Ultrasound-Guided Out-of-Plane Versus In-Plane Radial Artery Cannulation in Adult Cardiac Surgical Patients

Abstract Background: Given the low first-pass success rate of the conventional short-axis (SAX) or long-axis (LAX) approach, ultrasound-guided radial artery cannulation in adults with radial artery diameters less than 2.2 mm may still be challenging. In this study, we compare the efficacy of modified long-axis in-plane(M-LAIP) versus short-axis out-of-plane (SAOP) or conventional palpation(C-P) approaches for ultrasound-guided radial artery cannulation.Methods: This was a prospective, randomized and controlled trial, conducted from 1 July 2018 to 24 November 2018. A total of 201 patients (age 18 to 85 years, the diameter of the radial artery less 2.2 mm) were included. All patients were randomized 1:1:1 to the M-LAIP, SAOP or conventional palpation (C-P) approach. The primary outcome was the cannulation success rate. Secondary outcomes included first location time and cannulation time, number of attempts. The Chi-square (χ2) test was used to compare categorical data between 3 groups.Results: The cannulation success rate was significantly higher in the M-LAIP group than in the SAOP or C-P groups (first success rate: 80.3% vs 53.8% or 33.8%; p < 0.001; total success rate: 93.9% vs 78.5% or 50.8%; p < 0.001). First location time (seconds) was significantly longer in the M-LAIP group (31(28-35[12-44])) than in the SAOP (15(14-17[10-21]); p < 0.001) and C-P groups (12(8-13.5 [6-37]). However, the cannulation time (seconds) in the M-LAIP group (29(24-45[16-313])) was significantly shorter than that in the SAOP (45(28.5-135.5[14-346]); p = 0.002) and the C-P groups (138(27-308[12-363]); p < 0.001). The number of attempts was lower in the M-LAIP group compared with SAOP or C-P group (1.29±0.63 vs 1.8±0.89 or 2.22±0.93, p < 0.001).Conclusions: The use of the M-LAIP approaches significantly improved the success rate of radial artery cannulation in adults with radial artery diameters less than 2.2 mm, compared with that achieved with the use of traditional short-axis out-of-plane approach.Trial registration: ClinicalTrials.gov; No: ChiCTR-IOR-17011474; URL: http: // www. chictr.org. cn/index.aspx. Registered 24 June 2018.

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Dynamic needle tip positioning versus the angle-distance technique for ultrasound-guided radial artery cannulation in adults: a randomized controlled trial

BMC Anesthesiology ◽

10.1186/s12871-020-01152-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Bing Bai ◽

Yuan Tian ◽

Yuelun Zhang ◽

Chunhua Yu ◽

Yuguang Huang

Keyword(s):

Success Rate ◽

Radial Artery ◽

Posterior Wall ◽

Surgical Patients ◽

Arterial Cannulation ◽

Success Rates ◽

Ultrasound Guided ◽

Radial Artery Cannulation ◽

Artery Cannulation ◽

First Pass

Abstract Background Ultrasound guidance can increase the success rate and reduce the incidence of complications of arterial cannulation. There are few studies on the utility of the dynamic needle tip positioning (DNTP) technique versus the angle-distance (AD) technique for ultrasound-guided radial arterial cannulation in adult surgical patients. We assessed and compared the success rates and incidences of complications of these two short-axis out-of-plane techniques. Methods A total of 131 adult surgical patients were randomized into DNTP and AD groups to undergo ultrasound-guided radial artery cannulation. The primary outcome was first-pass success without posterior wall puncture. The secondary outcomes included the first-pass success rate, 10-min overall success rate, cannulation time, posterior wall puncture, and the number of skin punctures. Results The first-pass success rates without posterior wall puncture were 53.8% in the DNTP group and 44.6% in the AD group (RR = 1.22, 95% CI: 0.86–1.72; P = 0.26). The cannulation time was significantly longer (P = 0.01) in the DNTP group [79.65 (54.3–109.4) seconds] than in the AD group [47.6 (24.9–103.8) seconds]. The posterior wall puncture rate was significantly lower (P = 0.002) in the DNTP group (29.2%) than in the AD group (56.1%; RR = 0.56, 95% CI: 0.42–0.82). Conclusions There were no significant differences in the first-pass success rate, with or without arterial posterior wall puncture, or in the 10-min overall success rate between the DNTP and AD groups. However, the cannulation time was longer and the posterior wall puncture rate was lower in the DNTP group. Trial registration The trial was registered at www.clinicaltrials.gov (No: NCT03656978). Registered 4 September 2018.

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Modified Long-Axis In-Plane Ultrasound Versus Short-Axis Out-of-Plane Ultrasound For Radial Arterial Cannulation: A Prospective Randomized Controlled Trial

10.1101/19005496 ◽

2019 ◽

Author(s):

Jiebo Wang ◽

Liangcheng Zhang ◽

Qijian Huang ◽

Zhongmeng Lai ◽

Guohua Wu ◽

...

Keyword(s):

Success Rate ◽

Radial Artery ◽

Controlled Trial ◽

Short Axis ◽

Ultrasound Guided ◽

Radial Artery Cannulation ◽

Artery Cannulation ◽

Out Of Plane ◽

Cannulation Success Rate ◽

Cannulation Success

BACKGROUNDGiven a low first-pass success rate of the conventional SAX (short-axis) or LAX (long-axis) approach, ultrasound-guided radial artery cannulation in adults with radial artery diameter less than 2.2 mm may be still challenging.OBJECTIVETo assess the efficacy of modified long-axis in-plane(M-LAIP) versus short-axis out-of-plane (SAOP) or conventional palpation(C-P) approaches for ultrasound-guided radial artery cannulation.DESIGNA prospective, randomized and controlled trial.SETTINGOperating room in a tertiary university hospital, from 1 July 2018 to 24 November 2018.PATIENTSA total of 201 patients (age 18 to 85 years, the diameter of the radial artery less 2.2 mm) were included. Patients with history of forearm surgery, ulnar artery occlusion, abnormal Allen test, etc, were excluded from this study.INTERVENTIONSAll patients were randomized 1:1:1 to M-LAIP, SAOP or C-P.MAIN OUTCOME MEASURESThe primary outcome was the cannulation success rate. Secondary outcomes included first location time and cannulation time, number of attempts.RESULTSThe cannulation success rate was significantly higher in the M-LAIP group than in the SAOP group or C-P group (first success rate: 80.3% vs 53.8% or 33.8%; p =0.000; total success rate: 93.9% vs 78.5% or 50.8%; p =0.000). First location time (s) was significantly longer in the M-LAIP group compared with the SAOP group (31(28-35[12-44]) vs 15(14-17[10-21]); p =0.000) and the C-P group (31(28-35[12-44]) vs 12(8-13.5 [6-37]); p =0.000). However, the time of cannulation in the M-LAIP group (29(24-45[16-313])) was significantly shorter than that in the SAOP group (45(28.5-135.5[14-346]), p =0.002) and in the C-P group(138(27-308[12-363]), p =0.000). The number of attempts decreased in the M-LAIP group compared with SAOP or C-P group (1.29±0.63 vs 1.8±0.89 or 2.22±0.93, p =0.000).CONCLUSIONThe M-LAIP procedure for ultrasound-guided radial artery cannulation can offer a higher success rate of the first-attempt and total cannulation, fewer attempts and less time of cannulation.TRIAL REGISTRATIONThe study was registered at ClinicalTrials.gov (http://www.chictr.org.cn/index.aspx, number: ChiCTR-IOR-17011474).

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Comparison of three ultrasound-guided radial artery cannulation methods performed by anaesthesia residents: A prospective randomized controlled trial

10.21203/rs.3.rs-152370/v1 ◽

2021 ◽

Author(s):

Yingli Cao ◽

Jingxin Su ◽

Hang Fan ◽

Kang Kang ◽

Jiaqiang Zhang ◽

...

Keyword(s):

Success Rate ◽

Radial Artery ◽

Controlled Trial ◽

Return Time ◽

Ultrasound Guided ◽

Radial Artery Cannulation ◽

Clinical Trial Registry ◽

Artery Cannulation ◽

Radial Artery Catheterization ◽

Out Of Plane

Abstract BackgroundTo compare the short-axis/out-of-plane (SAX), long-axis/in-plane (LAX) and oblique-axis/out-of-plane (OAX) approaches for radial artery catheterization performed by anaesthesia residents with limited experience.MethodsTwo hundred and sixteen adult patients were scheduled to undergo surgery requiring continuous arterial pressure monitoring. They were randomized to the SAX, LAX and OAX groups at a 1:1:1 ratio. Thirty-three anaesthesia residents performed the cannulation procedures. The operators received an explanation of the theoretical anatomy of the radial artery and the operating process of three approaches for ultrasound-guided cannulation of the radial artery and practised artery cannulation on a model of radial artery cannulation. The primary outcome was the success rate of cannulation, and the secondary outcomes included the first-attempt success rate in the model and patients, the imaging time, blood return time, cannulation time, total time and incidence of adverse events.ResultsThe success rate of radial artery cannulation in the SAX group was significantly higher than that in the LAX group (71.4% vs 49.2%; P=0.009) and was clinically meaningfully higher than that in the OAX group (71.4% vs 61.7%; P=0.229). The total time was shorter in the SAX group than in the LAX and OAX groups: 51 (59) s vs 113 (66) s vs 86 (61) s; P=0.000. The first-attempt success rate for the model did not differ among the three groups. In the patients, the first-attempt success rate in the SAX group was significantly higher than those in both the LAX and OAX groups (69.7% vs 24.2% vs 6.1%; P=0.000).ConclusionAnaesthesia residents can achieve a higher success rate, higher satisfaction rate and shorter procedure time by using the SAX approach than by using the LAX and OAX approaches for radial artery catheterization.Trial registrrationChinese Clinical Trial Registry,ChiCTR200030416. Registered 1 March 2020,http://www.chictr.org.cn/edit.aspx?pid=50193&htm=4

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