Scale ultrasound-guided radial artery cannulation in infant: A randomized controlled trial

Background: Cannulation of the radial artery can be extremely challenging in infants. Scale ultrasound can provide accurate arterial location and guidance for operators. We hypothesized that scale ultrasound helps increase the initial success rate of radial artery cannulation in this population. Method: Seventy-six infants aged 0–3 months who needed arterial puncture after general anesthesia were randomly divided into two groups (1:1 ratio): the scale ultrasound group and the traditional ultrasound group. The primary endpoints were the success rate of the first attempt and the total success rate of arterial cannulation. The secondary endpoints were the time during arterial puncture and the incidence of vascular complications. Results: The success rate of the first attempt and the total success rate of arterial cannulation were 92.1% (35/38) versus 50% (19/38) and 100% (38/38) versus 86.8% (33/38) in the scale ultrasound and traditional ultrasound group ( p < 0.005), respectively. The median time to ultrasound location, needle entry into the radial artery, and successful cannulation in the scale ultrasound group were significantly shorter than those in the traditional ultrasound group: 10 (8.0, 17.2) s, 15 (11.7, 20) s, and 65 (53.8, 78.5) s vs 30 (26.5, 43.5) s, 35 (23, 51) s, and 224.5 (123.5, 356) s ( p < 0.001), respectively. The incidence of hematoma was higher in the traditional group ( p < 0.005). Conclusions: Scale ultrasound-guided radial arterial cannulation can significantly improved initial success rate and overall success rate, shorten puncture time in infant, compared with that achieved with the use of traditional ultrasound guidance.

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Scale Ultrasound-guided Radial Artery Cannulation in infant: A Randomized Controlled Trial

10.21203/rs.3.rs-133534/v1 ◽

2020 ◽

Author(s):

Fei Yang ◽

Shangyingying Li ◽

Hang Chen ◽

Rui Jiang ◽

Xuanqin Wang ◽

...

Keyword(s):

Success Rate ◽

Radial Artery ◽

Arterial Puncture ◽

Arterial Cannulation ◽

Ultrasound Guided ◽

Radial Artery Cannulation ◽

Artery Cannulation ◽

Successful Cannulation ◽

Ultrasound Group ◽

Initial Success Rate

Abstract BackgroundCannulation of the radial artery can be extremely challenging in infants. Scale ultrasound can provide accurate arterial location and guidance for operators. We hypothesized that scale ultrasound helps increase the initial success rate of radial artery cannulation in this population.MethodThis is a double-blinded, parallel-group trial prospective study. Seventy-six infants aged 0–3 months who needed arterial puncture after general anesthesia were randomly divided into two groups (1:1 ratio): the scale ultrasound group and the traditional ultrasound group. Patients in the traditional ultrasound group underwent conventional ultrasound-guided radial artery puncture, whereas radial artery puncture was guided by scale ultrasound in the scale ultrasound group. The primary endpoints were the success rate of the first attempt and the total success rate of arterial cannulation. The secondary endpoints were the time of ultrasound location, the time of the needle entering the radial artery, the time of successful cannulation, times of the arterial puncture and the incidence of vascular complications. Data analysis was performed with Minitab 18.0 (Minitab Inc., USA).Main ResultsThe success rate of the first attempt and the total success rate of arterial cannulation were 92.1% (35/38) and 100% (38/38) in the scale ultrasound group and 50% (19/38) and 86.8% (33/38) in the traditional ultrasound group (p < 0.005), respectively. The median time to ultrasound location, needle entry into the radial artery and successful cannulation in the scale ultrasound group were significantly shorter than those in the traditional ultrasound group: 10 (8.0, 17.2) s, 15 (11.7, 20) s and 65 (53.8, 78.5) s vs 30 (26.5, 43.5) s, 35 (23, 51) s and 224.5 (123.5, 356) s (p < 0.001), respectively. The incidence of hematoma was higher in the traditional group (p < 0.005).ConclusionsScale ultrasound-guided radial arterial cannulation can significantly improved initial success rate and overall success rate, shorten puncture time in infant,compared with that achieved with the use of traditional ultrasound guidance.

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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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Acoustic Shadowing Facilitates Ultrasound-guided Radial Artery Cannulation in Young Children

Anesthesiology ◽

10.1097/aln.0000000000002948 ◽

2019 ◽

Vol 131 (5) ◽

pp. 1018-1024 ◽

Cited By ~ 5

Author(s):

ZheFeng Quan ◽

Liang Zhang ◽

Chen Zhou ◽

Ping Chi ◽

HaiLi He ◽

...

Keyword(s):

Young Children ◽

Success Rate ◽

Radial Artery ◽

Ultrasound Guidance ◽

The Novel ◽

Ultrasound Guided ◽

Radial Artery Cannulation ◽

Artery Cannulation ◽

Ultrasound Group ◽

Acoustic Shadowing

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Arterial cannulation in young children can be challenging. Ultrasound guidance using focused acoustic shadowing may be suitable for guiding radial artery puncture in young children. The present research tested the hypothesis that ultrasound guidance using focused acoustic shadowing helps increase the success rate of radial artery cannulation in this population. Methods In a double-blinded, parallel-group trial, 79 young children undergoing surgery under general anesthesia were randomly assigned to two groups (1:1 ratio): the traditional ultrasound group and the novel ultrasound group. Young children in the traditional group underwent conventional ultrasound-guided radial artery puncture, whereas those in the novel ultrasound group underwent radial artery puncture guided by acoustic shadowing ultrasound with double developing lines. All radial artery punctures were performed using the short-axis out-of-plane approach. The primary endpoint was the success rate of cannulation at the first attempt. The secondary endpoints included cannulation failure rate, ultrasound location time, and puncture time. Results The success rate of cannulation at the first attempt in the novel ultrasound group (35 of 39 [90%]) was significantly higher than that in the traditional ultrasound group (24 of 40 [60%]; difference: 30% [95% CI, 12 to 48%], P =0.002). None of the patients in the ultrasound with acoustic shadowing group experienced failure of radial artery puncture and cannulation. The ultrasound location time and puncture time in the ultrasound acoustic shadowing group were significantly lower than that in the traditional ultrasound group (location time: median [interquartile range]: 6 [5, 8] vs. 18 [15, 21] s; puncture time: 24 [15, 41] vs. 40 [23, 56] s). Conclusions Acoustic shadowing via the use of double developing lines significantly improved the success rate of radial artery puncture in young children, compared with that achieved with the use of traditional ultrasound guidance.

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A Randomized Controlled Trial of Radial Artery Cannulation Guided by Modified Long Axis Ultrasound Versus Short Axis Ultrasound Versus Palpation

10.21203/rs.3.rs-80608/v1 ◽

2020 ◽

Author(s):

Jiebo Wang ◽

Liangcheng Zhang ◽

Zisong Zhao ◽

Zhongmeng Lai ◽

Qijian Huang ◽

...

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

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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Comparison of Effects of Guidewire-Assisted and Direct Arterial Puncture Techniques on Success Rate of Radial Artery Cannulation by Inexperienced Trainees

10.21203/rs.3.rs-601570/v1 ◽

2021 ◽

Author(s):

Worapot Apinyachon ◽

Natthaporn Boonyakad ◽

Inthuon Sangasilpa ◽

Phisut Lavanrattanakul

Keyword(s):

Success Rate ◽

Radial Artery ◽

Elective Surgery ◽

Catheter Insertion ◽

Arterial Puncture ◽

Technical Failure ◽

Radial Artery Cannulation ◽

Artery Cannulation ◽

Cannulation Technique ◽

Puncture Technique

Abstract Background: The radial artery is superficially palpable and easily accessible, making it the preferred site for arterial cannulation. Various placement techniques are available for radial artery catheter insertion. However, catheter insertion is sometimes difficult and requires multiple attempts, especially by inexperienced trainees, leading to technical failure and insertion-related complications. Guidewire-assisted cannulation is a simple and effective technique, but this maneuver requires practice. The main objective of this study was to compare the effects of a direct arterial puncture and a guidewire-assisted cannulation technique on the success rate of radial artery cannulation by inexperienced trainees.Methods: This study was a prospective, single-center, single-arm clinical trial with a historical control. Sixty patients with an American Society of Anesthesiologists physical status of I to III underwent elective surgery requiring radial artery cannulation. In the guidewire-assisted cannulation group (GW group), thirty radial artery cannulations were performed by inexperienced surgical residents using a guidewire-assisted cannulation technique. In the direct arterial puncture group (DP group), 30 patients underwent radial artery cannulation with a direct arterial puncture technique by inexperienced anesthesiology residents. The primary outcome was the success rate. Results: There were no differences in the baseline blood pressure or comorbidities between the two groups. Overall, the success rate of radial artery cannulation in the GW and DP groups were 90% and 50%, respectively (P = 0.001). The success rate of first-attempt cannulation in the GW and DP group were 66.7% and 26.7%, respectively (P = 0.002). The total procedural performance time was significantly shorter in the GW than DP group.Conclusion: The guidewire-assisted cannulation technique achieved a higher success rate than the direct arterial puncture technique when performed by inexperienced trainees.Trial registrationThe trial was registered on Thai Clinical Trials Registry (TCTR20200601004). Date of registration was January 19, 2020. (Retrospectively registered) http://www.thaiclinicaltrials.org/page_user/#

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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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Modified Long-Axis In-Plane Ultrasound Technique Versus Conventional Palpation Technique For Radial Arterial Cannulation: A Prospective Randomized Controlled Trial

10.1101/19001586 ◽

2019 ◽

Cited By ~ 1

Author(s):

Jiebo Wang ◽

Zhongmeng Lai ◽

Xianfeng Weng ◽

Yong Lin ◽

Guohua Wu ◽

...

Keyword(s):

Confidence Interval ◽

Success Rate ◽

Radial Artery ◽

Odds Ratio ◽

Success Rates ◽

Ultrasound Guided ◽

Radial Artery Cannulation ◽

Ultrasound Technique ◽

Artery Cannulation ◽

Cannulation Success

AbstractBackgroundA low first-pass success rate of radial artery cannulation was obtained when using the conventional palpation technique(C-PT) or ultrasound-guided techniques, we therefore evaluate the effect of a modified long-axis in-plane ultrasound technique (M-LAINUT) in guiding radial artery cannulation in adults.MethodsWe conducted a prospective, randomized and controlled clinical trial of 288 patients undergoing radial artery cannulation. Patients were randomized 1:1 to M-LAINUT or C-PT group at fujian medical university union hospital between 2017 and 2018. Radial artery cannulation was performed by three anesthesiologists with different experience. The outcome was the first and total radial artery cannulation success rates, the number of attempts and the cannulation time.Results285 patients were statistically analyzed. The success rate of first attempt was 91.6% in the M-LAINUT group (n=143) and 57.7% in the C-PT group (n=142; P<0.001) (odds ratio, 7.9; 95% confidence interval, 4.0-15.7). The total success rate (≤5 min and ≤3 attempts) in the M-LAINUT group was 97.9%, compared to 84.5% in the palpation group (p <0.001) (odds ratio, 8.5; 95% confidence interval, 2.5-29.2). The total cannulation time was shorter and the number of attempts was fewer in the M-LAINUT group than that in the C-PT group (p <0. 05).ConclusionModified long-axis in-plane ultrasound-guided radial artery cannulation can increase the first and total radial artery cannulation success rates, reduce the number of attempts and shorten the total cannulation time in adults.

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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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