/rgtlehq

scholarly journals A Chatbot Versus Physicians to Provide Information for Patients With Breast Cancer: Blind, Randomized Controlled Noninferiority Trial

10.2196/15787 ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. e15787 ◽  
Author(s):  
Jean-Emmanuel Bibault ◽  
Benjamin Chaix ◽  
Arthur Guillemassé ◽  
Sophie Cousin ◽  
Alexandre Escande ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Controlled Trial ◽  
Group Versus ◽  
Conversational Agent ◽  
Success Rates ◽  
Breast Cancer Patients ◽  
Conversational Agents ◽  
Randomized Controlled ◽  
Eortc Qlq

Background The data regarding the use of conversational agents in oncology are scarce. Objective The aim of this study was to verify whether an artificial conversational agent was able to provide answers to patients with breast cancer with a level of satisfaction similar to the answers given by a group of physicians. Methods This study is a blind, noninferiority randomized controlled trial that compared the information given by the chatbot, Vik, with that given by a multidisciplinary group of physicians to patients with breast cancer. Patients were women with breast cancer in treatment or in remission. The European Organisation for Research and Treatment of Cancer Quality of Life Group information questionnaire (EORTC QLQ-INFO25) was adapted and used to compare the quality of the information provided to patients by the physician or the chatbot. The primary outcome was to show that the answers given by the Vik chatbot to common questions asked by patients with breast cancer about their therapy management are at least as satisfying as answers given by a multidisciplinary medical committee by comparing the success rate in each group (defined by a score above 3). The secondary objective was to compare the average scores obtained by the chatbot and physicians for each INFO25 item. Results A total of 142 patients were included and randomized into two groups of 71. They were all female with a mean age of 42 years (SD 19). The success rates (as defined by a score >3) was 69% (49/71) in the chatbot group versus 64% (46/71) in the physicians group. The binomial test showed the noninferiority (P<.001) of the chatbot’s answers. Conclusions This is the first study that assessed an artificial conversational agent used to inform patients with cancer. The EORTC INFO25 scores from the chatbot were found to be noninferior to the scores of the physicians. Artificial conversational agents may save patients with minor health concerns from a visit to the doctor. This could allow clinicians to spend more time to treat patients who need a consultation the most. Trial Registration Clinicaltrials.gov NCT03556813, https://tinyurl.com/rgtlehq

Nurse-Performed Ultrasound-Guided Technique for Difficult Peripheral Intravenous Access in Critically Ill Patients: A Randomized Controlled Trial

2020 ◽  
Vol 25 (2) ◽  
pp. 34-39 ◽  
Author(s):  
Takuya Nishizawa ◽  
Takashi Matsumoto ◽  
Takafumi Todaka ◽  
Mikio Sasano ◽  
Hironobu Kitagawa ◽  
...  
Keyword(s):  
Success Rate ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Standard Of Care ◽  
Success Rates ◽  
Open Label ◽  
Icu Patients ◽  
Peripheral Intravenous Access ◽  
To Receive ◽  
Patient Enrollment

Highlights Abstract Purpose: The aim of this study was to compare nurse-performed ultrasound (US)-guided technique with standard of care (SOC) technique for difficult peripheral intravenous (PIV) access among patients admitted to the intensive care unit (ICU). Materials and Methods: This was a randomized, prospective, open-label single-site study. ICU nurses completed a standardized training program for US-guided PIV access placement before patient enrollment. ICU patients with difficult PIV access were randomized to either nurse-performed US-guided technique or SOC technique. Primary outcome was success rate on the first attempt. Secondary outcomes were success rate after 2 attempts and frequency of complications after successful placement. Results: A total of 60 patients were enrolled; 30 were randomized to receive US-guided technique, and 30 to SOC technique. Success rate on the first attempt was significantly higher with US-guided technique compared with SOC technique (70% vs 40%; P &lt; 0.05). Success rates after 2 attempts were 73.3% for US-guided technique and 46.6% for SOC technique (P = 0.065). Extravasation after successful placement occurred in 13.6% of patients with US-guided technique, and 28.6% of patients with SOC technique (P = 0.394). Conclusions: Among ICU patients with difficult PIV access, US-guided PIV access placement by nurses who underwent standardized training was more successful than placement with SOC technique.

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