Efficacy Evaluation of a non-human experimental model for ultrasound-guided superficial venous puncture: clinical randomized assay


  • Érica Patricio Nardino Discipline of Angiology and Vascular Surgery, Faculdade de Medicina do ABC, Santo André, São Paulo
  • Andrea Paula Kafejian-Haddad Discipline of Angiology and Vascular Surgery, Faculdade de Medicina do ABC, Santo André, São Paulo
  • Danilo Argollo Pirutti Silva Discipline of Angiology and Vascular Surgery, Faculdade de Medicina do ABC, Santo André, São Paulo
  • João Antonio Correa Discipline of Angiology and Vascular Surgery, Faculdade de Medicina do ABC, Santo André, São Paulo




experimental model, ultrasound, venous puncture, clinical randomized essay


Introduction: The use of a venipuncture simulator facilitates technique learning and improves skills, which reduces the risk of venipuncture complications in humans. Objective: To evaluate the efficacy of a non-human experimental model for Ultrasound guided superficial venipuncture. Methods: We randomized 39 nurses in two groups: A and B. The training had three steps: 1 - theoretical class, 2 - practical class, with the ultrasound device and 3 - ultrasound-guided puncture training in the non-human model. The group A participated in steps 1, 2 and 3 and group B in steps 1 and 2. After training, both groups were released for ultrasound guided venipuncture. Results: The success in puncture in group A (n = 20) was 90% and in group B (n = 19) it was 68.42%. In the sum of the identification and the puncture times, the average of group A was 61.5 seconds (95% CI, 33.58; 106.95) and in group B was 148.0 seconds (95% CI, 114.54; 208.44), which was statistically significant (p = 0.007, without overlapping the interval estimates). Conclusion: Nurses who received training with the nonhuman model had better identification and puncture times.


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1. Gorman PJ, Meier AH, Rawn C, Krummel TM. The future of medical education is no longer blood and guts, it is bits and bytes. Am J Surg. 2000;180(5):353-6. DOI: http://doi.org/10.1016/s0002-9610(00)00514-6

2. Evans LV, Dodge KL, Shah TD, Kaplan LJ, Siegel MD, Moore CL, et al. Simulation training in central venous catheter insertion: improved performance in clinical practice. Acad Med. 2010;85(9):1462-9. DOI: http://doi.org/10.1097/ACM.0b013e3181eac9a3

3. Di Domenico S, Santori G, Porcile E, Licausi M, Centanaro M, Valente U. Inexpensive homemade models for ultrasound-guided vein cannulation training. J Clin Anesth. 2007;19(7):491-6. DOI: http://doi.org/10.1016/j.jclinane.2007.05.002

4. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348:1123-33. DOI: http://doi.org/10.1056/NEJMra011883

5. Jacobson AF, Winslow EH. Variables influencing intravenous catheter insertion difficulty and failure: an analysis of 339 intravenous catheter insertions. Heart Lung. 2005;3495):345-59. DOI: http://doi.org/10.1016/j.hrtlng.2005.04.002

6. Dietrich CF, Horn R, Morf S, Chiorean L, Dong Y, Cui XW, et al. US-guided peripheral vascular interventions, comments on the EFSUMB guidelines. Med Ultrason. 2016;18(2):231-9. DOI: http://doi.org/10.11152/mu.2013.2066.182.umb

7. Kuo CC, Wu CY, Feng IJ, Lee WJ. Efficacy of ultrasound-guided peripheral intravenous access: a systematic review and meta-analysis. Hu Li Za Zhi. 2016;63(6):89-101. DOI: http://doi.org/10.6224/JN.63.6.89

8. Oliveira L, Lawrence M. Ultrasound-guided peripheral intravenous access program for emergency physicians, nurses, and corpsmen (technicians) at a military hospital. Mil Med. 2016;181(3):272-6. DOI: http://doi.org/10.7205/MILMED-D-15-00056

9. Zingg W, Pittet D. Peripheral venous catheters: an under-evaluated problem. Int J Antimicrob Agents. 2009;34(Suppl 4):S38-42. DOI: http://doi.org/10.1016/S0924-8579(09)70565-5

10. Egan G, Healy D, O'Neill H, Clarke-Moloney M, Grace PA, Walsh SR. Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis. Emerg Med J. 2013;30:521-6. DOI: http://doi.org/10.1136/emermed-2012-201652

11. Bauman M, Braude D, Crandall C. Ultrasound-guidance vs. standard technique in difficult vascular access patients by ED technicians. Am J Emerg Med. 2009;27(2):135-40. DOI: http://doi.org/10.1016/j.ajem.2008.02.005

12. Stolz LA, Stolz U, Howe C, Farrell IJ, Adhikari S. Ultrasound-guided peripheral venous access: a meta-analysis and systematic review. J Vasc Access. 2015;16(4):321-6. DOI: http://doi.org/10.5301/jva.5000346

13. Witting MD. IV access difficulty: incidence and delays in an urban emergency department. J Emerg Med. 2012;42:483-7. DOI: http://doi.org/10.1016/j.jemermed.2011.07.030

14. Shokoohi H, Boniface K, McCarthy M, KhedirAl-tiae T, Sattarian M, Ding R, et al. Ultrasound-guided peripheral intravenous access program is associated with a marked reduction in central venous catheter use in noncritically ill emergency department patients. Ann Emerg Med. 201 ;61(2):198-203. DOI: http://doi.org/10.1016/j.annemergmed.2012.09.016

15. Gregg SC, Murthi SB, Sisley AC, Stein DM, Scalea TM. Ultrasound - guided peripheral intravenous access in the intensive care unit. J Crit Care. 2010;25(3):514-9. DOI: http://doi.org/10.1016/j.jcrc.2009.09.003

16. Dargin JM, Rebholz CM, Lowenstein RA, Mitchell PM, Feldman JA. Ultrasonography-guided peripheral intravenous catheter survival in ED patients with difficult access. Am J Emerg Med. 2010;28:1-7. DOI: http://doi.org/10.1016/j.ajem.2008.09.001

17. Miranda RB, Nardino EP, Gomes T, Farias P. Nova técnica para treinamento em acessos vasculares guiados por ultrassom utilizando modelo de tecido animal. J Vas Bras. 2012;11(1):83-7. DOI: http://dx.doi.org/10.1590/S1677-54492012000100015

18. Singer J. A simple procedure to compute the sample size needed to compare two Independent groups when the population variances are unequal. Stat Med. 2001;20(7):1089-95. DOI: https://doi.org/10.1002/sim.722

19. Armitage P, Berry G. The planning of a statistical investigations. In: Armitage P, Berry G. Statistical methods in medical research. 2nd. Oxford: Blackwell; 1987; p. 179-85.

20. Gopalasingam N, Thomsen AE, Folkersen L, Juhl-Olsen P, Sloth E. A successful model to learn and implement ultrasound-guided venous catheterization in apheresis. J Clin Apher. 2017;32:437-43. DOI: https://doi.org/10.1002/jca.21533

21. Brannam L, Blaivas M, Lyon M, Flake M. Emergency nurses' utilization of ultrasound guidance for placement of peripheral intravenous lines in difficult-access patients. Acad Emerg Med. 2004;11(12):1361-3. DOI: https://doi.org/10.1197/j.aem.2004.08.027

22. Salleras-Duran L, Fuentes-Pumarola C, Bosch-Borràs N, Punset-Font X, Sampol-Granes FX. Ultrasound-guided peripheral venous catheterization in emergency services. J Emerg Nurs. 2016;42(4):338-43. DOI: https://doi.org/10.1016/j.jen.2015.11.005

23. Sou V, McManus C, Mifflin N, Frost SA, Ale J, Alexandrou E. A clinical pathway for the management of difficult venous access. BMC Nurs. 2017;16;64. DOI: https://doi.org/10.1186/s12912-017-0261-z

24. Ueda K, Hussey P. Dynamic Ultrasound-guided short-axis needle tip navigation technique for facilitating cannulation of peripheral veins in obese patients. Anesth Analg. 2017;124(3):831-3. DOI: https://doi.org/10.1213/ANE.0000000000001653

25. Mills CN, Liebmann O, Stone MB, Frazee BW. Ultrasonographically guided insertion of a 15-cm catheter into the deep brachial or basilica vein in patients with difficult intravenous access. Ann Emerg Med. 2007;50:68-72. DOI: https://doi.org/10.1016/j.annemergmed.2007.02.003

26. Benkhadra M, Collignon M, Fournel I, Oeuvrard C, Rollin P, Perrin M, et al. Ultrasound guidance allows faster peripheral IV cannulation in children under 3 years of age with difficult venous access: a prospective randomized study. Paediatr Anaesth. 2012;22(5):449-54. DOI: https://doi.org/10.1111/j.1460-9592.2012.03830.x

27. Witting MD, Schenkel SM, Lawner BJ, Euerle BD. Effects of vein width and depth on ultrasound-guided peripheral intravenous success rates. J Emerg Med. 2010;39(1):70-5. DOI: https://doi.org/10.1016/j.jemermed.2009.01.003

28. Panebianco NL, Fredette JM, Szyld D, Sagalyn EB, Pines JM, Dean AJ. What you see (sonographically) is what you get: vein and patient characteristics associated with successful ultrasound-guided peripheral intravenous placement in patients with difficult access. Acad Emerg Med. 2009;16(12):1298-303. DOI: https://doi.org/10.1111/j.1553-2712.2009.00520.x

29. Kerforne T, Petitpas F, Frasca D, Goudet V, Robert R, Mimoz O. Ultrasound-guided peripheral venous access in severely ill patients with suspected difficult vascular puncture. Chest. 2012;141(1):279-80. DOI: https://doi.org/10.1378/chest.11-2054

30. Meyer P, Cronier P, Rousseau H, Vicaut E,Choukroun G, Chergui K, et al. Difficult peripheral venous access: clinical evaluation of a catheter inserted with the Seldinger method under ultrasound guidance. J Crit Care. 2014;29:823-7. DOI: https://doi.org/10.1016/j.jcrc.2014.04.022

31. Doniger SJ, Ishimine P, Fox JC, Kanegaye JT. Randomized controlled trial of ultrasound-guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients. Pediatr Emerg Care. 2009;25(3):154-9. DOI: https://doi.org/10.1097/PEC.0b013e31819a8946

32. Scoppettuolo G, Pittiruti M, Pitoni S, Dolcetti L, Emoli A, Mitidieri A, et al. Ultrasound-guided "short" midline catheters for difficult venous access in the emergency department: a retrospective analysis. Int J Emerg Med. 2016;9:3. DOI: https://doi.org/10.1186/s12245-016-0100-0

33. Costantino TG, Parikh AK, Satz WA, Fojtik JP. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Emerg Med. 2005;46(5):456-61. DOI: https://doi.org/10.1016/j.annemergmed.2004.12.026

34. Ault MJ, Rosen BT, Ault B. The use of tissue models for vascular access training. Phase I of the procedural patient safety initiative. J Gen Intern Med. 2006;21(5):514-7. DOI: https://doi.org/10.1111/j.1525-1497.2006.00440.x

35. Stein J, George B, River G, Hebig A, McDermott D. Ultrasonographically guided peripheral intravenous cannulation in emergency department patients with difficult intravenous access: a randomized trial. Ann Emerg Med. 2009;54(1):33-40. DOI: https://doi.org/10.1016/j.annemergmed.2008.07.048

36. Nolting L, Hunt P, Cook T, Douglas B. An inexpensive and easy ultrasound phantom: a novel use for SPAM. J Ultrasound Med. 2016;35(4):819-22. DOI: https://doi.org/10.7863/ultra.14.06023

37. Morrow DS, Broder J. Cost-effective, reusable, leak-resistant ultrasound-guided vascular access trainer. J Emerg Med. 2015;49(3):313-7. DOI: https://doi.org/10.1016/j.jemermed.2015.04.005

38. Di Domenico S, Licausi M, Porcile E, Piaggio F, Troilo B, Centanaro M, et al. Introducing ultrasound-guided vein catheterization into clinical practice: a step-by-step guide for organizing a hands-on training program with inexpensive handmade models. J Ultrasound. 2008;11:135-42. DOI: https://doi.org/1016/j.jus.2008.09.002

39. Hocking G, Hebard S, Mitchell CH. A review of the benefits and pitfalls of phantoms in ultrasound-guided regional anesthesia. Reg Anesth Pain Med. 2011;3692):162-70.