Motion Analysis: An Objective Assessment of Novel Arterial Line Placement Protocol
Recommended Citation
Abou Daher L, Ayyar I, Polanco A, Baribeau V, Clark CR, Uribe-Marquez S, Guerra Londono C, Park A, Mitchell JD, Guruswamy J. Motion Analysis: An Objective Assessment of Novel Arterial Line Placement Protocol. Anesth Analg 2024; 139(5):296-298.
Document Type
Conference Proceeding
Publication Date
11-1-2024
Publication Title
Anesth Analg
Abstract
Introduction: Arterial line placement is a challenging skill for anesthesiology residents to master. Previous efforts have demonstrated the utility of analyzing data from motion trackers to objectively assess performance across procedural skills.1-2 While motion tracking has been previously used to assess radial artery access in interventional radiologists, the approach and equipment used was different from that traditionally used by anesthesiologists.3 Furthermore, this study was performed without guidance, with a skill trainer that required manual pulsation with a bulb device, potentially resulting in variability in rate and pulse pressure within and between attempts. Therefore, we developed and tested a standardized protocol for ultrasound guided arterial lines, integrating a machine-automated pulsatile arterial line simulator, and incorporating equipment commonly used by anesthesiologists. Our hypothesis was that our motion analysis would detect differences in performance between novices and experts. Methods: A Viper tracking system equipped with electromagnetic motion sensors (Polhemus Ltd, Colchester, VT), was used to record motion during the ultrasound-guided insertion of an arterial line. Sensor 1 was attached to the dorsum of the participant's dominant hand and sensor 2 was attached to the base of a Butterfly ultrasound probe (Butterfly Inc, Burlington, MA). An integrated arterial catheter (Arrow brand-Teleflex Medical, Carrington, NC) was used in this protocol as it is commonly used in anesthesiology for arterial line placement. The participants completed two trials of an arterial line procedure from image identification through cannulation on a pulsatile arterial line trainer (Simulab, Seattle, WA) using a heart rate of 80 BPM, a moderate pulse strength, and a standardized starting position and approach. Participants imaged the vessel, cannulated the vessel, passed the guidewire, advanced the catheter, and then removed the needle. All trials were recorded and de-identified for analysis. The 4 metrics measured were path length (total distance travelled), rotational sum (degrees rotated), translational motions (individual movements), and time from beginning to end of procedure. Data was collected on 10 novices (anesthesiology residents) and 3 experts (attending anesthesiologists) using identical protocols. Comparisons were made between novices and experts for each parameter measured using 2-tailed t-tests with unequal variance; significance was considered as p < 0.05. Results: Path length was not significantly different between novices and experts (p = 0.021). The remaining parameters were all significantly higher in novices than experts including rotational sum (p = 0.034), translational motions (p = 0.027), and time (p=0.021). Conclusions: In this protocol, novices could be reliably differentiated from experts based on rotational sum, translational motions, and time required to complete the procedure. Path length was not significantly different across cohorts. A non-significant difference in path length was potentially due to the lack of gross motor movements required to complete the procedure. More specifically, a lack of hand movement outside of the small procedural field and lack of sliding in the ultrasound probe. Meanwhile, greater rotational sum and translational motions in novices likely reflect their need for significantly more minor optimizations in angle needling with their dominant hand, probe fanning and rotation to image the needle tip, and overall redundancy in motion for both sensors after failing to effectively cannulate on first needle pass. Experts completing the procedure in less time suggests greater efficiency and familiarity with procedural flow. Future studies should aim to identify whether intermediate level trainees can be differentiated from novices and experts within this protocol. They should also explore the impact of naturally variable parameters such as artery depth and diameter, which convey significant variety in difficulty in clinical practice. Lastly, goal-directed moti n metric feedback should be explored as a tool to expedite learning curves in arterial line placement and mitigate skill decay. (Figure Presented).
Volume
139
Issue
5
First Page
296
Last Page
298
