Diagnostic Accuracy of Tissue Impedance Measurement Interpretation for Correct Veress Needle Placement in Canine Cadavers12. Issue 5 (1st February 2013)

• Record Type: Journal Article
• Authors: Whittemore, Jacqueline C.; Mitchell, Amanda; Hyink, Sara; Reed, Ann
• Is Part Of: Veterinary surgery. Volume 42:Issue 5(2013)
• Page Start: 613
• Page End: 622
• Publication Date: 2013-02-01
• Subjects: Veterinary surgery -- Periodicals; Veterinary Medicine -- Periodicals; Surgery -- Periodicals; Societies, Medical -- Periodicals; 636.0897
• DOI: 10.1111/j.1532-950X.2013.01107.x
• Languages: English
• ISSNs: 0161-3499

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="vsu1107-sec-0001" sec-type="section"> <title>Objective</title> <p>To establish the diagnostic accuracy of tissue impedance measurement interpretation (TIMI) for determining correct versus incorrect Veress needle placement.</p> </sec> <sec id="vsu1107-sec-0002" sec-type="section"> <title>Study Design</title> <p>Prospective, randomized, blinded trial.</p> </sec> <sec id="vsu1107-sec-0003" sec-type="section"> <title>Study Population</title> <p>Canine cadavers (n = 20).</p> </sec> <sec id="vsu1107-sec-0004" sec-type="section"> <title>Methods</title> <p>Two laparoscopists (1 experienced, 1 novice), blinded to tissue impedance measurement results, placed reusable Veress needles in canine cadavers in a randomized order. A 3rd individual interpreted impedance measurements as consistent with correct or incorrect Veress needle placement. Veress needle tip locations were marked by injecting contrasting colors of India ink. Tissue dissection was performed to localize ink. Sensitivity, specificity, accuracy, precision, and kappa statistics for TIMI for placements by the experienced and novice laparoscopist were determined. <italic>P</italic> < .05 was considered significant.</p> </sec> <sec id="vsu1107-sec-0005" sec-type="section"> <title>Results</title> <p>TIMI identified 29/33 correct and 7/7 incorrect placements, respectively. Impedance measurement interpretation had 87.9% sensitivity, 100% specificity, 90% accuracy, and 100% precision overall. Agreement between TIMI and Veress needle location was moderate (kappa 0.50, <italic>P</italic> = .01) for placements by the experienced laparoscopist and very high (kappa 0.88, <italic>P</italic> < .01) for the novice laparoscopist.</p> </sec> <sec id="vsu1107-sec-0006" sec-type="section"> <title>Conclusions</title> <p>Diagnostic accuracy of TIMI for Veress needle placement was higher than has been reported for other tests, and TIMI had a shallow learning curve. TIMI successfully detected all incorrect Veress needle placements. Further prospective evaluation of Veress needle placement with and without TIMI is warranted to determine if its use increases operator detection of inappropriate Veress needle placements or decreases installment phase complication rates.</p> </sec> </abstract>