Biplane Imaging Versus Standard Transverse Single-Plane Imaging for Ultrasound-Guided Peripheral Intravenous Access: A Prospective Controlled Crossover Trial
David Convissar, Edward A Bittner, Marvin G Chang, David Convissar, Edward A Bittner, Marvin G Chang
Abstract
Obtaining peripheral IV access in critically ill patients is often challenging especially for novice providers. The availability of biplane imaging for ultrasound guided peripheral access has the potential to improve successful venous cannulation compared with standard plane imaging.
Design: Single-center quasi-randomized (alternate allocation) crossover trial.
Setting: Surgical ICU at the Massachusetts General Hospital.
Subjects: Twenty surgical ICU nurses with no prior experience using ultrasound for peripheral IV were enrolled.
Interventions: All participants viewed instructional videos on single-plane and biplane imaging for peripheral IV insertion. The participants were then quasi-randomly assigned to use either single-plane or biplane imaging for peripheral IV insertion using a phantom model. The time to catheter completion, successful lumen cannulation, and attempts in which the needle was observed to go through the back wall of the vessel were recorded for each of the three attempts. The following day the participants repeated the peripheral IV insertion with the alternate imaging modality.
Measurements and main results: Biplane imaging compared with single-plane imaging was associated with a significantly greater overall success rate (78.3% ± 22.4% vs 41.7% ± 26%; p < 0.001), higher first-pass success rate (80% ± 41% vs 45% ± 51%; p = 0.015), faster cannulation times (27.8 ± 14.8 vs 36.6 ± 15.8 s; p = 0.003), and reduced frequency of backwall perforations (0.4 ± 0.7 vs 1.5 ± 0.8; p < 0.001).
Conclusions: This proof-of-principle study demonstrates that the biplane ultrasound imaging approach for vessel cannulation resulted in an overall faster, more successful, and safer peripheral IV access than the standard single-plane transverse approach when performed by novice ultrasound users.
Keywords: biplane imaging; clinical trial; critical care ultrasound; multiple plane imaging; point-of-care ultrasound; vascular access; x-plane imaging.
Conflict of interest statement
Dr. Convissar received a Butterfly iQ+ for evaluation, which was used in this study. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
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References
- Takashima M, Schults J, Mihala G, et al. . Complication and failures of central vascular access device in adult critical care settings. Crit Care Med. 2018; 46:1998–2009
- Gregg SC, Murthi SB, Sisley AC, et al. . Ultrasound-guided peripheral intravenous access in the intensive care unit. J Crit Care. 2010; 25:514–519
- Schmidt GA, Blaivas M, Conrad SA, et al. . Ultrasound-guided vascular access in critical illness. Intensive Care Med. 2019; 45:434–446
- Joing S, Strote S, Caroon L, et al. . Videos in clinical medicine. Ultrasound-guided peripheral i.v. placement. N Engl J Med. 2012; 366:e38.
- Stone MB, Moon C, Sutijono D, et al. . Needle tip visualization during ultrasound-guided vascular access: Short-axis vs long-axis approach. Am J Emerg Med. 2010; 28:343–347
- Lee JE, Kim MJ, Kwak KH. Posterior wall penetration of the internal jugular vein during central venous catheter insertion using real-time ultrasound: Two case reports. Medicine (Baltimore). 2020; 99:e22122.
- Seto AH, Abu-Fadel MS, Sparling JM, et al. . Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial). JACC Cardiovasc Interv. 2010; 3:751–758
- Stone M. Ultrasound Education: Biplane Imaging With Butterfly iQ+. 2020. Available at: . Accessed January 5, 2021
- Convissar D, Bittner EA, Chang MG. Biplane imaging using portable ultrasound devices for vascular access. Cureus. 2021; 13:e12561.
- Gokhroo RK, Ranwa BL, Kishor K, et al. . 3D Xplane echocardiographic technique for validation of mitral leaflet separation to assess severity of mitral stenosis. Echocardiography. 2016; 33:896–901
- McGhie JS, de Groot-de Laat L, Ren B, et al. . Transthoracic two-dimensional xPlane and three-dimensional echocardiographic analysis of the site of mitral valve prolapse. Int J Cardiovasc Imaging. 2015; 31:1553–1560
- Patrick Lindsay M, Gibson L, Bittner EA, et al. : Portable Point of Care Ultrasound (PPOCUS): An Emerging Technology for Improving Patient Safety. Anesthesia Patient Safety Foundation, 2020; 35. Available at: . Accessed January 5, 2021
- Maecken T, Grau T. Ultrasound imaging in vascular access. Crit Care Med. 2007; 35:S178–S185
- Kornbau C, Lee KC, Hughes GD, et al. . Central line complications. Int J Crit Illn Inj Sci. 2015; 5:170–178
- Palepu GB, Deven J, Subrahmanyam M, et al. . Impact of ultrasonography on central venous catheter insertion in intensive care. Indian J Radiol Imaging. 2009; 19:191–198
- Weinberg G, Rupnik B, Aggarwal N, et al. : Local Anesthetic Systemic Toxicity (LAST) Revisited: A Paradigm in Evolution. Anesthesisa Patient Safety Foundation Newsletter, 2020; 35. Available at: . Accessed January 5, 2021
- Parienti JJ, Mongardon N, Mégarbane B, et al. ; 3SITES Study Group. Intravascular complications of central venous catheterization by insertion site. N Engl J Med. 2015; 373:1220–1229
- Bell T, O’Grady NP. Prevention of central line-associated bloodstream infections. Infect Dis Clin North Am. 2017; 31:551–559
- Gibson LE, Low SA, Bittner EA, et al. . Ultrasound teleguidance to reduce healthcare worker exposure to coronavirus disease 2019. Crit Care Explor. 2020; 2:e0146.
- Gibson LE, Bittner EA, Chang MG. Handheld ultrasound devices: An emerging technology to reduce viral spread during the Covid-19 pandemic. Am J Infect Control. 2020; 48:968–969
Source: PubMed