Venous Line Placement Research Articles

A 3D-Printed Forearm Trainer for the Practice of Ultrasound-Guided Arterial and Venous Line Placement

As sonography (US) continues to become a mainstay in medicine, both as a screening device and as a procedural tool, the use of task-based sonographic trainers (i.e., phantoms) in medical training has become increasingly necessary. This is especially true for what has been termed ‘the global use of US’, or the use of US as an imperative tool during structural planning and placement of peripheral and central lines within patients in emergency and hospital settings. However, despite the frequency and technicality of US-guided procedures involving arterial and venous line placement, the benefit of such hands-on US simulation training for employees and professional students alike is often outweighed by cost. The current market for US trainers displaying human forearm anatomy and branching vessels comes at a high price tag of over 2,000 USD per model. The authors’ experiment utilises 3D printing techniques and biodegradable ballistics gel to create a cost-effective, versatile, and yet realistic peripheral line simulator in order to cultivate real-time learning of arterial/venous arm anatomy, while providing mechanical practice for needle driving and US technique, all at a fraction of the commercial price.

Do children without a known bleeding tendency undergoing PICC placement require coagulation laboratory testing?

Obtaining basic hemostatic laboratory investigations prior to peripherally inserted central catheter (PICC) insertion remains controversial, even if the procedure is converted to a tunneled central venous line (CVL) placement. To determine the value of pre-procedural blood screening (hemoglobin level, platelet count, aPTT/INR) in hospitalized children without a known bleeding diathesis. This retrospective review included pediatric patients undergoing PICC insertion who had both laboratory screening and post-PICC hemoglobin level. Two cohorts (A: 0-3 months; B: >3 months-18 years) were analyzed for procedural major/minor bleeding. Of 1,441 consecutive children identified during a 3-year period, 832 patients (226 in cohort A, 606 in cohort B) fulfilled the inclusion criteria. Overall, 36% (300/832) of the patients had at least one abnormal laboratory result. Only 0.2% (3/1,441) of patients required conversion to a central venous line. In cohort A no major bleeding occurred; the minor bleeding frequency was 30% (68/226). Neither abnormal laboratory results nor correction of abnormal laboratory results was associated with minor bleeding complications. The positive and negative predictive values (PPV/NPV) of having abnormal laboratory screening were 0.22 and 0.68, respectively. In cohort B the major bleeding frequency was 1% (6/606) but no patient required any blood transfusion; minor bleeding occurred in 29% (174/606). Neither abnormal laboratory results nor correction of abnormal laboratory results was associated with minor bleeding complications. The PPV and NPV of abnormal laboratory screening results were 0.24 and 0.72, respectively. Pre-procedural blood screening did not predict bleeding in hospitalized children without a known bleeding diathesis undergoing PICC insertion. The rarity of major bleeding complications and need for conversion to a central venous line did not support a need for laboratory screening.

An Audit of Central Venous Line Insertion, the use of Ultrasound Guidance and the Incidence of Carotid Artery Puncture

Review of the literature suggests a decrease in complication rates when using ultrasound guidance in central venous line (CVL) placement. Carotid artery puncture is the most common complication of attempted internal jugular vein catheterisation with an incidence of 2 to 8%. This audit reviewed our local practice in CVL insertion techniques and carotid artery puncture rates for the period May 2008 to May 2009. The findings were reported and a repeat audit was performed for the period of February 2010 to February 2011. The results were interesting.