Incidence of posterior vessel wall puncture during ultrasound-guided vessel cannulation in a simulated model.
OBJECTIVE
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.
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, USA. cindyhm@gmail.com
Cynthia H
CH
Moon
David
D
Blehar
Michael A
MA
Shear
Paradis
P
Uyehara
Romolo J
RJ
Gaspari
Jeremy
J
Arnold
Jeffrey
J
Cukor
D020212:Carotid Artery Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002983:Clinical Competence; D015331:Cohort Studies; D016001:Confidence Intervals; D004503:Education, Medical, Graduate / Q000379:methods; D004635:Emergency Medicine / Q000193:education; D005260:Female; D006801:Humans; D015994:Incidence; D007396:Internship and Residency; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008348:Manikins; D008953:Models, Anatomic; D011677:Punctures; D018084:Ultrasonography, Interventional