title: Ultrasound guided Deep Vein cannulation: "Perpendicular Insertion Technique (PIT)", an edge over "Conventional Insertion Technique (CIT)".
abstract: BACKGROUND
  The use of ultrasound imaging before or during vascular cannulation greatly improves first-pass success and reduces complications, but this skill must then be combined with manual dexterity to perform the three dimensional (3D) procedure of placing a catheter into the deep veins while analyzing the 2D images. Hence this study is an attempt to still decrease the above mentioned limitation of guided deep vein cannulation by slight modification in the insertion technique.
  
  
  OBJECTIVE
  Aims to compare the ultrasound guided deep vein cannulation by conventional insertion technique(CIT) v/s ultrasound guided perpendicular insertion technique (PIT). Main comparison parameters here are number of attempts required, time taken for successful insertion, vessel counter puncture, arterial puncture and other known mechanical complications of deep venous cannulation.
  
  
  METHODS
  Prospective, non randomized cross sectional study, done over 200 patients in two arms. Data-analysed by epi2k and state-9 software.
  
  
  RESULTS
  Total number of insertions were 64 by CIT v/s 136 by the PIT. Mean of number of attempts required were 1.918 with the CIT v/s 1.106 for the PIT method. Mean of time of cannulation was 78.62 + 18 sec with CIT while it was 66.98 + 12 sec for PIT and this was statistically significant(P = 0.041). Incidence of vessel counter-puncture was much lower in PIT as compared to CIT (6.1 % v/s 16.2%). 5.9% cannulation done by CIT had arterial puncture v/s 0.8% with the PIT. Not a single episode of any other mechanical complications with either of the method.
  
  
  CONCLUSIONS
  USG guided perpendicular method is less time consuming, less number of attempts are required and there are less chances of arterial picture or vessel counter puncture.
authors.affiliation: Department of Emergency Medicine, Smt. NHL Municipal Medical College, Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India.
authors.forename: Bhavesh S
authors.initials: BS
authors.lastname: Jarwani
authors.affiliation: Department of Emergency Medicine, Smt. NHL Municipal Medical College, Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India.
authors.forename: Harsh
authors.initials: H
authors.lastname: Shah
authors.affiliation: Department of Emergency Medicine, Smt. NHL Municipal Medical College, Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India.
authors.forename: Aharnish
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Emergency Medicine, Smt. NHL Municipal Medical College, Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India.
authors.forename: Malhar
authors.initials: M
authors.lastname: Madariya
keywords: Attempts; Emergency Medicine Department; perpendicular method; ultrasound-guided