Radial artery reliability using arterial Doppler assessment prior to arterial cannulation

Guidelines for Performing Ultrasound-Guided Vascular Cannulation: Recommendations of the American Society of Echocardiography

Vascular access is a commonly performed procedure to facilitate patient care. This document provides expert consensus from diverse specialists on best practices and techniques for incorporating ultrasound (US) into vascular access procedures. This update replaces the 2011 American Society of Echocardiography guidelines for US-guided vascular cannulation. It includes recommendations for US-guided access to central and peripheral veins and arteries in adult and pediatric patients based on the strength of the scientific evidence present in the literature. The major roles of US during vascular access include (1) precannulation vessel assessment, (2) dynamic US guidance during cannulation, and (3) identification of local complications. This document discusses the general aspects of anatomic and US imaging of vessels, US-guided vascular cannulation techniques, and the identification of local vascular cannulation complications. Proper training should impart the cognitive knowledge and technical skills necessary to perform US-guided cannulation. There is an increasing body of literature indicating that US-guided vascular access improves success rates and reduces complications, although the quality of the evidence to date remains weak. A gap remains between the existing evidence and guidelines for the use of US in clinical practice. The availability of US equipment and clinical proficiency will more likely influence the role of US-guided vascular access as a standard of care than will future research studies.

Evaluation of radial and ulnar artery blood flow after radial artery decannulation using colour Doppler ultrasound

Background

There is a lack of reports in the literature regarding changes in radial artery blood flow after decannulation. The objective of this study was to investigate changes in radial and ulnar artery blood flow after radial artery decannulation using Doppler ultrasound and to explore the factors that influence radial artery blood flow recovery.

Methods

In current observational study, we used colour Doppler ultrasound to measure the cross-sectional area of the radial (S_R) and ulnar artery (S_U) and peak systolic velocity of the radial (PSV_R) and ulnar artery (PSV_U) for both hands at four time points in patients with radial artery cannulation: pre-cannulation (T0), 30 min after decannulation (T1), 24 h after decannulation (T2), and 7 days after decannulation (T3). Repeated measures analysis of variance and logistic regression analysis were performed to analyse the data.

Results

Overall, 120 patients were included in the present study. We obtained the following results on the side ipsilateral to the cannulation: compared with T0, the ratio of PSV_U/PSV_R increased significantly at T1 and T2 (p < 0.01); compared with T1, the ratio of PSV_U/PSV_R decreased significantly at T2 and T3 (p < 0.01); compared with T2, the ratio of PSV_U/PSV_R decreased significantly at T3 (p < 0.01). Female sex (OR, 2.76; 95% CI, 1.01–7.57; p = 0.048) and local hematoma (OR 3.04 [1.12–8.25]; p = 0.029) were factors that were significantly associated with the recovery of radial artery blood flow 7 days after decannulation.

Conclusions

There was a compensatory increase in blood flow in the ulnar artery after ipsilateral radial artery decannulation. Female sex and local hematoma formation are factors that may affect the recovery of radial artery blood flow 7 days after catheter removal.