title: Wireless Ultrasound Guidance for Femoral Venous Cannulation in Electrophysiology: Impact on Safety, Efficacy, and Procedural Delay.
abstract: BACKGROUND
  Ultrasound (US) guidance increases safety and efficacy in vascular cannulation and is considered the standard of care. However, barriers including workflow interference and the need to be assisted by a second operator limit its adoption in clinical routine. The use of wireless US (WUS) may overcome these barriers. The aim of this study was to assess the impact of a novel WUS probe during its initial implantation in an electrophysiology (EP) laboratory.
  
  
  METHODS
  Thirty-six patients requiring femoral venous cannulation for EP procedures were included in this single center, prospective, observational study, comparing WUS guidance with the anatomical landmark approach. The primary endpoint was time to successful cannulation. Secondary endpoints included rate of unsuccessful punctures, accidental arterial punctures, and workflow interference.
  
  
  RESULTS
  Compared with anatomical landmark approach, WUS guidance significantly reduced mean time to successful cannulation (87.3 ± 94.3 vs 238.1 ± 294.7 seconds, P < 0.01). Workflow interference was predominantly nonexistent or mild and decreased after the first three weeks of use. In addition, WUS guidance improved safety and efficacy, reducing the rate of accidental arterial punctures (0.02 ± 0.1 vs 0.25 ± 0.5 arterial punctures per cannulation, P < 0.05) and unsuccessful attempts (0.26 ± 0.8 vs 1.75 ± 2.1 attempts per cannulation, P < 0.01).
  
  
  CONCLUSIONS
  WUS guidance resulted in faster, safer, and more effective femoral venous cannulation than the anatomical landmark approach without adding significant workflow interference. The application of wireless technology in this setting contributed to overcoming some of the barriers preventing a more widespread clinical use of US guidance.
authors.affiliation: From the Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rodríguez Muñoz
authors.affiliation: From the Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Franco Díez
authors.affiliation: From the Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Moreno
authors.affiliation: From the Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lumia
authors.affiliation: From the Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Carbonell San Román
authors.affiliation: From the Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Segura De La Cal
authors.affiliation: From the Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Matía Francés
authors.affiliation: From the Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Hernández Madrid
authors.affiliation: From the Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Zamorano Gómez
mesh_terms: D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014159:Transducers / Q000009:adverse effects; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000295:instrumentation*; D057772:Vascular System Injuries / Q000209:etiology / Q000517:prevention & control; D059015:Wireless Technology / Q000295:instrumentation*; D057188:Workflow
keywords: cannulation; electrophysiology; femoral vein; wireless ultrasound