title: Needle guides for venous catheter insertion during chest compressions: a crossover simulation trial.
abstract: OBJECTIVE
  Recent guidelines for cardiopulmonary resuscitation emphasize that all rescuers should minimize the interruption of chest compressions, even for intravenous access. We assessed the utility of needle guides during ultrasound-guided central venous catheterization (US-CVC) with chest compressions via simulation.
  
  
  METHODS
  Twenty-five anesthesiologists with more than 2years of experience performed US-CVC on a manikin with or without a needle guide and with or without chest compressions. Insertion success rate within 2minutes, insertion time, and subjective difficulty of venous puncture or guide wire insertion were measured.
  
  
  RESULTS
  In normal trials, 1 participant failed US-CVC without compressions, whereas 6 failed with compressions (P=.04). In needle-guided trials, all participants succeeded without compressions, whereas only 1 failed with compressions (P=.31). Insertion time was significantly longer with chest compressions in both normal and needle-guided trials (P<.001, each). Ultrasound-guided central venous catheterization insertion time in normal trials was significantly longer than in needle-guided trials with compressions (P<.001). Difficulty of operation on a visual analog scale for venous puncture or guide wire insertion was significantly higher in normal trials than in needle-guided trials with compressions.
  
  
  CONCLUSIONS
  Needle guides shortened the insertion time and improved the success rate of US-CVC during chest compressions by anesthesiologists in simulations.
authors.affiliation: Department of Anesthesiology, Matsushita Memorial Hospital, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Cho
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan. Electronic address: ane078@poh.osaka-med.ac.jp.
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Komasawa
authors.affiliation: Department of Anesthesiology, Hidaka General Hospital, Hidaka, Wakayama, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Haba
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Fujiwara
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Mihara
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Minami
mesh_terms: D002405:Catheterization, Central Venous / Q000295:instrumentation*; D018592:Cross-Over Studies; D006336:Heart Massage; D006801:Humans; D008348:Manikins; D009339:Needles; D013997:Time Factors; D018084:Ultrasonography, Interventional