Catheterization, Central Venous Clinical Trial
Official title:
Central Venous Access Catheter Placement by Interventional Radiologists Using the Sonic Flashlight for Real Time Ultrasound Guidance
The investigators have developed a new device for guiding invasive procedures with
ultrasound (US), which they call the sonic flashlight (SF). They attach a half-silvered
mirror and a small flat-panel monitor directly to an ultrasound transducer to project a
virtual image of the US scan into its actual location within the patient. This permits the
operator to guide a needle through the skin by aiming directly at the image, using natural
hand-eye coordination rather than looking away from the patient at a conventional display.
The device requires no tracking or head-mounted apparatus, and provides an intuitive merger
of the visual exterior of the patient with an in situ ultrasound image, which can be
simultaneously viewed by others assisting the operator. The investigators believe the SF
will increase the accuracy, safety, and speed for a wide variety of invasive procedures, and
will require less extensive training than conventional US displays.
Given the wide variety of procedures for which the SF could be used, the investigators have
narrowed their focus to applying it to a single application: vascular access. They have
demonstrated clinically that the SF can be used successfully to guide the placement of the
peripherally inserted central catheter (PICC) lines. The research proposed here will expand
this application to include the insertion of other central venous access (CVA) lines through
the internal jugular vein, subclavian vein, and femoral vein. The historical approach to CVA
line placements has involved the physical exam and identification of visible landmarks. With
the introduction and common usage of ultrasound, it has become routine to use ultrasound
guidance.
Much of the difficulty in learning conventional ultrasound (CUS) guided procedures stems
from the displaced sense of hand-eye coordination that occurs when the operator looks away
from the operating field to see the ultrasound display. The SF directly addresses many of
these issues and therefore the investigators believe that it is well suited for this
application. They have already shown that novice US users learn vascular access procedures
in training phantoms more quickly using the SF than CUS. They have also shown that
intravenous (IV) team nurses already proficient in CUS guided PICC lines perform vascular
access in training phantoms more quickly using the SF than CUS guidance. Finally, as
mentioned earlier, the investigators have shown that the SF can be used successfully to
guide the placement of PICC lines. This study will test the hypothesis that the SF will
successfully facilitate catheter placement in the subclavian, femoral, and internal jugular
veins demonstrating equal vasculature visualization as conventional ultrasound.
We have developed a new device for guiding invasive procedures with ultrasound (US), which
we call the Sonic Flashlight (SF). We attach a half-silvered mirror and a small flat-panel
monitor directly to an ultrasound transducer to project a virtual image of the US scan into
its actual location within the patient. This permits the operator to guide a needle through
the skin by aiming directly at the image, using natural hand-eye coordination rather than
looking away from the patient at a conventional display. The device requires no tracking or
head-mounted apparatus, and provides an intuitive merger of the visual exterior of the
patient with an in situ ultrasound image, which can be simultaneously viewed by others
assisting the operator. We believe the SF will increase accuracy, safety, and speed, for a
wide variety of invasive procedures, and will require less extensive training than
conventional US displays.
Given the wide variety of procedures for which the SF could be used, we have narrowed our
focus to applying it to a single application: vascular access. We have demonstrated
clinically that the SF can be used successfully to guide the placement of the Peripherally
Inserted Central Catheter (PICC) lines. The research proposed here will expand this
application to include the insertion of other Central Venous Access (CVA) lines through the
internal jugular vein, subclavian vein, and femoral vein. The historical approach to CVA
line placements has involved the physical exam and identification of visible landmarks. With
the introduction and common usage of ultrasound, it has become routine to use ultrasound
guidance.
Much of the difficulty in learning conventional ultrasound (CUS) guided procedures stems
from the displaced sense of hand-eye coordination that occurs when the operator looks away
from the operating field to see the ultrasound display. The SF directly addresses many of
these issues and therefore we believe that it is well suited for this application. We have
already shown that novice US users learn vascular access procedures in training phantoms
more quickly using the SF than CUS. We have also shown that IV team nurses already
proficient in CUS guided PICC lines perform vascular access in training phantoms more
quickly using the SF than CUS guidance. Finally, as mentioned earlier, we have shown that
the SF can be used successfully to guide the placement of PICC lines. This study will test
the hypothesis that the SF will successfully facilitate catheter placement in the
subclavian, femoral, and internal jugular veins demonstrating equal vasculature
visualization as conventional ultrasound.
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Time Perspective: Prospective
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