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

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.

Use of a colorimetric carbon dioxide sensor for nasoenteric feeding tube placement in critical care patients compared with clinical methods and radiography.

BACKGROUND: Misplacement of nasoenteric feeding tubes (NFTs) into the airway instead of the esophagus leads to complications. Healthcare providers have relied on clinical methods, devices such as carbon dioxide (CO(2)) sensors, and radiography (the gold standard) to evaluate NFT placements. Most institutions include radiographs in their protocols for NFT insertions, making it expensive and cumbersome. A new commercial CO(2) sensor was developed to assist in these procedures, and the authors evaluated its use. METHODS: Nurses performing NFT placement completed questionnaires following each procedure. The nurses recorded the clinical methods used to determine proper insertion and, based on them, where the NFT was located. Nurses then evaluated NFT insertion with the CO(2) sensor; from the readings, they recorded where the tube was located. Confirmation of tube placement was performed radiographically. RESULTS: The authors evaluated 424 NFT insertions. Of these, 15 (3.5%) were incorrectly placed into the airway, and 409 were correctly placed into the esophagus. The CO(2) sensor correctly assessed NFT placement in 421 (99%) of the 424 cases. The authors found the device to have a sensitivity of 86.7% and a specificity of 99.8%. CONCLUSIONS: The CO(2) sensor is a helpful bedside tool to use in conjunction with clinical methods during NFT insertions. However, there is insufficient evidence to abandon the use of radiographs to confirm tube placement.