title: Do echo-enhanced needles make a difference in sonographically guided vascular access?
abstract: OBJECTIVE
  The purpose of this study was to compare sonographically guided vascular access using standard and echo-enhanced needles in a variety of tissue-simulating vascular phantoms.
  
  
  METHODS
  We conducted a prospective single-blinded observational study at an academic medical center. All participants performed real-time sonographically guided vascular access using both a standard 18-gauge needle and an echo-enhanced needle in both in-plane and out-of plane approaches on 3 different vascular access phantoms. The outcome measures included time to dye flash, first-pass success, visibility of the needle tip at the time of puncture, total number of attempts, number of redirections, and incidence of posterior wall penetration.
  
  
  RESULTS
  A total of 408 sonographically guided cannulations were performed by 34 participants. The time from needle stick to dye flash, first-pass success, and the total number of attempts were not significantly different between the two needles (P> .05). The tip of the needle was seen at the time of puncture in 79% of attempts with the standard needle (95% confidence interval [CI], 68%-86%) and in 86% of attempts with the echo-enhanced needle (95% CI, 76%-92%), although this difference was not significant (P= .103). The posterior wall was penetrated with the standard needle in 14% of attempts (95% CI, 9.6%-20%) and in 6% of attempts with the echo-enhanced needle (95% CI, 3.5%-11%), and the difference was significant (P < .02).
  
  
  CONCLUSIONS
  Echo-enhanced needles decreased the incidence of posterior wall punctures when compared to standard needles during sonographically guided vascular access. However, there were no significant differences in other sonographically guided vascular access metrics.
authors.affiliation: MS, Department of Emergency Medicine, University of Arizona Medical Center, PO Box 245057, Tucson, AZ 85724 USA. sriadhikari@aol.com.
authors.forename: Todd
authors.initials: T
authors.lastname: Crum
authors.forename: Srikar
authors.initials: S
authors.lastname: Adhikari
authors.forename: Lina
authors.initials: L
authors.lastname: Lander
authors.forename: Michael
authors.initials: M
authors.lastname: Blaivas
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D002983:Clinical Competence; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation*; D015588:Observer Variation; D019047:Phantoms, Imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000295:instrumentation*; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D014680:Veins / Q000000981:diagnostic imaging* / Q000293:injuries*
keywords: echo-enhanced needle; emergency ultrasound; posterior wall puncture; vascular access