title: Randomized, prospective, observational simulation study comparing residents' needle-guided vs free-hand ultrasound techniques for central venous catheter access.
abstract: BACKGROUND
  Short-axis ultrasound-guided placement of central venous catheters (CVCs) is widely accepted as safe practice. However, utilizing the long-axis approach could further improve safety, as it allows for better visualization of the needle as it is advanced to the target vessel. However, the long-axis approach has not widely been used due to the technical difficulty. Recently, a new needle guidance device has become available to aid in the long-axis approach. We hypothesized that the use of a needle guide paired with the long-axis approach would facilitate puncture of the target vessel in a simulation model more effectively than similar free-hand techniques.
  
  
  METHODS
  A prospective observational study of anaesthesia residents using a CVC partial-task training device was conducted. Each resident performed needle puncture of the target vessel with three different techniques, assigned in random order: short-axis free hand (S-FH), long-axis free hand (L-FH), and long-axis needle guide (NG). To prove the effectiveness of the needle guide, the fraction of time the needle tip remained in view of the ultrasound was recorded and compared. Time required for completing the task and the number of needle sticks and needle re-directions were compared.
  
  
  RESULTS
  Thirty-three residents participated in the study. The fraction of time the needle tip remained in view of the ultrasound was significantly higher for the residents using NG [0.90 (0.10)] compared with residents using the other techniques [L-FH: 0.36 (0.20), S-FH: 0.18 (0.10)] (P<0.001). For each resident, the use of the needle guide in the long-axis approach increased visualization by 352 (276)% compared with that of L-FH and by 1028 (1804) % compared with that of S-FH. There was no significant difference in time required to puncture the target between NG [23.7 (14.6) s] and L-FH [30.3 (36.5) s] (P=0.21); however, both were significantly longer than S-FH [17.0 (13.3) s] (P=0.012). The numbers of needle sticks and of needle re-directions did not differ among the groups.
  
  
  CONCLUSIONS
  The needle guide device used in the long-axis approach improved the needle visualization compared with free-hand techniques. The needle guide used in the long-axis technique, however, did not facilitate puncture of the target vessel in this simulation model when compared with free-hand techniques.
authors.affiliation: Department of Anesthesiology,  University of Pittsburgh Medical Center, University of Pittsburgh, Liliane S. Kaufmann Building, 3471 Fifth Avenue Suite 910, Pittsburgh, PA 15213,  USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Ball
authors.forename: N E
authors.initials: NE
authors.lastname: Scouras
authors.forename: S
authors.initials: S
authors.lastname: Orebaugh
authors.forename: J
authors.initials: J
authors.lastname: Wilde
authors.forename: T
authors.initials: T
authors.lastname: Sakai
mesh_terms: D000776:Anesthesiology / Q000193:education*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002405:Catheterization, Central Venous / Q000379:methods*; D002408:Catheters, Indwelling; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008348:Manikins; D009333:Neck / Q000000981:diagnostic imaging; D009339:Needles; D011446:Prospective Studies; D018401:Sample Size; D012867:Skin / Q000293:injuries; D018084:Ultrasonography, Interventional / Q000379:methods*