Discussion
injury of posterior venous wall
STERILE
Whereas guidelines actually recommend ultrasound use for CVC insertion, some uncertainty remains for the best approach to use between OOP and IP [Out-of-plane approach is most often used for jugular and femoral CVC insertion owing to its convenience. However, it is associated with risk of injury of posterior venous wall [We demonstrate here that, compared to IP-FH and OOP-FH, IP-NG approach significantly increases success rate at first pass in all sites. This is in keeping with previous studies reporting similar success rate with guiding system for jugular (82% and 81%) [Accidental arterial puncture with the NG-IP approach was observed only once at the jugular and subclavian site and never at the femoral site. Using a different needle guiding system, Augoustides et al. reported a rate of accidental arterial puncture at jugular site of 10%, similar to the rate observed with the landmark approach [The study reported here presents anyway several limits, the most important being that we should confirm our data in the clinical setting. Moreover the device was not used under a sterile sheath. This has not been investigated in the present study. The prototype had first to be assessed in a simulation model before being tested in the real life.We chose to include operators with limited proficiency considering that whether guide improves performance this would be true especially among operators with limited experience. Compared to IP-FH and OOP-FH, IP-NG translated in shorter total procedure duration only for subclavian puncture whatever proficiency. It should also be outlined that all IP-NG subclavian punctures (considered as the more complex puncture) performed by operators with the smallest experience were completed in less than 48 s. This confirms that needle-guiding interest is relevant especially for subclavian puncture [This study presents the first ultrasound needle-guiding device for IP (CVC) insertion, constructed using an open-source and homemade method. The cost of production and ease of construction are noteworthy. This approach could allow every operator to obtain a guiding device that is adapted to his ultrasound probes.The online version contains supplementary material
