TY - JOUR
T1 - Localization of needle tip with color Doppler during pericardiocentesis
T2 - In vitro validation and initial clinical application
AU - Armstrong, Guy
AU - Cardon, Lisa
AU - Vilkomerson, David
AU - Lipson, David
AU - Wong, James
AU - Rodriguez, L. Leonardo
AU - Thomas, James D.
AU - Griffin, Brian P.
N1 - Funding Information:
Guy Armstrong, MD, Lisa Cardon, RDCS, David Vilkomerson, PhD, David Lipson, PhD, James Wong, MD, PhD, L. Leonardo Rodriguez, MD, James D. Thomas, MD, and Brian P. Griffin, MD, Cleveland, Ohio; Princeton, New Jersey; and Lexington, Massachusetts This study evaluates a new device that uses color Doppler uitrasonography to enable real-time image guidance of the aspirating needle, which has not been possible until now. The ColorMark device (EchoCath Inc, Princeton, NJ) induces high-frequency, low-amplitude vibrations in the needle to enable localization with color Doppler. We studied this technique in 25 consecutive patients undergoing pericardiocentesis, and in vitro, in a urethane phantom with which the accuracy of color Doppler localization of the needle tip was compared with that obtained by direct measurement. Tip localization was excellent in vitro; errors axial to the ultrasound beam (velocity Doppler -0.13 + 0.90 ram; power Doppler -0.05 ± 1.7 Pericardiocentesis is a challenging procedure that is often required for the rapid removal of even small amounts of fluid in acute cardiac tamponade and for diagnostic purposes when the underlying cause is unknown. In such instances, there may be only a relatively small margin of percutaneously accessible fluid that separates parietal pericardium from visceral pericardium. The safety of pericardiocentesis has improved markedly since it was first described by Schuh 1 in 1840. Reports from large centers where small numbers of experienced operators perform From The Cleveland Clinic Foundation, Ohio; EchoCath, Inc, Princeton, NJ (D.V.); and Medispectra, Lexington, Mass (D.L.) Reprint requests: Brian 1). Griffin, MD, Cardiology - F15, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Clevcland OH 44195 (E-mail: griffib@ccforg). Supported in part by Grant NCC9-60, National Aeronautics and Space Administration, Houston, Tex, and from the March Foundation, Jupiter Beach, Fla. G.A. was partially supported by the National Heart Foundation of New Zealand. Copyright © 2001 by the American Society of Echocardiography. 0894-7317/2001 $35.00 + 0 27/1/106680 doi:10.1067/mje.2001.106680 ram) were less than lateral errors (velocity-O.36 ± 1.8 turn; power -0.02 + 2.8 ram). In 18 of 25 patients, the needle was identified and guided into the pericardial space with the ColorMark technique, and it allowed successful, uncomplicated drainage of fluid. Initial failures were the result of incorrect settings on the echocardiographic machine and inappropriate combinations of the needle puncture site and imaging window, This study demonstrates a novel color Doppler technique that is highly accurate at localizing a needle tip. The technique is feasible for guiding pericardiocentesis. Further clinical validation of this technique is required. (J Am Soc Echocardiogr 2001;14: 29-37.) the procedure under echocardiographic guidance have demonstrated an excellent safety record. 1-5 However, in smaller institutions where the procedure is performed less frequently and experienced operators are less available, the success and safety rate of pericardiocentesis may be lower. 6 Although both fluoroscopy and ultrasonographic guidance are helpful in determining the site and track with which to approach a pericardial effusion, current technology prevents adequate imaging of the needle tip and cardiac structures for the actual puncture and drainage to be guided in real time. A new device has recently been developed that induces vibratory motion in a needle, enabling real-time visualization with the use of color Doppler (ColorMark; EchoCath, Inc, Princeton, NJ). We hypothesized that this technology would allow improved visualization of the aspirating needle during pericardiocentesis. First, we evaluated in vitro its ability to localize a needle tip and the factors affecting accuracy.We subsequently applied this technology in the clinical setting of pericardiocentesis to determine its potential utility and the technical factors for its optimal application.
PY - 2001/1
Y1 - 2001/1
N2 - This study evaluates a new device that uses color Doppler ultrasonography to enable real-time image guidance of the aspirating needle, which has not been possible until now. The ColorMark device (EchoCath Inc, Princeton, NJ) induces high-frequency, low-amplitude vibrations in the needle to enable localization with color Doppler. We studied this technique in 25 consecutive patients undergoing pericardiocentesis, and in vitro, in a urethane phantom with which the accuracy of color Doppler localization of the needle tip was compared with that obtained by direct measurement. Tip localization was excellent in vitro; errors axial to the ultrasound beam (velocity Doppler -0.13 ± 0.90 mm, power Doppler -0.05 ± 1.7 mm) were less than lateral errors (velocity-0.36 ± 1.8 mm, power -0.02 ± 2.8 mm). In 18 of 25 patients, the needle was identified and guided into the pericardial space with the ColorMark technique, and it allowed successful, uncomplicated drainage of fluid, initial failures were the result of incorrect settings on the echocardiographic machine and inappropriate combinations of the needle puncture site and imaging window. This study demonstrates a novel color Doppler technique that is highly accurate at localizing a needle tip. The technique is feasible for guiding pericardiocentesis. Further clinical validation of rials technique is required. (J Am Soc Echocardiogr 2001;14: 29-37.).
AB - This study evaluates a new device that uses color Doppler ultrasonography to enable real-time image guidance of the aspirating needle, which has not been possible until now. The ColorMark device (EchoCath Inc, Princeton, NJ) induces high-frequency, low-amplitude vibrations in the needle to enable localization with color Doppler. We studied this technique in 25 consecutive patients undergoing pericardiocentesis, and in vitro, in a urethane phantom with which the accuracy of color Doppler localization of the needle tip was compared with that obtained by direct measurement. Tip localization was excellent in vitro; errors axial to the ultrasound beam (velocity Doppler -0.13 ± 0.90 mm, power Doppler -0.05 ± 1.7 mm) were less than lateral errors (velocity-0.36 ± 1.8 mm, power -0.02 ± 2.8 mm). In 18 of 25 patients, the needle was identified and guided into the pericardial space with the ColorMark technique, and it allowed successful, uncomplicated drainage of fluid, initial failures were the result of incorrect settings on the echocardiographic machine and inappropriate combinations of the needle puncture site and imaging window. This study demonstrates a novel color Doppler technique that is highly accurate at localizing a needle tip. The technique is feasible for guiding pericardiocentesis. Further clinical validation of rials technique is required. (J Am Soc Echocardiogr 2001;14: 29-37.).
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U2 - 10.1067/mje.2001.106680
DO - 10.1067/mje.2001.106680
M3 - Article
C2 - 11174431
AN - SCOPUS:0035138507
VL - 14
SP - 29
EP - 37
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
SN - 0894-7317
IS - 1
ER -