A WIN for Safety and Efficacy: Evaluation of Developmental WINguide and Hybrid Guide for Wire-in-Needle Peripherally Inserted Central Line Catheter (PICC) Cannulation

Highlights

• A randomized, controlled trial with 65 participants compared the efficacy of a newly designed universal guidewire advancer (WINguide) with novel wire-in-needle (WIN) technique (WT) and a newly designed needle guide (Hybrid Guide) for use with the newly described hybrid technique (HT) versus freehand modified Seldinger technique (MST) with the HT for effectively and safely achieving vein cannulation with a peripherally inserted central line catheter (PICC) guidewire on a simulation model.

• The HT for PICC line placement uses ultrasound to view a short axis puncture, rotating to long axis (LA) for guidewire placement. This provides real-time visualization of the needle tip during the entire procedure.

• Of the total participants, 63.1% believe the procedure is faster with WINguide with WT and Hybrid Guide with HT (WT/HT). Inexperienced participants (82.9%) felt PICC guidewire placement is safer using WT/HT. Inexperienced participants (82.9%) prefer WT/HT over freehand MST, and 90.8% of all participants would use WT/HT again.

• There were significantly fewer disappearances of LA view with devices (P = .002) and significantly fewer unique cases with disappearances of LA view (P = .002).

• Using survey results, there seems to be a preference to use the WT/HT compared to MST for guidewire placement. In all metrics evaluated, the two techniques had either statistically similar results or the WT/HT had statistically significantly better results than did MST.

Abstract

Purpose/Design: This study was conducted to determine the efficacy of WINguide with the wire-in-needle (WIN) technique and the Hybrid Guide with hybrid technique (WT/HT) in effectively and safely achieving vein cannulation with a peripherally inserted central line catheter (PICC) guidewire on a simulation model.

Methods: Two videos were watched. The first illustrates freehand modified Seldinger technique (MST) for PICC guidewire placement with ultrasound using a short axis (SA) puncture, rotating to long axis (LA) for placement into a Blue Phantom© manikin. The second uses the same SA and LA method using WT/HT. Randomized selection was performed to eliminate control bias; participants were recorded for data collection. Participants completed a survey on past proficiency and experience with the study devices.

Results: Sixty-three of the 65 total participants’ hands were video recorded with the ultrasound screen during procedures and were included in data analysis. There were significantly fewer disappearances (the image of the vein on the ultrasound screen disappears) of LA view with devices (P = .002) and significantly fewer unique cases with disappearances of the LA view (P = .002). Survey results of all 65 participants are included in descriptive statistics. Of the total participants, 63.1% believe the procedure is faster with WT/HT. Of the inexperienced participants, 82.9% felt PICC guidewire placement is safer using WT/HT; 82.9% of inexperienced participants prefer WT/HT over freehand MST; and 90.8% of all participants would use WT/HT again.

Limitations: Future research should be done with larger sample size.

Conclusions: Using survey results, there seems to be a preference for using the WT/HT compared to MST for guidewire placement. In all metrics evaluated, the two techniques had either statistically similar results or the WT/HT had statistically significantly better results than MST.