一项随机交叉研究,比较超声引导下模型外周静脉穿刺的横断面和纵向入路。

IF 3.6 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Critical Ultrasound Journal Pub Date : 2017-12-01 Epub Date: 2017-04-03 DOI:10.1186/s13089-017-0064-1
James Griffiths, Amadeus Carnegie, Richard Kendall, Rajeev Madan
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引用次数: 6

摘要

背景:超声引导下的外周静脉通路可能为外周静脉困难患者提供一种替代中央或骨内通路的方法。我们以虚拟模型的静脉穿刺为例,研究了超声新手在超声引导下学习接触外周静脉时,应该采用横断面还是纵向方法。这一结果将为该程序的结构化培训方法的发展提供信息。方法:对30名医学生进行随机对照试验。受试者接受35分钟的训练,然后在超声引导下尝试从训练模型的深静脉抽吸1 ml合成血液。受试者尝试了横断面和纵向两种方法。组1先采用横断面法,后采用纵向法。第2组先采用纵向法,后采用横断面法。我们测量了从第一次穿刺模型皮肤到吸液的时间,以及所需的尝试次数。受试者还报告了每种方法的难度等级。采用配对样本t检验进行统计分析。结果:横断面入路平均尝试次数为1.13次,纵向入路平均尝试次数为1.30次(p = 0.17)。横断面入路平均吸液时间为45.1 s,纵向入路平均吸液时间为52.8 s (p = 0.43)。横断面方法的平均困难分为3.97分,纵向方法的平均困难分为3.93分(p = 0.95)。结论:我们发现超声引导下的横断面和纵向入路在模型上的有效性没有显著差异。我们认为这两种方法都应该包括在超声引导下的周围血管通路教学中。为了确定哪一种方法在临床实践中是最好的,我们建议在未来对患者进行两种方法的测试。
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A randomised crossover study to compare the cross-sectional and longitudinal approaches to ultrasound-guided peripheral venepuncture in a model.

Background: Ultrasound-guided peripheral intravenous access may present an alternative to central or intraosseous access in patients with difficult peripheral veins. Using venepuncture of a phantom model as a proxy, we investigated whether novice ultrasound users should adopt a cross-sectional or longitudinal approach when learning to access peripheral veins under ultrasound guidance. This result would inform the development of a structured training method for this procedure.

Methods: We conducted a randomised controlled trial of 30 medical students. Subjects received 35 min of training, then attempted to aspirate 1 ml of synthetic blood from a deep vein in a training model under ultrasound guidance. Subjects attempted both the cross-sectional and longitudinal approaches. Group 1 used cross-sectional first, followed by longitudinal. Group 2 used longitudinal first, then cross-sectional. We measured the time from first puncture of the model's skin to aspiration of fluid, and the number of attempts required. Subjects also reported difficulty ratings for each approach. Paired sample t-tests were used for statistical analysis.

Results: The mean number of attempts was 1.13 using the cross-sectional approach, compared with 1.30 using the longitudinal approach (p = 0.17). Mean time to aspiration of fluid was 45.1 s using the cross-sectional approach and 52.8 s using the longitudinal approach (p = 0.43). The mean difficulty score out of 10 was 3.97 for the cross-sectional approach and 3.93 for the longitudinal approach (p = 0.95).

Conclusions: We found no significant difference in effectiveness between the cross-sectional and longitudinal approaches to ultrasound-guided venepuncture when performed on a model. We believe that both approaches should be included when teaching ultrasound-guided peripheral vascular access. To confirm which approach would be best in clinical practice, we advocate future testing of both approaches on patients.

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Critical Ultrasound Journal
Critical Ultrasound Journal RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
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审稿时长
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