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Nobuaki Shime - One of the best experts on this subject based on the ideXlab platform.

  • long axis in plane approach versus short axis out of plane approach for ultrasound guided Central Venous Catheterization in pediatric patients a randomized controlled trial
    Pediatric Critical Care Medicine, 2020
    Co-Authors: Jun Takeshita, Kazuya Tachibana, Yasufumi Nakajima, Gaku Nagai, Ai Fujiwara, Hirofumi Hamaba, Hideki Matsuura, Tomonori Yamashita, Nobuaki Shime
    Abstract:

    Objectives The aim of this study was to compare the occurrence of posterior wall puncture between the long-axis in-plane and the short-axis out-of-plane approaches in a randomized controlled trial of pediatric patients who underwent cardiovascular surgery under general anesthesia. Design Prospective randomized controlled trial. Setting Operating room of Osaka Women's and Children's Hospital. Patients Pediatric patients less than 5 years old who underwent cardiovascular surgery. Interventions Ultrasound-guided Central Venous Catheterization using the long-axis in-plane approach and short-axis out-of-plane approach. Measurements and main results The occurrence of posterior wall puncture was compared between the long-axis in-plane and short-axis out-of-plane approaches for ultrasound-guided Central Venous Catheterization. Patients were randomly allocated to a long-axis group or a short-axis group and underwent ultrasound-guided Central Venous Catheterization in the internal jugular vein using either the long-axis in-plane approach (long-axis group) or the short-axis out-of-plane approach (short-axis group). After exclusion, 97 patients were allocated to the long-axis (n = 49) or short-axis (n = 48) groups. Posterior wall puncture rates were 8.2% (4/49) and 39.6% (19/48) in the long-axis and short-axis groups, respectively (relative risk, 0.21; 95% CI, 0.076-0.56; p = 0.0003). First attempt success rates were 67.3% (33/49) and 64.6% (31/48) in the long-axis and short-axis groups, respectively (relative risk, 1.04; 95% CI, 0.78-1.39; p = 0.77). Overall success rates within 20 minutes were 93.9% (46/49) and 93.8% (45/48) in the long-axis and short-axis groups, respectively (relative risk, 0.99; 95% CI, 0.90-1.11; p = 0.98). Conclusions The long-axis in-plane approach for ultrasound-guided Central Venous Catheterization is a useful technique for avoiding posterior wall puncture in pediatric patients, compared with the short-axis out-of-plane approach.

  • combined approach versus 2 conventional approaches in ultrasound guided Central Venous Catheterization a randomized controlled trial
    Journal of Cardiothoracic and Vascular Anesthesia, 2019
    Co-Authors: Jun Takeshita, Kei Nishiyama, Atsushi Fukumoto, Nobuaki Shime
    Abstract:

    Objective The authors compared the occurrence of posterior wall puncture using the short-axis out-of-plane and long-axis in-plane approaches with that using the combined short-axis-and-long-axis approach that the authors previously showed to be effective in observational and manikin studies. Design Randomized controlled study. Setting Single tertiary institution. Participants One hundred twenty patients who underwent cardiac or vascular surgery under general anesthesia. Interventions The patients were divided randomly into combined short-axis-and-long-axis (n = 40), short-axis out-of-plane (SA-OOP) (n = 40), and long-axis in-plane (LA-IP) (n = 40) groups and received ultrasound-guided Central Venous Catheterization at the right internal jugular vein. Measurements and Main Results Successful guidewire insertion without posterior wall puncture was performed in 40 patients (100%) in the combined short-axis-and-long-axis approach group, 28 (70%) in the short-axis out-of-plane approach group, and 38 (95%) in the LA-IP approach group (combined short-axis-and-long-axis v SA-OOP, p = 0.0002 [relative risk = 1.43; 95% CI: 1.17-1.75]; combined short-axis-and-long-axis v LA-IP, p = 0.49 [relative risk = 1.05; 95% CI: 0.98-1.13]). Procedure durations were 28.5 (24.1-36.4) seconds in the combined short-axis-and-long-axis group, 31.7 (24.4-40.6) seconds in the SA-OOP group, and 24.3 (20.8-32.1) seconds in the long-axis in-plane group (combined short-axis-and-long-axis v SA-OOP, p = 0.53; combined short-axis-and-long-axis v LA-IP, p = 0.044). Conclusion The combined short-axis-and-long-axis approach for ultrasound-guided Central Venous Catheterization had a lower posterior wall puncture rate than the SA-OOP approach, but there was no significant difference with the long-axis in-plane approach.

  • comparing combined short axis and long axis ultrasound guided Central Venous Catheterization with conventional short axis out of plane approaches
    Journal of Cardiothoracic and Vascular Anesthesia, 2019
    Co-Authors: Jun Takeshita, Kei Nishiyama, Atsushi Fukumoto, Nobuaki Shime
    Abstract:

    Objective Visualizing the needle tip using the short-axis out-of-plane (SA-OOP) ultrasound-guided Central Venous Catheterization approach is difficult and results in posterior wall puncture (PWP). To improve needle tip visualization in the long-axis view, combining the SA-OOP and the long-axis in-plane approaches has been suggested. The authors, who previously reported on the utility of this technique using a manikin model, examined the feasibility of this novel method (referred to as the combined short-axis and long-axis [CSLA] approach) and compared the CSLA approach with the SA-OOP approach in humans for the present study. Design Prospective observational study. Setting Single institution, Rakuwakai Otowa Hospital. Participants Patients undergoing cardiac or vascular surgeries. Interventions The CSLA and SA-OOP approaches were used for ultrasound-guided right jugular Venous puncture. The puncturing procedures were determined arbitrarily preoperatively without consideration of the patient's neck anatomy and were based on the operator's preference without randomization. Measurements and Main Results The study comprised 100 patients. Successful guidewire insertion without PWP was performed in 48 patients (96%) in the CSLA approach group and 33 (66%) in the SA-OOP approach group; the rate was significantly higher in the CSLA approach group (p = 0.0001). The procedural durations were 27.5 (range 17.0-122.0) seconds in the CSLA approach group and 25.0 (range 15.0-158.0) seconds in the SA-OOP approach group (p = 0.19). Conclusions This study showed that the CSLA approach to ultrasound-guided Central Venous Catheterization might help prevent PWP.

  • combined short and long axis ultrasound guided Central Venous Catheterization is superior to conventional techniques a cross over randomized controlled manikin trial
    PLOS ONE, 2017
    Co-Authors: Jun Takeshita, Kei Nishiyama, Satoru Beppu, Nozomu Sasahashi, Nobuaki Shime
    Abstract:

    Objectives Visualizing the needle tip using the short-axis (SA) ultrasound-guided Central Venous Catheterization approach can be challenging. It has been suggested to start the process with the SA approach and then switch to the long-axis (LA); however, to our knowledge, this combination has not been evaluated. We compared the combined short- and long-axis (SLA) approach with the SA approach in a manikin study. Methods We performed a prospective randomized controlled cross-over study in an urban emergency department and intensive care unit. Resident physicians in post-graduate years 1–2 performed a simulated ultrasound-guided internal jugular vein puncture using the SA and SLA approaches on manikins. Twenty resident physicians were randomly assigned to two equal groups: (1) one group performed punctures using the SA approach followed by SLA; and (2) the other performed the same procedures in the opposite order. We compared the success rate and procedure duration for the two approaches. Procedural success was defined as insertion of the guide-wire into the vein while visualizing the needle tip at the time of anterior wall puncture, without penetrating the posterior wall. Results Six resident physicians (30%) performed both approaches successfully, while 12 (60%) performed the SLA approach, but not the SA, successfully. Those who performed the SA approach successfully also succeeded with the SLA approach. Two resident physicians (10%) failed to perform both approaches. The SLA approach had a significantly higher success rate than the SA approach (P < 0.001). The median (interquartile range) procedure duration was 59.5 [46.0–88.5] seconds and 45.0 [37.5–84.0] seconds for the SLA and SA approaches, respectively. The difference of the duration between the two procedures was 15.5 [0–28.5] seconds. There was no significant difference in duration between the two approaches (P = 0.12). Conclusions Using the SLA approach significantly improved the success rate of internal jugular vein puncture performed by novice physicians on a manikin model, without increasing procedural duration. Further clinical trials are warranted to confirm the procedure’s utility in actual patients. Trial registration UMIN Clinical Trials Registry UMIN000026199

  • ultrasound imaging reduces failure rates of percutaneous Central Venous Catheterization in children
    Pediatric Critical Care Medicine, 2015
    Co-Authors: Nobuaki Shime, Koji Hosokawa, Graeme Maclaren
    Abstract:

    Objective: Ultrasound imaging has been shown to be beneficial for percutaneous Central Venous cannulation in systematic reviews of randomized controlled trials in adult patients, but not in pediatrics. The aim of this updated review was to determine whether percutaneous Central Venous Catheterization with the aid of ultrasound reduces cannulation failure in children. Data Sources: PubMed was searched using the terms: ultrasound, Catheterization, Central vein (including internal jugular and femoral veins), and pediatrics. Study Selection: Both nonrandomized comparative studies and randomized controlled trials were eligible for inclusion if they assessed the rate of cannulation failure using real-time, dynamic ultrasound guidance, ultrasound-Assisted vein prelocation, and/or anatomic landmark technique. Data Extraction: Five nonrandomized studies and nine randomized controlled trials were included. The rates of cannulation failure and arterial puncture were retrieved. Data Synthesis: Random-effects meta-Analysis was applied. Conclusions: The meta-Analysis of five nonrandomized studies showed that the rate of cannulation failure was significantly lower with real-time ultrasound guidance than anatomic landmark technique (odds ratio, 0.44 [95% CI, 0.27-0.72]; p = 0.001). The combination of nine randomized controlled trials also showed lower failure rates with either the real-time ultrasound guidance or the prelocation technique over the landmark technique (odds ratio, 0.22 [95% CI, 0.07-0.69]; p = 0.0003) and fewer arterial punctures in the ultrasound group (odds ratio, 0.31 [95% CI, 0.09-1.08]; p = 0.07). However, seven out of nine studies were assessed as having high risk of bias. Since the lower cannulation failure and less frequent chance of arterial puncture with ultrasound were predominantly shown in studies at high risk of bias, further definitive and adequately powered studies with clear outcomes are needed.

Rodrigo Montana - One of the best experts on this subject based on the ideXlab platform.

  • assessment of Central Venous Catheterization in a simulated model using a motion tracking device an experimental validation study
    Annals of Surgical Innovation and Research, 2016
    Co-Authors: Julian Varas, Pablo Achurra, Felipe Leon, Richard Castillo, Natalia De La Fuente, Rajesh Aggarwal, Leticia Clede, M P Bravo, Marcia Corvetto, Rodrigo Montana
    Abstract:

    Background Central Venous Catheterization (CVC) is a basic requirement for many medical specialties. Simulated training in CVC may allow the acquisition of this competency but few reports have established a valid methodology for learning and acquiring procedural skills for CVC. This study aims to validate the use of a tracking motion device, the imperial college surgical assessment device (ICSAD), by comparing it with validated global rating scales (GRS) to measure CVC performance in a simulated torso.

  • Assessment of Central Venous Catheterization in a simulated model using a motion-tracking device: an experimental validation study
    Annals of Surgical Innovation and Research, 2016
    Co-Authors: Julian Varas, Pablo Achurra, Felipe Leon, Richard Castillo, Natalia De La Fuente, Rajesh Aggarwal, Leticia Clede, M P Bravo, Marcia Corvetto, Rodrigo Montana
    Abstract:

    Background Central Venous Catheterization (CVC) is a basic requirement for many medical specialties. Simulated training in CVC may allow the acquisition of this competency but few reports have established a valid methodology for learning and acquiring procedural skills for CVC. This study aims to validate the use of a tracking motion device, the imperial college surgical assessment device (ICSAD), by comparing it with validated global rating scales (GRS) to measure CVC performance in a simulated torso. Methods Senior year medical students, first and last year residents (PGY1, LYR), and expert anesthesiologists performed a jugular CVC assessment in a simulated model (Laerdal IV Torso). A validated GRS for objective assessment of technical skills and motion analysis by ICSAD was used. Statistical analysis was performed through Mann–Whitney and Kruskal–Wallis tests for construct validity and Spearman correlation coefficients between the ICSAD and GRS scores for concurrent validity between both. Results 32 subjects were recruited (10 medical students, 8 PGY1, 8 LYR and 8 experts). Total path length measured with ICSAD and GRS scores were significantly different between all groups, except for LYR compared to experts (p = 0.664 for GRS and p = 0.72 for ICSAD). Regarding jugular CVC procedural time, LYR and experts were faster than PGY1 and MS (p 

Irene W Y - One of the best experts on this subject based on the ideXlab platform.

  • an experimental study on the impact of clinical interruptions on simulated trainee performances of Central Venous Catheterization
    Advances in Simulation, 2017
    Co-Authors: Jessica Jones, Jeff K Caird, Matthew Wilkins, Alyshah Kaba, Adam Cheng, Irene W Y
    Abstract:

    Interruptions are common in the healthcare setting. This experimental study compares the effects of interruptions on simulated performances of Central Venous Catheterization during a highly versus minimally complex portion of the task. Twenty-six residents were assigned to interruptions during tasks that are (1) highly complex: establishing ultrasound-guided Venous access (experimental group, n = 15) or (2) minimally complex: skin cleansing (control group, n = 11). Primary outcomes were (a) performance scores at three time points measured with a validated checklist, (b) time spent on the respective tasks, and (c) number of attempts to establish Venous access. Repeated measure analyses of variances of performance scores over time indicated no main effect of time or group. The interaction between time and group was significant: F (2, 44) = 4.28, p = 0.02, and partial eta2 = 0.16, indicating a large effect size. The experimental group scores decreased steadily over time, while the control group scores increased with time. The experimental group required longer to access the vein (148 s; interquartile range (IQR) 60 to 361 vs. 44 s; IQR 27 to 133 s; p = 0.034). Median number of attempts to establish Venous access was higher in the experimental group (2, IQR 1–7 vs. 1, IQR 1–2; p = 0.03). Interruptions during a highly complex task resulted in a consistent decrement in performance scores, longer time required to perform the task, and a higher number of Venous access attempts than interruptions during a minimally complex tasks. We recommend avoiding interrupting trainees performing bedside procedures.

  • part versus whole a randomized trial of Central Venous Catheterization education
    Advances in Health Sciences Education, 2015
    Co-Authors: Angela Chan, Kevin Mclaughlin, Sunita K Singh, Adam Dubrowski, Daniel Pratt, Nadia Zalunardo, Parvarthy Nair, Irene W Y
    Abstract:

    Central Venous Catheterization (CVC) is a complex but commonly performed procedure. How best to teach this complex skill has not been clearly delineated. We conducted a randomized trial of the effects of two types of teaching of CVC on skill acquisition and retention. We randomly assigned novice internal medicine residents to learning CVC in-part or in-whole. The part-group was taught the first part of the procedure, followed by practice, followed by being taught the second and final portion of the procedure, and followed by practice. The whole-group was taught the procedure in its entirety, followed by practice. Teaching and practice time for both groups was otherwise held constant. Performances were assessed at baseline, post-training, and at 1 month. The primary outcome was skill retention at 1-month, rated by using a global rating scale and a 22-item checklist, and defined as the score increase between 1-month and baseline. Skill acquisition is defined as the score increase post-training and baseline. Raters were blinded to the participants’ identity, group assignment, and time point. Participants in the part-task group outperformed the whole-task group in skill acquisition (2.2 ± 0.8 vs 1.3 ± 1.0; g = 1.01; p = 0.04) and in skill retention (1.5 ± 0.7 vs 0.5 ± 0.8; g = 1.39; p = 0.006) using the global rating scale. Scores rated by the checklist were not significantly different (52.0 ± 25.3 vs 43.5 ± 23.4; g = 0.33; p = 0.47 for skill acquisition; and 48.5 ± 34.9 vs 41.1 ± 20.4; g = 0.35; p = 0.44 for skill retention). For teaching ultrasound-guided CVC to novice learners, teaching in part is preferable than teaching in whole.

  • measuring competence in Central Venous Catheterization a systematic review
    SpringerPlus, 2014
    Co-Authors: Irene W Y, Nishan Sharma, Mary Brindle, Jeff K Caird, Kevin Mclaughlin
    Abstract:

    Objectives Central Venous Catheterization is a complex procedural skill. This study evaluates existing published tools on this procedure and systematically summarizes key competencies for the assessment of this technical skill.

  • improving internal medicine residents performance knowledge and confidence in Central Venous Catheterization using simulators
    Journal of Hospital Medicine, 2009
    Co-Authors: Scott J Millington, Irene W Y, Roger Y Wong, Barry O Kassen, James M Roberts
    Abstract:

    BACKGROUND: Efficacy of simulators in teaching Central Venous Catheterization (CVC) in an internal medicine residency program is unknown. OBJECTIVE: To determine whether or not learning CVC on simulators is associated with improvement in performance of CVC, knowledge about the procedure, and self-reported confidence. METHODS: All consenting first-year internal medicine residents who completed training in CVC on simulators were included. Participants were evaluated pre- and post-training by video-recorded CVC insertion and multiple-choice knowledge assessments. Procedural technique was rated in a blinded fashion by two independent adjudicators. Knowledge retention and self-reported confidence were reassessed at 18 months. MEASUREMENTS: Primary outcome of CVC performance was assessed based on global rating score (minimum 1, maximum 5). Secondary measures include checklist score (out of ten), knowledge score and self-reported confidence (6-point Likert scale ranging from “none” to “complete”). RESULTS: Median global rating scores in 30 participants increased from 3.5 (IQR = 3-4) to 4.5 (IQR = 4-4.5) (P < 0.001). Checklist score increased from 9 (IQR = 6-9.5) to 9.5 (IQR = 9-9.5) (P < 0.001). Knowledge score increased from 65.7 ± 11.9% to 81.2 ± 10.7% (P < 0.001). Confidence increased from 3 (“moderate”, IQR = 2-3) to 4 (“good”, IQR=3-4) (P < 0.001). Sixteen participants completed the retention tests. Improvement in knowledge score and confidence at 18 months was retained compared with baseline (P = 0.002 and P < 0.0001 respectively). CONCLUSIONS: Use of simulators in teaching CVC in an internal medicine residency program results in improved procedural performance, knowledge, and self-reported confidence. Improvement in knowledge and confidence was retained at 18 months. Journal of Hospital Medicine 2009;4:410–416. © 2009 Society of Hospital Medicine.

Ken Tegtmeyer - One of the best experts on this subject based on the ideXlab platform.

  • Central Venous Catheterization subclavian vein
    The New England Journal of Medicine, 2007
    Co-Authors: Dana Braner, Susanna Lai, Scott Eman, Ken Tegtmeyer
    Abstract:

    Most of the necessary equipment can be found in commercially available kits. These kits typically include skin-preparation solution and a drape, lidocaine, sterile gauze, non-Luer lock syringes, a scalpel, a catheter, a dilator, several needles, and a guidewire. You will also need a sterile gown, sterile gloves, a surgical cap, a mask with a face shield, and drapes to cover the patient’s entire body. Flush solution is also not commonly found in the kits. Determine the catheter length and depth of placement by referring to the patient’s external landmarks. The tip of the catheter should reach the junction of the superior vena cava and the right atrium. Common catheters used range from 4-French catheters for infants to 7-French catheters for adults; 11.5-French catheters may be used for dialysis. Because the risk of infection increases with an increasing number of lumens, a catheter with the fewest number of lumens required should be used. p r E p a r a t I o n

A Pirat - One of the best experts on this subject based on the ideXlab platform.