Peripherally inserted central catheter placement with the sonic flashlight: initial clinical trial by nurses

Abstract

Objective: We describe a case series constituting the first clinical trial by intravenous (IV) team nurses using the sonic flashlight (SF) for ultrasound guidance of peripherally inserted central catheter (PICC) placement.

Methods: Two IV team nurses with more than 10 years of experience with placing PICCs and 3 to 6 years of experience with ultrasound attempted to place PICCs under ultrasound guidance in patients requiring long-term IV access. One of two methods of ultrasound guidance was used: conventional ultrasound (CUS; 60 patients) or a new device called the SF (44 patients). The number of needle punctures required to gain IV access was recorded for each patient.

Results: In both methods, 87% of the cases resulted in successful venous access on the first attempt. The average number of needle sticks per patient was 1.18 for SF-guided procedures compared with 1.20 for CUS-guided procedures. No significant difference was found in the distribution of the number of attempts between the two methods. Anecdotal comments by the nurses indicated the comparative ease of use of the SF display, although the relatively small scale of the SF image compared with the CUS image was also noted.

Conclusions: We have shown that the SF is a safe and effective device for guidance of PICC placement in the hands of experienced IV team nurses. The advantage of placing the ultrasound image at its actual location must be balanced against the relatively small scale of the SF image.

Figure 1

Top: The Sonic Flashlight (SF) showing a small organic light-emitting diode (OLED) display and half-silvered mirror attached to the ultrasound probe. Bottom: The same device with a sterile probe cover, showing the clip-on disposable mirror-frame assembly shown outside the probe cover.

Figure 2

Enactment of the basic procedure of needle insertion into deep vein of the arm for peripherally inserted central catheter (PICC) placement using the Sonic Flashlight (SF). The operator holds the SF in one hand while looking down through the half-silvered mirror, guiding the needle into the reflected ultrasound image of the vein. (see Fig. 3 for operator viewpoint)

Figure 3

Photograph from the operator’s point of views for the same procedure shown in Fig. 2 in a cadaver upper using the Sonic Flashlight. The in-situ virtual image is shown in the white box, magnified on the left. The needle tip is visible within the right basilic vein (shown in cross-section as a dark circular area around the bright needle tip). Figure 3 is adapted with permission from Radiology.