This experiment tried to answer the question of clinicians unfamiliar with the use of ultrasound for vascular cannulation who may be able to learn and practice the skill of ultrasound guided cannulation in a simulation model and are subsequently able to apply this skill in the clinical setting. Portable ultrasound devices are increasingly available in clinically areas because they are more affordable today than in the past, but clinicians need to be trained on how to use them successfully. Novices can learn the technique of ultrasound-guided cannulation fast when they have the opportunity to train on simulation models and make multiple attempts before they apply the same technique in their clinical setting.
The use of ultrasound during the cannulation has the advantage of providing information about the depth, size, and direction of vascular structure before the actual cannulation occurs. Further, it provides a clear vision of the needle tip being observable during the cannulation process. We are planning on performing a survey amongst senior clinicians to determine their views and perspectives on the use of this technique and what kind of barriers in the clinical space may exist.
To begin, cut a regular raw chicken breast horizontally with a sharp kitchen knife to allow for the insertion of three or more fluid-filled artificial blood vessels. Fill a 50-milliliter catheter-tipped syringe with cold rose hip tea. Push the fluid in the balloon and remove any air bubbles at the same time by repeatedly pushing the syringe in and out of the modeling balloon.
At the end, ensure the balloon is free of air bubbles and slightly pressurized. Tighten the modeling balloon with a knot to avoid any fluid leaks. Place the fluid-filled modeling balloon on the lower half of the chicken breast.
Fold the other half of the chicken breast over the balloon. Wrap this chicken breast simulation model with a transparent film and place it on a tray. To begin, place a point-of-care ultrasound or POCUS device with a linear probe and a probe cover onto the prepared simulation model.
Apply ultrasound gel to the area of interest in the simulation model. In a transverse view, visualize a simulated vessel in the simulation model. Place the ultrasound probe on top of the simulation model and center the view of the vessel in the middle of the screen of the ultrasound device where vessels appear as a black circular structure.
Move the ultrasound probe across the simulation model to place the vessel in the center of the screen of the POCUS device so that the whole vascular structure is visible. Adjust the image size and contrast settings to obtain optimal vision of the vessel and surrounding tissue. Press the Freeze function button to freeze the image.
Next, place digital markers to indicate the depth of the center of the vessel and to measure the diameter of the vessel. Rotate the ultrasound probe by 90 degrees to obtain a longitudinal view of the blood vessel. Observe the direction of the vessel being aligned with the probe.
Place the linear probe in a transverse view of the vessel. Remove the protective needle cover of the peripheral intravenous catheter cannula to commence the cannulation procedure. Place the transverse vision of the vessel centrally on the screen of the POCUS device.
Slowly and carefully cannulate in the middle of the linear probe, the simulation model, at an angle of around 40 degrees, aiming for the top of the vessel. Advance the needle tip into the tissue of the simulation model, aiming for the vessel. While advancing through the tissue, visually identify the needle tip on the screen of the POCUS device.
Further advance the needle through the tissue towards the vessel, following the needle tip with the ultrasound probe simultaneously. Visualize the needle tip entering the intravascular space. Then level the needle to a shallower angle and advance it to rest in the center of the vessel.
To validate the position of the needle tip, change the angle of the ultrasound probe or move it in small increments back and forth until the needle tip visually disappears and reappears on the screen. Observe the opposite end of the peripheral intravenous catheter for some evidence of red-colored fluid to confirm correct placement. Finally, remove the stylet from the peripheral intravenous catheter.
