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Ultrasound-guided positioning of IP: more comfortable, fewer complications

Interview with Doctor Eric Desruennes, Head of the central venous access unit in the Gustave Roussy Oncology Institute, Department of Anaesthesia & Intensive care
 
The ‘Central venous access’ Unit (IGR) implants approximately 1500 implantable ports each year.   Dr Eric Desruennes thinks that he has personally implanted 10 – 12,000 over his career …   He was one of the pioneers of ultrasound-guiding at the beginning of the 2000s.   In his eyes this is a major advance in implanting central venous access.

 
[…]  The ultrasound-guiding procedure is more comfortable than ultrasound -identification for the operator, who can visualise the progress of the needle towards the vein in real time, allowing the procedure to be performed faster, more precisely and more safely.   For the patient, ultrasound -guidance has almost removed complications, particularly arterial punctures and pneumothoraces, which have disappeared from our practice.   The smaller number of puncture attempts also reduces the risk of nerve damage or infection and reduces treatment delays and discomfort for the patient. […]
 
[…]  The doctor has to want to begin learning a new technique. This is not the case however with some experienced practitioners who have mastered their procedure blind.   Our interns however who are trained in ultrasound-guiding from the beginning would never think of not using it once they have tried it.   The price of ultrasound-guiding instruments however can be a limiting factor:  they are currently 20 - > 30,000 Euros depending on whether they have 1 or 2 probes.   PEROUSE MEDICAL however has developed a portable ultrasound for venous access insertion, the ECHO-Site®, which will be far more affordable.   This instrument has a smaller screen than conventional ultrasounds but the image quality is sufficiently good for vascular ultrasound and perfectly visualises the jugular, subclavicular, femoral and forearm veins.   Its cost should help to equip centres which do not yet have them and allow the ultrasound-guided puncture technique to spread widely. […]
 
[…]  Apart from ultrasound […], a disposable sterile hood is needed to sheath the ultrasound probe, which we obtained from a medical equipment distributor.   A sterile conducting gel or simply any sterile liquid such as Betadine or chlorhexidine is used as the interface between the sterile cover and the patient’s skin, unless a top of the range ultrasound is used in which case the puncture needles provided with the port are clearly visible then sufficiently echogenic  needles are needed.   Finally, venous return can be checked with a syringe.   A complete disposable kit is currently being developed by PEROUSE MEDICAL and to my knowledge there are currently no others.



 


 

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