A WINning Technique: The Wire-in-Needle Feasibility Study.
BACKGROUND
Dynamic ultrasound guidance reduces complications associated with central venous catheter placement. However, successful central venous cannulation often remains challenging, particularly in hypotensive patients. The new wire-in-needle (WIN) technique can further increase periprocedural safety. Here, a needle is "preloaded" with a guidewire that is then advanced toward the tip of needle. The vein is then cannulated using long-axis ultrasound guidance.


OBJECTIVE
To evaluate the feasibility and safety profile of the WIN technique.


METHODS
Medical students, and resident and attending physicians participated in this study. After a brief lecture and practice session on the WIN technique, they underwent a skills assessment evaluating different aspects of both techniques. Participants then completed a survey assessing their prior experience regarding procedural ultrasound, and their assessment of the WIN technique.


RESULTS
Sixty clinicians participated. The assessment of both techniques revealed no significant differences in the number of needle redirections, cannulation attempts, number of arterial punctures, or overall dexterity with the procedure. The WIN technique was faster (45.9 vs. 61.5 s, p = 0.0005) than the traditional technique. More participants confirmed the accurate position of the guidewire in the vein (75% vs. 95%, p = 0.002). More than 90% of study participants met the predefined safety aspects of the WIN technique. Almost all participants reported that they plan on using the WIN technique in their clinical practice.


CONCLUSIONS
This study demonstrates that the WIN technique can be learned quickly and easily by clinicians with various levels of training. In this study, using manikins, it was as successful and safe as the traditional short-axis approach.
Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan.
Torben K
TK
Becker
Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan.
Joseph A
JA
Betcher
Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan.
Suzanne L
SL
Dooley-Hash
Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan.
Christopher H
CH
Fung
Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan.
Cody C
CC
Soyk
Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan.
David F
DF
Barton
Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan.
Nik R
NR
Theyyunni
D001291:Attitude of Health Personnel; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D007396:Internship and Residency; D007858:Learning; D008348:Manikins; D008505:Medical Staff, Hospital; D061646:Operative Time; D013337:Students, Medical; D018084:Ultrasonography, Interventional
Seldinger technique; central line; central venous catheter; procedural safety; ultrasound