Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.202300382
Jornal Vascular Brasileiro
Original Article

Needle visualization during ultrasound-guided puncture: image optimization

Visualização da agulha durante punção guiada por ultrassom: otimização de imagem

Augusto Cézar Lacerda Brasileiro; Aeudson Víctor Cunha Guedes e Silva; Ariana Lacerda Garcia; Beatriz Ribeiro Coutinho de Mendonça Furtado; Frederico Augusto Polaro Araújo Filho; Laís Nóbrega Diniz; Leonardo César Maia e Silva; Lorena Agra da Cunha Lima

Downloads: 2
Views: 353

Abstract

Abstract: Background: Obtaining an adequate image of the needle by ultrasound reduces complications resulting from punctures, increasing patient safety and reducing hospitalization costs.

Objectives: To verify human perception in relation to number of pixels, while also identifying the best puncture angle and which needle should be used, and to evaluate whether there is a difference if needle visualization software is used.

Methods: 20 images were analyzed by 103 students who classified them as being sufficient or insufficient and were compared with the quality observed using photoshop. We evaluated whether there were differences between puncture angles of less than 45º and more than 45º, between IV catheter and introducer needles, and between images obtained with and without visualization software.

Results: There was a higher percentage of sufficient ratings for images those that had more than 60 pixels and when the puncture angle was less than 45º, with significant associations between students’ evaluations and each of these groups (p < 0.001). The percentages of images classified as sufficient were higher for images in which a IV catheter was used and also higher for those using the needle visualization software, with significant associations between the results for students’ classifications and each of these groups (p < 0.001).

Conclusions: The human eye classifies an image as sufficient according to higher numbers of pixels. Images of punctures at angles smaller than 45º in relation to the surface, of punctures performed with a IV catheter, and when using specific visualization software are also better detected by the human eye.

Keywords

needle, ultrasound, angle, needle visualization software

Resumo

Resumo: Contexto: A obtenção de uma imagem adequada da agulha pelo ultrassom diminui complicações decorrentes de punções, trazendo segurança para os pacientes e diminuindo custos com hospitalização.

Objetivos: Verificar a percepção do olho humano em relação aos pixels, identificar qual o melhor ângulo da punção e qual agulha deve ser utilizada e avaliar se há diferença com o uso de software de visualização de agulha.

Métodos: Vinte imagens foram analisadas por 103 alunos, que as classificaram como sendo suficientes ou insuficientes, e comparadas com a qualidade observada pelo photoshop. Avaliou-se se havia diferença entre punções com menos de 45º e mais de 45º, entre cateter EV e agulha introdutora e entre imagens obtidas com e sem software de visualização.

Resultados: Houve um percentual mais elevado de imagens suficientes entre aquelas que tinham mais de 60 pixels e quando o ângulo era menor que 45º, com associação significativa entre a classificação das avaliações pelos alunos e cada um desses grupos (p < 0,001). O percentual de imagens suficientes foi maior nas imagens realizadas com cateter EV e naquelas que utilizaram o software de visualização da agulha, ocorrendo associação significativa entre os resultados da classificação pelos alunos e cada um desses grupos (p < 0,001).

Conclusões: O olho humano classifica a imagem como sendo suficiente de acordo com a maior quantidade de pixels. Imagens puncionadas com ângulos menores que 45º em relação à superfície, realizadas com cateter EV e utilizando software específico de visualização também são mais bem detectadas pelo olho humano.
 

Palavras-chave

agulha, ultrassom, ângulo, software de visualização de agulha

References

1 Seleznova Y, Brass P, Hellmich M, Stock S, Müller D. Cost-effectiveness-analysis of ultrasound guidance for central venous catheterization compared with landmark method: a decision-analytic model. BMC Anesthesiol. 2019;19(1):51. http://dx.doi.org/10.1186/s12871-019-0719-5. PMid:30967124.

2 Chapman GA, Johnson D, Bodenham AR. Visualisation of needle position using ultrasonography. Anaesthesia. 2006;61(2):148-58. http://dx.doi.org/10.1111/j.1365-2044.2005.04475.x. PMid:16430568.

3 Sites BD, Brull R, Chan VW, et al. Artifacts and pitfall errors associated with ultrasound-guided regional anesthesia. Part I: understanding the basic principles of ultrasound physics and machine operations. Reg Anesth Pain Med. 2007;32(5):412-8. http://dx.doi.org/10.1097/00115550-200709000-00010. PMid:17961841.

4 Scholten HJ, Pourtaherian A, Mihajlovic N, Korsten HHM, A Bouwman R. Improving needle tip identification during ultrasound-guided procedures in anaesthetic practice. Anaesthesia. 2017;72(7):889-904. http://dx.doi.org/10.1111/anae.13921. PMid:28542716.

5 Saugel B, Scheeren TWL, Teboul JL. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 2017;21(1):225. http://dx.doi.org/10.1186/s13054-017-1814-y. PMid:28844205.

6 Lamperti M, Biasucci DG, Disma N, et al. European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access. Eur J Anaesthesiol. 2020;37(5):344-76. http://dx.doi.org/10.1097/EJA.0000000000001180. PMid:32265391.

7 Chin KJ, Perlas A, Chan VW, Brull R. Needle visualization in ultrasound-guided regional anesthesia: challenges and solutions. Reg Anesth Pain Med. 2008;33(6):532-44. http://dx.doi.org/10.1097/00115550-200811000-00005. PMid:19258968.

8 Schafhalter-Zoppoth I, McCulloch CE, Gray AT. Ultrasound visibility of needles used for regional nerve block: an in vitro study. Reg Anesth Pain Med. 2004;29(5):480-8. http://dx.doi.org/10.1097/00115550-200409000-00014. PMid:15372394.

9 Takatani J, Takeshima N, Okuda K, Uchino T, Hagiwara S, Noguchi T. Enhanced Needle Visualization: advantages and indications of an ultrasound software package. Anaesth Intensive Care. 2012;40(5):856-60. http://dx.doi.org/10.1177/0310057X1204000514. PMid:22934870.

10 Luz FM, Yacoub VRD, Silveira KAA, Reis F, Dertkigi SSJ. A model for training ultrasound-guided fine-needle punctures. Rev Assoc Med Bras. 2022;68(7):948-52. http://dx.doi.org/10.1590/1806-9282.20220150. PMid:35946773.

11 Kobayashi Y, Hamano R, Watanabe H, et al. Preliminary in vivo evaluation of a needle insertion manipulator for central venous catheterization. Robomech J. 2014;1(1):18. http://dx.doi.org/10.1186/s40648-014-0018-3.

12 Miura M, Takeyama K, Suzuki T. Visibility of ultrasound-guided echogenic needle and its potential in clinical delivery of regional anesthesia. Tokai J Exp Clin Med. 2014;39(2):80-6. PMid:25027252.

13 Kendall JL, Faragher JP. Ultrasound-guided central venous access: a homemade phantom for simulation. CJEM. 2007;9(5):371-3. http://dx.doi.org/10.1017/S1481803500015335. PMid:17935654.

14 Kline J. Reliable needle visualization during ultrasound guided regional and vascular procedures: a simple solution to steep angle echogenicity loss with any ultrasound system, based on target depth. Anesthesia Journal. 2015;3(2):1-4.

15 Bai B, Tian Y, Zhang Y, Yu C, Huang Y. Dynamic needle tip positioning versus the angle-distance technique for ultrasound guided radial artery cannulation in adults: a randomized controlled trial. BMC Anesthesiol. 2020;20(1):231. http://dx.doi.org/10.1186/s12871-020-01152-1. PMid:32928119.

16 Reusz G, Sarkany P, Gal J, Csomos A. Needle-related ultrasound artifacts and their importance in anaesthetic practice. Br J Anaesth. 2014;112(5):794-802. http://dx.doi.org/10.1093/bja/aet585. PMid:24566811.

17 Nichols K, Wright LB, Spencer T, Culp WC. Changes in ultrasonographic echogenicity and visibility of needles with changes in angles of insonation. J Vasc Interv Radiol. 2003;14(12):1553-7. http://dx.doi.org/10.1097/01.RVI.0000099527.29957.A6. PMid:14654490.

18 Maecken T, Zenz M, Grau T. Ultrasound characteristics of needles for regional anesthesia. Reg Anesth Pain Med. 2007;32(5):440-7. http://dx.doi.org/10.1016/j.rapm.2007.07.002. PMid:17961844.
 


Submitted date:
03/28/2023

Accepted date:
05/01/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
64b6ea91a953955ab724ecb2 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections