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      Nova técnica para treinamento em acessos vasculares guiados por ultrassom utilizando modelo de tecido animal Translated title: New technique for ultrasound-guided vascular access training using an animal tissue model

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          Abstract

          A ultrassonografia Doppler deixou de ter seu uso apenas como método diagnóstico e vem galgando espaço nos procedimentos terapêuticos. Com maior aplicabilidade e uso de cateteres venosos centrais e procedimentos guiados por ultrassom, há preocupação com a melhora da eficácia e segurança durante o procedimento, assim como com a diminuição das potenciais complicações. Para isso, o treinamento da técnica em modelos (phantoms) é desejável. Os modelos industrializados para treinamento em acesso vascular guiado por ultrassom são caros e não reproduzem adequadamente a ecotextura e a densidade dos tecidos humanos. Na tentativa de treinar e aprimorar os profissionais para o uso do ultrassom em procedimentos de acessos vasculares, desenvolveu-se um modelo animal de baixo custo, fácil confecção e excelente aplicabilidade.

          Translated abstract

          Duplex ultrasonography has not been used only as a noninvasive diagnostic method. Recently it has been applied for therapeutic procedures. Due to the increasing use and applicability of central venous catheters and eco-guided vascular procedures, there are concerns about improving results regarding accuracy and safety, reducing complication rates during those procedures. It would be desirable that training was accomplished using phantoms before actual procedures in human subjects. Industrialized phantoms are expensive and they do not reproduce human's ecographic density and texture. In order to train and improve ultrasound guided vascular access, we have developed a cheap animal tissue model, which is of easy preparation and applicability.

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          Most cited references16

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          Ultrasonic locating devices for central venous cannulation: meta-analysis.

          To assess the evidence for the clinical effectiveness of ultrasound guided central venous cannulation. 15 electronic bibliographic databases, covering biomedical, science, social science, health economics, and grey literature. Systematic review and meta-analysis of randomised controlled trials. Populations Patients scheduled for central venous access. INTERVENTION REVIEWED: Guidance using real time two dimensional ultrasonography or Doppler needles and probes compared with the anatomical landmark method of cannulation. Risk of failed catheter placement (primary outcome), risk of complications from placement, risk of failure on first attempt at placement, number of attempts to successful catheterisation, and time (seconds) to successful catheterisation. 18 trials (1646 participants) were identified. Compared with the landmark method, real time two dimensional ultrasound guidance for cannulating the internal jugular vein in adults was associated with a significantly lower failure rate both overall (relative risk 0.14, 95% confidence interval 0.06 to 0.33) and on the first attempt (0.59, 0.39 to 0.88). Limited evidence favoured two dimensional ultrasound guidance for subclavian vein and femoral vein procedures in adults (0.14, 0.04 to 0.57 and 0.29, 0.07 to 1.21, respectively). Three studies in infants confirmed a higher success rate with two dimensional ultrasonography for internal jugular procedures (0.15, 0.03 to 0.64). Doppler guided cannulation of the internal jugular vein in adults was more successful than the landmark method (0.39, 0.17 to 0.92), but the landmark method was more successful for subclavian vein procedures (1.48, 1.03 to 2.14). No significant difference was found between these techniques for cannulation of the internal jugular vein in infants. An indirect comparison of relative risks suggested that two dimensional ultrasonography would be more successful than Doppler guidance for subclavian vein procedures in adults (0.09, 0.02 to 0.38). Evidence supports the use of two dimensional ultrasonography for central venous cannulation.
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            Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial).

            The aim of this study was to compare the procedural and clinical outcomes of femoral arterial access with ultrasound (US) guidance with standard fluoroscopic guidance.
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              Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients

              Introduction Central venous cannulation is crucial in the management of the critical care patient. This study was designed to evaluate whether real-time ultrasound-guided cannulation of the internal jugular vein is superior to the standard landmark method. Methods In this randomised study, 450 critical care patients who underwent real-time ultrasound-guided cannulation of the internal jugular vein were prospectively compared with 450 critical care patients in whom the landmark technique was used. Randomisation was performed by means of a computer-generated random-numbers table, and patients were stratified with regard to age, gender, and body mass index. Results There were no significant differences in gender, age, body mass index, or side of cannulation (left or right) or in the presence of risk factors for difficult venous cannulation such as prior catheterisation, limited sites for access attempts, previous difficulties during catheterisation, previous mechanical complication, known vascular abnormality, untreated coagulopathy, skeletal deformity, and cannulation during cardiac arrest between the two groups of patients. Furthermore, the physicians who performed the procedures had comparable experience in the placement of central venous catheters (p = non-significant). Cannulation of the internal jugular vein was achieved in all patients by using ultrasound and in 425 of the patients (94.4%) by using the landmark technique (p < 0.001). Average access time (skin to vein) and number of attempts were significantly reduced in the ultrasound group of patients compared with the landmark group (p < 0.001). In the landmark group, puncture of the carotid artery occurred in 10.6% of patients, haematoma in 8.4%, haemothorax in 1.7%, pneumothorax in 2.4%, and central venous catheter-associated blood stream infection in 16%, which were all significantly increased compared with the ultrasound group (p < 0.001). Conclusion The present data suggest that ultrasound-guided catheterisation of the internal jugular vein in critical care patients is superior to the landmark technique and therefore should be the method of choice in these patients.
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                Author and article information

                Journal
                jvb
                Jornal Vascular Brasileiro
                J. vasc. bras.
                Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) (Porto Alegre, RS, Brazil )
                1677-5449
                1677-7301
                March 2012
                : 11
                : 1
                : 83-87
                Affiliations
                [03] orgnameCentro Universitário Anhanguera de Santo André orgdiv1Enfermagem
                [02] São Bernardo do Campo SP orgnameClínica Médica Especializada SS Ltda orgdiv1Laboratório de Ecografia Vascular Brasil
                [04] São Bernardo do Campo SP orgnameClínica Médica Especializada SS Ltda orgdiv1Fluxo Brasil
                [01] São Bernardo do Campo SP orgnameClínica Médica Especializada SS Ltda orgdiv1Laboratório de Ecografia Vascular da Fluxo Brasil
                Article
                S1677-54492012000100015 S1677-5449(12)01100100015
                55f2efae-b3f9-4ae9-8b11-c84b12590864

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 01 May 2011
                : 28 October 2011
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 16, Pages: 5
                Product

                SciELO Brazil

                Categories
                Inovações

                surgical procedures, minimally invasive,procedimentos cirúrgicos minimamente invasivos,ultrassonografia,Doppler,ultrasonography, Doppler,models,animal, training,modelos animais,treinamento

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