Time-Action Analysis of Catheter Manipulation During Navigation Tasks in Bifurcations

Endovascular intervention is a form of minimally invasive intervention that allows catheters to be placed in practically any location of the vascular tree. However, to provide access to all these remote locations, an extensive array of catheters is needed. A specific catheter is choose based on experience, without any objective indication of its suitability during the actual procedure (Bakker, N. H., Tanase, D., Reekers, J. A., and Grimbergen, C. A., 2002, “Evaluation of Vascular and Interventional Procedures with Time—Action Analysis: A Pilot Study,” J. Vasc. Intervent. Radiol., 13(5), pp. 483–488). The aim of this study is to evaluate several catheters using time-action analysis during a navigation task in bifurcations of various geometries. The relation between the geometry of bifurcations, the catheters, and the time taken to perform specific actions is investigated. Nine novices manipulated five widely used selective catheters with a 0.035” guidewire in a model. In the model, four bifurcations of various diameters and angles were selected. Each bifurcation was cannulated six times with two different yet suitable catheters. The participants had no direct vision of the model but navigated the instruments using the images that were captured by a camera and displayed on a screen. All images presented to the participant were recorded and used for detailed time-action analysis of the various actions to cannulate a branch (e.g., catheter or guidewire retracted, rotated, and advanced). On average, the participants needed 28.3 s to cannulate a branch. When the ratio between the diameter of the main and side branch was high, the average time per task increased significantly, as did the number of attempts to navigate into a branch. However, neither the choice between the two suitable catheters for each bifurcation, nor the angles of the bifurcation made a significant difference in navigation time. Time-action analysis enabled objective measurement of the time spent on various actions to cannulate a branch. The results revealed that most time was spent on retracting and rotating the catheter. This was comparable for all catheters and branches, showing that all the instruments were manipulated in a similar way and presented the same difficulties.