2023 FSA Podium and Poster Abstracts
P033: BI-PLANE ULTRASOUND UTILIZATION IMPROVES ACCURACY AND SAFETY FOR PERIPHERAL VASCULAR ACCESS ON PHANTOM SIMULATION IN ANESTHESIA CLINICIANS
Amanda M Frantz, MD; Ge Qu, MD; Cynthia S Garvan, PhD; Nikolaus Gravenstein, MD; Joshua W Sappenfield, MD; Department of Anesthesiology, College of Medicine, University of Florida
Introduction: Ultrasound-guided vascular access has a better performance compared to traditionally landmark-guided techniques and has been widely established in variety fields of medicine. [1,2] However, one of the limitations of the current technique is that the standard linear ultrasound transducer can only produce single axis views, which force a clinician to choose between two views, long-axis or short-axis (Figure 1a).
Both approaches have different strengths and weaknesses. In theory, combining the strengths from both approaches would result in enhanced performance, which is suggested by emerging anecdotal reports using Butterfly iQ with Biplane imaging, which is a portable and afordable ultrasound allows for simutaneous display of both views. [3,4] (Figure 1b)
We hypothesize that compared with the standard ultrasound with single plane technique, IV placement by using the butterfly iQ with biplane imaging would show superiority in performance in subjects of Anesthesia clinicians with variety of training levels.
Methods: After approval of IRB202102918, 30 volunteers were enrolled for IV placement on phantom limbs. Each participant performed 6 IV placements, of which 3 were with Bi-plane mode (ON group), and 3 were with standard single-plane mode (OFF group). The sequence of ON and OFF modes was randominzed for each participant. All attampts were timed from needle insertion until the IV catheter was hubbed on the ballistic gel. An observer recorded the number of attempts and needle advances, as well as any complications.
Results: As shown in Table 1, Overall, the Biplane group showed significantly less needle redirections (1.52±1.53 vs 2.14±2.08, P= 0.0017), and less backwall complication (0.12 ±0.19 vs 0.28 ±0.41, P=0.0332). No statistically significance in time to success placement or number of attempts until success placement between two groups.
Conclusion: Use of Biplane mode on the Butterfly iQ significantly reduced needle advances (or needle redirections) and observed backwalls when placing an IV in a phantom. No significant association was observed related to time to insertion or number of attempts.
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|
Biplane OFF Mean (SD) |
Biplane ON Mean (SD) |
|
|
|---|---|---|---|
| Time to success placement (Seconds) | 38.66 (34.82) | 36.50 (36.82) | 0.8646 |
| Needle advances (redirections) | 2.14 (2.08) | 1.52 (1.53) | 0.0017 |
| Attempts | 1.22 (0.48) | 1.13 (0.33) | 0.3828 |
| Backwalls | 0.28 (0.41) | 0.12 (0.19) | 0.0332 |
References:
1. Lazaar S, et al. Ultrasound guidance for urgent arterial and venous catheterisation: randomised controlled study. Br J Anaesth. 2021 Dec;127(6):871-878.
2. Saugel B,et al. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 2017 Aug 28;21(1):225.
3. Convissar D, et al. Biplane Imaging Using Portable Ultrasound Devices for Vascular Access. Cureus. 2021 Jan 7;13(1):e12561
4. Kaplowitz J, et al. A new biplane ultrasound probe for real-time visualization and cannulation of the internal jugular vein. Case Rep Anesthesiol. 2014;2014:349797