David J Wasiak

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• Samsel, K., Wasiak, D., Situ-LaCasse, E., Adhikari, S., & Acuña, J. (2025). Real-time Ultrasound-guided Lumbar Puncture: A Comparison of Two Techniques Using Simulation. Western Journal of Emergency Medicine, 26(Issue 3). doi:10.5811/westjem.21163
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  Introduction: The current literature on the use of real-time ultrasound-guidance for lumbar punctures (LP) is limited. Two techniques have been described: the paramedian sagittal oblique (PSO); and the transverse interlaminar (TL) approach. Our objectives in this study were to compare the procedure outcomes between these two techniques and assess the ability of emergency physicians to perform ultrasound-guided LPs. Methods: This was a prospective study whose participants included emergency physicians. Participants were randomized into either Group P (PSO technique) or Group T (TL technique). After a didactic session, participants then performed an ultrasound-guided LP on a training manikin, during which we collected procedure data. A survey was administered after completion of the procedure. Results: A total of 31 participants were included, 16 in Group P and 15 in Group T. Most participants (90.3%) successfully performed the procedure, without a statistical difference between Group P and Group T (15/16 vs 13/15, P = 0.95). Group T required a longer average time to complete the procedure (176.7 ± 140.4 seconds [s] vs 311.2 ± 202.3 s, P = 0.04). There was no statistically significant difference between Group P and Group T with regard to average time needed to obtain the required ultrasound view (18.3 ± 14.6 s vs 35.1 ± 32.9 s, P = 0.09); number of needle redirections; total number of needle passes; first puncture success; number of participants who advanced the needle without visualization of the tip (13/16 vs 14/15, P = 0.64); penetration of the anterior dura; and needle contact with bone. The Likert-style questionnaire responses (reported on a 1-10 scale) revealed no difference between Group P and Group T as to perceived difficulty of finding the required ultrasound view (3 [interquartile range (IQR) 2-5) vs 5 (IQR 3-6.5), P = 0.10), perceived difficulty of needle tracking, or rating of the needle view when entering the intrathecal space. However, Group T reported a higher overall perceived level of difficulty (4 [IQR 3-5] vs 6 (IQR 5.5-7.5), P= 0.01). Conclusion: This study suggests emergency physicians can be trained to use ultrasound-guidance for lumbar puncture in the simulation setting without significantly prohibitive training. Both techniques were performed with high success rates. There may be a preference for implementing the paramedian sagittal oblique approach over the transverse interlaminar.
• Wasiak, D., Snell, E. W., Gaither, J. B., Demant, M., Bradley, G., & Acuña, J. (2025). The use of paramedics to establish an in-hospital ultrasound-guided peripheral intravenous access program. Journal of Vascular Access. doi:10.1177/11297298251333494
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  Introduction: The objective of this study is to evaluate the feasibility and effectiveness of an ultrasound-guided peripheral intravenous access program performed by paramedics in the emergency department. Methods: This was a retrospective, multicenter study. The medical director for each site was required to provide proof of completion of didactic training on the use of ultrasound to facilitate peripheral intravenous catheter placement; paramedic completion of hands-on training; and direct observation of successful cannulation. Training and requirements for credentialing were standardized among all institutions. Each institution utilized a secure data collection tool to collect data. Paramedics were required to complete a brief survey to collect quality improvement data each time an ultrasound-guided peripheral intravenous access attempt was made. Results: A total of 1368 survey responses were collected over 19 different sites. The overall success rate for ultrasound-guided PIV catheter placement was 95.72% (1297). Of those successful cannulations, 96.38% (1250) were completed on the first attempt of insertion, 3.32% (43) required two attempts, and 0.31% (4) reported requiring three attempts. Twenty-four complications following cannulation attempts were reported, with the most common being infiltration. The out-of-plane approach was most often used (83.77%, 1146), versus in-plane approach (16.23%, 222). The most frequent site of peripheral intravenous catheter placement was the forearm. (57.7%, 749), followed by the antecubital fossa, brachial and basilic vein respectively. The highest complication rate occurred at the basilic vein. Conclusion: In the face of expanding staffing shortages and a continued need for timely peripheral intravenous catheter placement, it is imperative to explore its application among paramedics. By incorporating ultrasound-guided peripheral intravenous catheter placement into their practice, paramedics may have the potential to improve the efficiency and success of catheter placements, thereby enhancing patient outcomes and streamlining workflow in the emergency department.