Highly Controlled Vascular Syringes for Pericardiocentesis
Highly Controlled Vascular Syringes for Pericardiocentesis
Objectives. The present study determined the utility and needle control characteristics of highly controlled vascular syringes for image-guided pericardiocentesis.
Background. Vascular syringes have been integrated into invasive cardiovascular procedures with improved patient safety, but to date have not been used in pericardiocentesis. To address this issue, we determined the method of use of vascular syringes for pericardiocentesis.
Methods. A vascular syringe with reciprocating plungers, the reciprocating procedure device (RPD syringe), replaced the corresponding 10 ml and 20 ml conventional syringes in a standard pericardiocentesis tray. The vascular syringe is controlled with one hand, and can either aspirate or inject by pushing the corresponding aspiration or injection plunger. Four hundred and thirty seven subjects underwent vascular syringe procedures. The linear displacement method was used to precisely measure control of the needle tip in millimeters (mm) in vascular syringes compared to conventional syringes in 20 individual operators.
Results. Relative to the corresponding 10 ml and 20 ml conventional syringes, vascular syringes significantly reduced unintended forward penetration of the needle tip by 44% (7.0 ± 4.3 mm; p < 0.0001) and 53% (10.1 ± 5.5 mm; p < 0.0001), respectively, and reduced unintended retraction of the needle by 56% (2.7 ± 2.2 mm; p < 0.001) and 60% (3.5 ± 2.5 mm; p < 0.001), respectively. During pericardiocentesis, the mechanical syringe permitted facile one-handed aspiration and maintained the operator's ability to clear the needle. In the 437 vascular syringe procedures, there were no complications, with an estimated cost savings of $10–65 per procedure.
Conclusion. Vascular syringes improve needle control in pericardiocentesis, promote patient safety and permit one-handed aspiration and injection.
Advances in the diagnosis of pericardial disease have progressed remarkably with the growth of noninvasive diagnostic methods including echocardiography, computed tomography, fluoroscopy and magnetic resonance imaging. Although these imaging modalities have improved noninvasive detection of complicated pericardial disease, invasive pericardiocentesis performed with a syringe and needle remains an essential tool in the emergent evaluation, diagnosis and therapy of a large pericardial effusion with or without cardiac tamponade. The complications of pericardiocentesis can be serious and include cardiac puncture, laceration of the coronary arteries, puncture of the left internal mammary artery, pneumothorax, pneumopericardium, hemothorax, mediastinitis, abscess, cardiopulmonary arrest or death. Many of these complications are directly related to misdirection, inadequate control or mismanipulation of the needle and/or syringe.
Vascular syringes have been developed for invasive procedures where precise and safer control of the needle-tip is important. Since procedural complications cause considerable patient suffering, cost an additional $7,000–13,000 per complication and increase the overall costs of medical care, patient safety experts recommend the integration of inexpensive safety technologies wherever possible, assuming that the individual procedure in question can still be performed efficiently using that safety technology. The present report determined the feasibility of using highly-controlled vascular procedure syringes to improve the performance and safety of pericardiocentesis.
Abstract and Introduction
Abstract
Objectives. The present study determined the utility and needle control characteristics of highly controlled vascular syringes for image-guided pericardiocentesis.
Background. Vascular syringes have been integrated into invasive cardiovascular procedures with improved patient safety, but to date have not been used in pericardiocentesis. To address this issue, we determined the method of use of vascular syringes for pericardiocentesis.
Methods. A vascular syringe with reciprocating plungers, the reciprocating procedure device (RPD syringe), replaced the corresponding 10 ml and 20 ml conventional syringes in a standard pericardiocentesis tray. The vascular syringe is controlled with one hand, and can either aspirate or inject by pushing the corresponding aspiration or injection plunger. Four hundred and thirty seven subjects underwent vascular syringe procedures. The linear displacement method was used to precisely measure control of the needle tip in millimeters (mm) in vascular syringes compared to conventional syringes in 20 individual operators.
Results. Relative to the corresponding 10 ml and 20 ml conventional syringes, vascular syringes significantly reduced unintended forward penetration of the needle tip by 44% (7.0 ± 4.3 mm; p < 0.0001) and 53% (10.1 ± 5.5 mm; p < 0.0001), respectively, and reduced unintended retraction of the needle by 56% (2.7 ± 2.2 mm; p < 0.001) and 60% (3.5 ± 2.5 mm; p < 0.001), respectively. During pericardiocentesis, the mechanical syringe permitted facile one-handed aspiration and maintained the operator's ability to clear the needle. In the 437 vascular syringe procedures, there were no complications, with an estimated cost savings of $10–65 per procedure.
Conclusion. Vascular syringes improve needle control in pericardiocentesis, promote patient safety and permit one-handed aspiration and injection.
Introduction
Advances in the diagnosis of pericardial disease have progressed remarkably with the growth of noninvasive diagnostic methods including echocardiography, computed tomography, fluoroscopy and magnetic resonance imaging. Although these imaging modalities have improved noninvasive detection of complicated pericardial disease, invasive pericardiocentesis performed with a syringe and needle remains an essential tool in the emergent evaluation, diagnosis and therapy of a large pericardial effusion with or without cardiac tamponade. The complications of pericardiocentesis can be serious and include cardiac puncture, laceration of the coronary arteries, puncture of the left internal mammary artery, pneumothorax, pneumopericardium, hemothorax, mediastinitis, abscess, cardiopulmonary arrest or death. Many of these complications are directly related to misdirection, inadequate control or mismanipulation of the needle and/or syringe.
Vascular syringes have been developed for invasive procedures where precise and safer control of the needle-tip is important. Since procedural complications cause considerable patient suffering, cost an additional $7,000–13,000 per complication and increase the overall costs of medical care, patient safety experts recommend the integration of inexpensive safety technologies wherever possible, assuming that the individual procedure in question can still be performed efficiently using that safety technology. The present report determined the feasibility of using highly-controlled vascular procedure syringes to improve the performance and safety of pericardiocentesis.
