Real-time Ultrasound-guided Technique Research Articles

Biopsy of intrinsic brain lesions: comparison of computed tomography-guided stereotactic and real-time ultrasound-guided techniques.

Biopsy of intrinsic brain lesions: comparison of computed tomography-guided stereotactic and real-time ultrasound-guided techniques.

A Comparison of Techniques of Internal Jugular Vein Cannulation: Anatomical Landmark, Ultrasound Guided Pre-location, and Real-Time Ultrasound Guided.

The objective of our study is to compare the success rate, duration, and incidence of complications of a right internal jugular vein (IJV) cannulation by using three different techniques. A randomised controlled trial was conducted at atertiary care teaching hospital. A total of201 patients were randomly allocated to one of the following three groups (67 in each group). Techniques were categorised as anatomical landmark technique group (Group ALT), ultrasound guided pre-location group (Group USG-Pre), and real-time ultrasound-guided technique group (Group USG-RT). Central venous catheter insertion via three techniques. In 138 (73.01%) patients' IJV canulated in the first attempt, USG-RT, USG-Pre, and ALT were 51 (83.6%), 44 (72.1%), and 43 (64.2%), respectively. On the other hand, 37 (19.57%) patients were required in the second attempt, while only 14 (7.40%) patients were required in the third attempt for successful IJV cannulation. The success rates, as defined in our study, were only 138 (73%) as, in 51 (27%), we cannulated in more than a single attempt or switched to another technique. We found a significant difference in preparation time in all techniques as P-value <0.05, but no significant difference was found in venous access time, cannulation time, and duration of the procedure. Any technique can be used for IJV cannulation, but the most acceptable is the real-time US technique. However, no difference in the overall procedure time among all three techniques was noted, and no major incidence of complication was found.

A retrospective observational study of real-time ultrasound-guided peripheral arterial cannulation in infants.

To examine first attempt success and overall success of real-time ultrasound guided peripheral arterial cannulation in infants. Retrospective review of 477 ultrasound guided peripheral arterial cannulations in infants less than 1 year of age. Procedural and patient characteristics were evaluated to better understand factors related to procedural success. Ultrasound guided peripheral arterial cannulation had a first attempt success rate of 65% and an overall success rate of 86%. Success rates significantly differed by arterial location (p < 0.001). First attempt success and overall success were highest in the radial artery (72%, 91%) and lowest in the posterior tibial artery (44%, 71%). Success was more likely with greater age and greater weight (p = 0.006, p = 0.002). Success rates are high when using a real-time ultrasound-guided technique for peripheral arterial cannulation in infants. An infant's weight and selected artery are strong predictors of success when performing peripheral arterial cannulation. The use of procedural ultrasound may reduce unnecessary attempts and minimize procedure-related harm.

COMPARISON OF PRE PROCEDURAL AND REAL TIME ULTRASOUND GUIDED SPINAL ANESTHESIA FOR TRAUMATIC LOWER LIMB INJURY

Objectives:The study aimed to compare real time ultrasound-guided approach with pre procedural ultrasound-guided approach for spinal anaesthesia in trauma patients. Methods: 200 patients in two groups: group pre-procedure (PP) and group real time (RT) of 100 patients in each group using inclusion and exclusion criteria. Standard monitoring done and Spinal anesthesia was administered by a trained anesthetist. The outcome measures included the number of attempts took to access the subarachnoid space, number of skin punctures, time from first needle insertion to completion of the intrathecal injection, total procedure time, success rate of cerebrospinal fluid acquisition, failure and complications were recorded and statistical analysis was performed. A two-tailed p-value &lt;0.05 was considered as statistically significant. Results: Mean number of needle passes, median number of skin puncture, total time for successful lumbar puncture, the block failure rate and procedural complications were significantly less in the RT group as compared to PP group. There are widely varying reports of the failure rate of spinal anesthesia in the literature. The individual studies have reported higher success rates (97% and 100%) using real-time US guidance than with pre-procedure ultrasound (80%). Conclusion: Real-time ultrasound-guided technique is a clinically feasible, higher success rate, less time consuming and less complication rate as compared to preprocedural ultrasound guidance technique.

Femoral Artery Cannulation Timing for a Pediatric Aortic Arch Repair.

We have previously introduced a blood delivery method via femoral artery cannulation to provide perfusion to the organs in the lower part of the body during pediatric aortic arch repair surgeries. In the original procedure, the femoral artery cannulation was performed after the patient had been covered with a sterile drape. Here, we suggest that the femoral artery cannulation should be performed before the patient is draped to allow optimal visibility of the target artery and puncture needle via aseptic real-time ultrasound-guided technique by reducing the inclusions between the patient's skin and ultrasound probe which attenuate the ultrasound beam.

Simulation for ultrasound-guided renal biopsy using boiled egg.

Real-time ultrasound-guided renal biopsy is generally applied to diagnose multiple kidney diseases. A practical simulation model is desired since it is an invasive technique with higher risks of complications such as bleeding. We developed a simple simulation tool for ultrasound-guided renal biopsy using boiled eggs. Boiled chicken eggs were embedded in the agar, and a biopsy simulation was performed using a real-time ultrasound-guided technique as the renal biopsy simulator by trainees and biopsy-proficient nephrologists, and the feedback from the participants was obtained. The ultrasonographic evaluation revealed a clear contrast between egg yolk and white, which clearly mimicked the kidney cortex and medulla region. In addition, we observed the needle entering the egg white under needle penetration, and we obtained the biopsy core consisting of egg white. As for the simulations, all the participants succeeded in obtaining the appropriate samples. A total of 92% of the trainees agreed that the simulation could reduce their fears of performing renal biopsies in patients. In addition, all the trainees and biopsy-proficient nephrologists recommend using the simulator for trainees before conducting renal biopsies on patients. The total cost of the simulator was low (<USD 1/simulator). Collectively, our simulation tool using boiled eggs may be a good candidate for practical simulation models of renal biopsy.

Real-time ultrasound-guided lumbosacral epidural anaesthesia in obese or appropriate body condition score dogs: A randomized clinical trial

Correctly identifying the puncture site and needle position in obese dogs can be challenging to achieve epidural anaesthesia. The current study aimed to evaluate a real-time ultrasound-guided technique, to perform epidural anaesthesia in obese or appropriate body condition score dogs, based on visualization of local anaesthetic flow during its injection, compared to the traditional method of palpation of anatomical landmarks. Seventy-two client-owned dogs were evaluated in a prospective, comparative, randomized clinical trial, allocated into four groups of 18 dogs. For the Palpation-guided 1 (PG1) and 2 (PG2) groups, epidural anaesthesia was based on palpating anatomical landmarks. Dogs with a body condition score (BCS) 1-5/9 were included in the PG1 (non-obese), and those with a BCS 6-9/9 in PG2 (obese) groups. In the Ultrasound-guided 1 (USG1 - BCS 1-5/9) and 2 (USG2 – BCS 6-9/9) groups, epidural anaesthesia was guided by ultrasound (US).The flow of anaesthetic through the epidural canal was observed in all dogs by US. There were fewer needle-to-bone contacts in the US-guided groups when performing epidural anaesthesia; this only occurred on the vertebral laminae, never in the vertebral canal. Ultrasound guidance enabled local anaesthetic injection into the epidural space without the need for palpation of anatomical landmarks to guide needle placement. Blood reflux occurred in 11.1% (PG1), 22.2% (PG2), 5.5% (USG1), and 0% (USG2) of the dogs. Ultrasound-guided punctures led to fewer vascular punctures. Epidural anaesthesia was effective in all animals, and no complications were observed.

PO-01-094 Novel real-time ultrasound-guided technique for intralesional injection of Xiapex (CCH) in the treatment of Peyronie's disease: Assessment of efficacy and adverse events rates

PO-01-094 Novel real-time ultrasound-guided technique for intralesional injection of Xiapex (CCH) in the treatment of Peyronie's disease: Assessment of efficacy and adverse events rates

Recent developments in ultrasound imaging for neuraxial blockade.

Recent research has shed further light on the place of ultrasound imaging in neuraxial blockade in routine clinical practice, its use in thoracic epidurals, and real-time ultrasound-guided techniques. Compared with the conventional technique of surface landmark palpation, preprocedural ultrasound imaging minimizes technical difficulty associated with lumbar neuraxial blockade in patients with poor-quality surface landmarks. Novice practitioners are able to learn to employ the technique effectively. Safety benefits include a reduction in postprocedural back pain associated with fewer needle passes and a lower risk of procedure-associated bleeding. The advantage of ultrasound is minimal however in patients with easily discernible surface landmarks, especially if the practitioner is highly experienced. Recent trials show that preprocedural ultrasound scanning for thoracic epidural insertion reduces needle punctures and increases early analgesic efficacy compared with the palpation technique. Real-time ultrasound-guided techniques, while feasible, remain challenging and may not offer significant benefit over preprocedural imaging in lumbar neuraxial blockade. Their role in thoracic epidural insertion requires further investigation. Ultrasound imaging of the spine is a valuable technique that, while not indicated for routine use, should be part of the skillset of any practitioner that regularly performs lumbar and thoracic neuraxial blockade.

Ultrasound-guided cannulation of hemodialysis access

Because hemodialysis therapy cannot be performed without the cannulation of a vascular access, establishing a well-functioning vascular access is crucial. Recently, the number of patients with difficult arteriovenous (AV) fistula cannulation has increased due to changes in the epidemiology of the dialysis population. To address this issue, indications for real-time ultrasound-guided techniques have recently been reported. This review discusses methods of ultrasound-guided cannulation of dialysis access; it is difficult to cannulate a deep, small, or stiff vessel of an AV fistula on the first attempt with static ultrasound guidance in which the ultrasound probe remains stationary. Mastering a method in which the precise location of the needle tip can be continuously identified during the insertion by dynamic probe scanning is required. To achieve this, understanding the theory of ultrasound guidance, off/on-the-job training, and a sense of professionalism are important. The use of ultrasound also enables the safe catheter placement into a collapsed central vein and repeated direct puncture of a femoral vein. The latter reduces the risk of catheter-related blood stream infection by avoiding the use of an indwelling dual-lumen catheter. In conclusion, ultrasound-guided techniques enable precise vascular cannulation, which can result in significant patient and financial impact. The accumulation of further reports is required for the method to be acknowledged as the standard to cope with difficult vascular access for dialysis. As most of the latest ultrasound machines for procedural guidance are optimized for peripheral nerve block, a compact and affordable ultrasound device with image quality focused on vascular access is also needed.

The Relationship of the Subclavius Muscle with Relevance to Venous Cannulation below the Clavicle.

Introduction. The catheter “pinch-off syndrome” has been described to be secondary to crimping of the catheter between the clavicle and the first rib, as well as entrapment of the catheter at the site of penetration of the subclavius muscle. The lateral insertion technique has been recommended to prevent catheter pinch-off, but it is unknown if this technique can prevent entrapment by the subclavius muscle. We undertook this study to evaluate the anatomical relationship of the subclavius muscle and the subclavian vein. Methods. Twenty-eight adult cadavers were studied on both right and left sides. The adherence between the subclavian vein and subclavius muscle was subjectively assessed and the distance between the two structures was measured in mm. Results. The subclavius muscle and subclavian vein were tightly adherent in 72% of specimens, partly adherent in 14% with a mean distance of 4.5 mm and loosely connected in 14% with a mean distance of 6.1 mm. Conclusions. The anatomical relationship between the subclavius muscle and vein was very close in the majority of specimens, suggesting that the lateral insertion technique may not prevent penetration of the muscle, which may contribute to catheter pinch-off. The real-time ultrasound-guided technique may prevent penetration of the subclavius muscle.

Ultrasound guided internal jugular venous cannulation: comparison with land-mark technique.

To compare real-time ultrasonography-guided technique versus the traditional land-mark technique for internal Jugular venous cannulation. Randomized controlled trial. Department of Anaesthesia, Combined Military Hospital, Rawalpindi, from September 2013 to July 2014. A total of 200 patients who required internal jugular vein cannulation were randomly assigned using either real-time ultrasound-guided technique or land-mark technique. Access time, number of attempts until successful cannulation, complications and the demographics of each patient were recorded. Access time was significantly less in real-time ultrasound group (34.95 ± 11.47 vs. 146.59 ± 40.20 seconds, p < 0.001). Cannulation was performed in first attempt in 99% of patients in ultrasound group as compared to 89% of landmark group. Complication rate was significantly higher in the land-mark group than in the ultrasound-guided group. Carotid artery puncture rate (9% vs. 1%) and haematoma formation (7% vs. 0%) were more frequent in the land-mark group than in the ultrasound-guided group. Brachial plexus irritation was also more in land-mark group (6% vs. 0%). Access time, failure rate and procedure related complications are reduced when real-time ultrasonography is used to cannulate internal Jugular vein.

Residents learning ultrasound-guided catheterization are not sufficiently skilled to use landmarks

IntroductionUltrasound-guided (UG) technique is the recommended procedure for central venous catheterization (CVC). However, as ultrasound may not be available in emergency situations, guidelines also propose that physicians remain skilled in landmark (LM) placement. We conducted this prospective observational study to determine the learning curve of the LM technique in residents only learning the UG technique.MethodsDuring the first three months of their rotation in our ICU, residents inexperienced in CVC used only the real-time UG technique. During the following three months, residents were allowed to place CVC by means of the LM technique when authorized by the attending physician.ResultsA total of 172 procedures (84 UG and 88 LM) were performed by the inexperienced residents during the study. The success rate was lower (72% versus 84%; P = 0.05) and the complication rate was higher (22% versus 10%; P = 0.04) for LM compared to UG procedures. Comparison between the five last UG procedures and the first five LM procedures performed demonstrated that the transition between the two techniques was associated with a marked decrease of the success rate (65% versus 93%; P = 0.01) and an increase of the complication rate (33% versus 8%; P = 0.01). After 10 LM procedures, residents achieved a success rate and a complication rate of 81% and 6%, respectively.ConclusionsResidents who only learn the UG technique will not be immediately able to perform the LM technique, but require specific training based on at least 10 LM procedures. The question of whether or not the LM technique should still be taught when an ultrasound device is not available must therefore be addressed.

Prospective comparison of incidence of bloodstream infection using real-time ultrasound-guided technique versus landmark technique in the catheterisation of central venous catheters

Prospective comparison of incidence of bloodstream infection using real-time ultrasound-guided technique versus landmark technique in the catheterisation of central venous catheters

Ultrasound localization of the femoral vein facilitates successful cannulation for hemodialysis

Real-time ultrasound-guided techniques allow for improved cannulation of the internal jugular vein and femoral vein for hemodialysis; however, these techniques require extra sterilization procedures, specialized probes, or needle guides. A simpler ultrasound vessel localization method was performed to investigate whether this alternative approach would aid in the cannulation of the femoral vein for patients in whom temporary angioaccess was required for hemodialysis. Patients requiring temporary femoral vein catheters for hemodialysis were divided into 2 groups on alternating days of the week during a 6-month period. One group underwent ultrasound localization of the femoral vein before cannulation and the second group received conventional landmark localization. Data regarding the strength of the femoral arterial pulse, number of attempts, failures, and complications were recorded. Ultrasound localization resulted in significantly improved first-attempt success rates, reduced attempts, and reduced failure and complication rates overall (p < 0.001, p < 0.001, p = 0.002 and p = 0.004 respectively) as well as in the group of patients with a clearly discernible arterial pulse (p < 0.001, p = 0.001, p = 0.004 and p = 0.011 respectively). The same trend was observed among patients with faintly palpable or non-palpable femoral arterial pulses, although the differences were not statistically significant. Cannulation of the femoral vein for hemodialysis should be performed with the aid of ultrasound. If real-time ultrasound-guided cannulation is not available, the vessel localization method is a good alternative, given its known limitations and the fact that it is simpler. It remains to be determined whether 1 - dimensional localization or localization including vessel depth information can improve outcomes in patients with faintly palpable or non-palpable femoral arterial pulses.

Real-time ultrasound-guided technique for internal jugular vein catheterization after inserting laryngeal mask: an analysis of clinical effectiveness

Real-time ultrasound-guided technique for internal jugular vein catheterization after inserting laryngeal mask: an analysis of clinical effectiveness

Biochemical outcomes after prostate brachytherapy with 5-year minimal follow-up: Importance of patient selection and implant quality

Purpose A prostate brachytherapy program was initiated in 1990, when comparatively little was known of the relative importance of disease- and treatment-related factors on outcome. Patients treated during the first 6 years of the program were analyzed to determine the value of patient selection and implant quality on biochemical control. Methods and materials We treated 243 patients with clinically localized prostate cancer with radioactive seed implantation and underwent 1-month CT-based dosimetric analysis. Follow-up ranged from 61 to 135 months (median 75). The Gleason score was ≤6 in 78% ( n = 189), 7 in 14% ( n = 35), and 8–10 in 8% ( n = 19). The initial prostate-specific antigen (PSA) level was ≤10 ng/mL in 61% ( n = 149), 10.1–20 ng/mL in 26% ( n = 63), and >20 ng/mL in 13% ( n = 31). The disease stage was T2a or less in 49% ( n = 120), and Stage T2b-T2c in 51% ( n = 123). A real-time ultrasound-guided technique was used with 125I ( n = 138) and 103Pd ( n = 105) isotopes. No patient underwent external beam radiotherapy as part of their primary treatment. Of the 243 patients, 60% also received hormonal ablation for at least 3 months before and 2–3 months after seed implantation. All patients included underwent a 1-month CT-based dosimetric analysis. The implant dose was defined as the dose delivered to 90% of the prostate volume on postimplant dosimetry (D 90). On the basis of prior dose–response analyses, patients were retrospectively grouped into optimal D 90 ( 125I ≥140 Gy Task Group 43 or 103Pd ≥100 Gy) and suboptimal D 90 ( 125I <140 Gy or 103Pd <100 Gy) dose groups. Biochemical failure was defined using the American Society for Therapeutic Radiology Oncology definition. Results Disease-related factors, including initial PSA level, Gleason score, and stage, were significant predictors of biochemical failure. The actuarial 8-year freedom from biochemical failure (bFFF) rate was 80% for those with a PSA level ≤10 ng/mL, 86% for PSA 10.1–20 ng/mL, and 45% for PSA >20 ng/mL ( p = 0.0019). Patients with a Gleason score of ≤6 had an 8-year bFFF rate of 81% vs. 67% for those with Gleason score 7 and 53% for those with Gleason score 8–10 ( p = 0.0003). Patients with Stage T2a or less had an 8-year bFFF rate of 85% compared with 69% for those with Stage T2b-T2c ( p = 0.013). The 8-year bFFF rate was 88% for low-risk patients (Stage T2a or less, Gleason score ≤6, and initial PSA level ≤10 ng/mL; n = 75), 81% for moderate-risk patients (Stage T2b or Gleason score 7 or initial PSA level >10.1–20 ng/mL; n = 70), and 65% for high-risk patients (two or more moderate-risk features or Gleason score ≥8 or initial PSA level >20 ng/mL; n = 98; p = 0.0009). Patients with optimal dose implants ( n = 145) had an 8-year bFFF rate of 82% compared with 68% for those with suboptimal dose implants ( n = 98; p = 0.007). Hormonal therapy did not significantly affect biochemical failure ( p = 0.27). In multivariate analysis, the statistically significant variables included initial PSA level ( p <0.0001), Gleason score ( p = 0.024), and dose group ( p = 0.046). Because our current practice limits implantation alone to low-risk patients, an analysis of this subgroup was undertaken to validate the importance of dose. In the optimal dose group, low-risk patients had an 8-year bFFF rate of 94% vs. 75% for the low-risk patients in the suboptimal dose group ( p = 0.02). Conclusion With minimal follow-up of 5 years, these data continue to support the use of implantation alone in low-risk prostate cancer patients and demonstrate the importance of implant quality (dose) in achieving optimal outcomes. Low-risk patients who receive an optimal dose implant have a 94% bFFF rate at 8 years.

Prostate brachytherapy in patients with prostate volumes ≥ 50 cm 3: dosimetic analysis of implant quality

Objectives: Permanent implantation with 125I in patients with localized prostate cancer who have prostate volumes ≥ 50 cm 3 is often technically difficult owing to pubic arch interference. The objective of this study was to describe dosimetry outcomes in a group of patients who were implanted using the real-time ultrasound-guided technique who had prostate volumes ≥ 50 cm 3. Materials and Methods: A total of 331 patients received an 125I prostate seed implant from January 1, 1995, to June 1, 1999, of whom 66 (20%) had prostate volumes ≥ 50 cm 3 at the time of the procedure. The real-time seed implant method was used in all patients and consisted of intraoperative planning and real-time seed placement using a combination of axial and sagittal ultrasound imaging. Pubic arch interference was managed using an extended lithotomy position or by angling the tip of the ultrasound probe in an anterior direction. No preimplant pubic arch CT scan study was performed and no patients were excluded from treatment because of prostate size. Implant quality was assessed using CT-based dosimetry performed 1 month postimplant. Dose–volume histograms for the prostate, bladder, rectum, and urethra volumes were generated. The target dose for these implants was 160 Gy and an adequate implant was defined as the dose delivered to 90% of the prostate (D90) ≥ 140 Gy. The dose delivered to 95% of the prostate (D95) and doses to 30% of the rectal (DRECT30) and urethral (DURE30) volumes were also calculated. Results: Prostate volumes in the 66 patients ranged from 50 to 93 cm 3 (median 57, mean 61 cm 3). Total activity implanted was 27.8–89.1 mCi (median 57 mCi), with a range in activity per seed of 0.36–0.56 mCi (median 0.4 mCi). The prostate D90s and D95s ranged from 13,245 to 22,637 cGy (median 18,750) and 11,856 to 20,853 cGy (median 16,725), respectively. Only one patient (1.5%) had a D90 < 140 Gy. The DURE30 values ranged from 15,014 to 27,800 cGy (median 20,410) and the DRECT30 values were 3137–9910 cGy (median 5515). Conclusion: Implantation of the large prostate can be accomplished using the real-time method. A total of 98.5% of the patients receive a high-quality implant. In addition, these implants should not put patients at increased risk for significant urinary and bowel complications because urethral and rectal doses can be kept at acceptable levels.