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Yücel ED, Tekgul ZT, Okur O. The distal quarter of the forearm is the optimal insertion site for ultrasound-guided radial artery cannulation: A randomized controlled trial. J Vasc Access 2024; 25:538-545. [PMID: 36203357 DOI: 10.1177/11297298221126284] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Current guidelines recommend the use of ultrasound guidance for arterial cannulation. However, there are no recommendations on the best insertion site for radial artery cannulation in terms of catheter dwell time and incidence of complications. METHODS In this randomized controlled study 94 patients were randomly assigned into three groups, corresponding to three different sites of insertion for radial artery cannulation: hand wrist: (Site/group 1, n = 29), distal quarter part of the forearm (Site/group 2, n = 30) and the midpoint of the forearm (Site/group 3, n = 35). Age, height, weight, and diagnosis of each patient were recorded prior to insertions which were performed by a single investigator experienced in ultrasound-guided vascular access. RESULTS Radial artery diameters were similar (2.4 ± 0.4 vs 2.5 ± 0.3 vs 2.6 ± 0.4 mm), however skin to vessel distances were different between groups, and the depth of the radial artery increased progressively from distal to proximal sites. There was a significant difference between groups in terms of success rates at the first attempt. Only two cannulations were successful at first attempt, and overall, only 17 of 35 cannulations were successful at Site 1. Arterial cannula dislodgement rate was highest at Site 1(8/29, 26.7%), while the longest dwell time was at Site 2 with a median of 4 (IQR 3) days. CONCLUSIONS Considering the high removal rate at the wrist region and the high failure rate at the midpoint of the forearm, the distal quarter of the forearm can be identified as "the optimal insertion site' for ultrasound-guided radial artery cannulation.
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Affiliation(s)
- Ezgi Direnç Yücel
- Istanbul Basaksehir Çam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Zeki Tuncel Tekgul
- Izmir Bozyaka Training and Research Hospital, Bahar mh, Karabaglar, İzmir, Turkey
| | - Onur Okur
- Istanbul Prof. Dr. Cemil Tascioglu City Hospital, Sisli, Istanbul, Turkey
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Wang H, He L, Han C, Wan J. Evidence-based systematic review of removal of peripheral arterial catheter in critically ill adult patients. BMC Anesthesiol 2024; 24:79. [PMID: 38408893 PMCID: PMC10895724 DOI: 10.1186/s12871-024-02458-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/17/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVE To evaluate and summarize literature pertaining to evidence of peripheral arterial catheterization in adults, and to provide a reference for clinical practice. METHODS We undertook a systematic review of literature on the removal of peripheral arterial manometric catheters in adult patients from various sources such as UpToDate, BMJ, National Institute for Health and Care Excellence (NICE), Medlive, Cochrane Library, Joanna Briggs Institute (JBI) Evidence-based Health Care Center Database, CINAHL, PubMed, Wanfang Data, VIP, and other databases. The retrieval time was set as from the establishment of the database till August 30, 2021. We screened the studies that fulfilled the inclusion criteria, evaluated their quality, and retrieved and summarized such articles. RESULTS The review included 8 articles: 1 clinical decision, 3 guidelines, 2 evidence summaries, 1 systematic review, and 1 expert consensus. In all, 17 pieces of strong evidence were collected and extracted based on the following 5 dimensions: assessment of removal timing, preparation before removal, removal procedure, compression time, and key points after removal. CONCLUSIONS The removal of a peripheral arterial manometry catheter requires careful consideration by medical professionals. In order to increase the removal standardization rate and decrease the incidence of clinical complications, standardized procedures and training need to be developed.
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Affiliation(s)
- Hongju Wang
- Department of Thoracic Surgery, The Second Hospital of Shandong University, Jinan, 250033, China
| | - Lihuan He
- Department of Cardiovascular Surgery, The Second Hospital of Shandong University, 247 Beiyuan Street, Jinan, Shangdong, 250033, China
| | - Chun Han
- Department of Cardiovascular Surgery, The Second Hospital of Shandong University, 247 Beiyuan Street, Jinan, Shangdong, 250033, China
| | - Jianhong Wan
- Department of Cardiovascular Surgery, The Second Hospital of Shandong University, 247 Beiyuan Street, Jinan, Shangdong, 250033, China.
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Sun J, Lu B, Shan J, Pan Z, Sun J. Optimal insertion site for ultrasound-guided radial artery catheterization utilizing the dynamic needle tip positioning technique: A prospective randomized controlled study. J Vasc Access 2024:11297298241233713. [PMID: 38390724 DOI: 10.1177/11297298241233713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The dynamic needle tip positioning technique represents an advanced version of the short-axis out-of-plane ultrasound-guided approach employed for radial artery catheterization. The study aimed to explore the most effective insertion site capable of expeditiously and accurately executing the procedure in a clinical setting. METHODS A prospective randomized controlled study encompassed 246 elective surgery patients necessitating invasive arterial monitoring. Participants were randomly assigned to three distinct groups: Site 1 (targeting the radial styloid process), Site 2 (midway between Sites 1 and 3), and Site 3 (distal one-third of the forearm). The dynamic needle tip positioning technique was implemented across all groups. Crucial parameters, such as first-attempt success rate, time to success, overall success rate, total catheterization time, number of attempts, and complications, were meticulously documented and compared. RESULTS The Site 2 cohort presented a significantly heightened first-attempt success rate compared to Site 1 (97.5% vs 80%, p = 0.003) and Site 3 (97.5% vs 81.25%, p = 0.006). Moreover, Site 2 displayed a reduced time to success in contrast to Site 1 (31.5 vs 38, p = 0.003) and Site 3 (31.5 vs 40, p = 0.006). Total catheterization time was significantly shorter in Site 2 compared to Site 1 (32 vs 42.5, p < 0.001) and Site 3 (32 vs 43.5, p < 0.001). Site 2 necessitated fewer attempts than Site 1 (p = 0.02) and Site 3 (p = 0.03). Male gender and puncture at Site 2 were associated with expedited time to success. Adverse events manifested more frequently in the Site 3 group compared to the Site 1 group (15% vs 3.75%, p = 0.03) and the Site 2 group (15% vs 2.5%, p = 0.01). CONCLUSIONS The optimal insertion site for ultrasound-guided radial artery catheterization utilizing the dynamic needle tip positioning technique in adult patients is situated midway between the radial styloid process and the distal one-third of the forearm.
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Affiliation(s)
- Jiahui Sun
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Bo Lu
- Department of Anesthesiology, Ningbo No.2 Hospital, Ningbo, China
| | - Jianbo Shan
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Zhihao Pan
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Jianliang Sun
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Liu Y, Dong Y, Liu Y, Xu L. A novel track guidance ultrasound facilitates radial arterial cannulation: A prospective randomized controlled trial. J Vasc Access 2023:11297298231209382. [PMID: 37997017 DOI: 10.1177/11297298231209382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Ultrasound guidance for radial arterial cannulation is currently considered a best practice approach despite its clear advantages over the blind and palpation technique, the success rate is related to several factors, including clinician's experience and technical ability. The study aimed to explore the use of a novel track guidance ultrasound that may increase the success rate of radial arterial cannulation. METHODS A randomized controlled trial was conducted, in which 80 adults scheduled for elective surgery requiring radial arterial cannulation were recruited and randomly assigned to either the experimental group, which utilized novel track ultrasound guidance (group T, n = 40), or the control group, which utilized traditional ultrasound guidance (group U, n = 40). The novel track guidance ultrasound comprises a positioning track and a guided track. The radial artery could be positioned at the center of the positional track on the ultrasound image, and the direction and angle of needle are fixed and toward the center of the positioning track. The primary endpoint of the study was the first-pass cannulation success rate, while the secondary endpoints included the failure rate of cannulation, the number of radial artery punctures, the time of cannulation, and the incidence of hematoma. RESULTS The success rate of cannulation at the first attempt in group T (35 of 40 (87.5%)) was significantly higher than that in group U (23 of 40 (57.5%); p = 0.003). Although seven patients in Group U (7 of 40 (17.5%)) experienced failed cannulation compared to one in Group T (1 of 40 (2.5%)), the difference in failure rate between the two groups did not reach statistical significance (p = 0.06). CONCLUSIONS The implementation of novel track ultrasound guidance has demonstrated a notable improvement in the success rates at the first attempt while reducing the frequency of punctures and cannulation times.
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Affiliation(s)
- Yongzhe Liu
- Department of Anesthesiology, the Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuyan Dong
- Department of Anesthesiology, Yuncheng Central Hospital, Yuncheng, China
| | - Yi Liu
- Department of Anesthesiology, the Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Longhe Xu
- Department of Anesthesiology, the Third Medical Center of Chinese PLA General Hospital, Beijing, China
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Siddaramaiah MN, Sharma A, Goyal S, Kumar S, Kumari K, Goel AD, Bhatia P, Kothari N. Comparison of ultrasound-guided dynamic needle tip positioning and acoustic shadowing technique with palpation technique for radial arterial cannulation by experienced clinicians: A randomized controlled trial. J Vasc Access 2023:11297298231183472. [PMID: 37376777 DOI: 10.1177/11297298231183472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Radial artery cannulation is usually done for monitoring invasive blood pressure during intraoperative period. The dynamic needle tip positioning approach allows continuous visualization of the needle tip during ultrasound-guided cannulation. The acoustic shadowing technique, using two lines on the ultrasound probe, might be used to facilitate radial artery puncture. We aimed to compare these two ultrasound-guided techniques of radial artery cannulation with the traditional palpation method in adult patients. METHODS In this trial, 180 adult patients requiring arterial cannulation were randomized into three groups (Traditional palpation (TP), Dynamic needle tip positioning (DNTP), and acoustic shadow technique (AST)). All cannulations were carried out by experienced anesthetists. Data was analyzed for the success rate of arterial cannulation in the first attempt, total number of attempts in 5 min, time taken to cannulate, number of cannulas used, and complications related to the procedure. RESULTS The first attempt success rates among TP, DNTP, and AST were 66.7%, 66.7%, and 71.7%, respectively (p = 0.794). The median time taken for cannulation was 60.5 (37.0, 129.5) s, 71.0 (50.0, 170.0) s, and 108.0 (58.0, 181.0) s, respectively (p = 0.066) and the median number of cannulation attempts was 1, in all the three groups (p = 0.684). There was also no difference in the total number of cannulas used, the overall success rate of cannulation, and complications related to the procedure in the three groups. CONCLUSION The TP, DNTP, and AST technique for radial artery cannulation had comparable first attempt success rate, the time taken for cannulation, the number of cannulas used, and overall complications. We conclude that radial arterial cannulation by palpation, as well as ultrasound-guided DNTP and AST techniques performed by experienced clinicians in hemodynamically stable adult patients are equally advantageous.
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Affiliation(s)
| | - Ankur Sharma
- Department of Trauma & Emergency (Anaesthesiology), All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Shilpa Goyal
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Sandeep Kumar
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Kamlesh Kumari
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Akhil Dhanesh Goel
- Department of Community & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Pradeep Bhatia
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Nikhil Kothari
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
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Kim H, Park K, Lee J, Shin D, Son WG, Lee I. Transillumination facilitates coccygeal arterial cannulation in anaesthetised small-breed dogs. Vet Rec 2023; 192:e2881. [PMID: 37004214 DOI: 10.1002/vetr.2881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 02/13/2023] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Arterial access in small-breed dogs is challenging, but arterial visualisation may facilitate the procedure, as evidenced in human medicine. This prospective, randomised study investigated the result of using transillumination to guide coccygeal artery cannulation in small-breed dogs. METHODS Coccygeal artery cannulation was attempted in dogs anaesthetised with butorphanol, midazolam, propofol and sevoflurane. In 70 dogs (standard technique group [STECHNIQUE group]), arterial cannulation was performed using pulse palpation. In 71 dogs (transilluminating-standard technique group [TSTECHNIQUE group]), a transilluminating device was utilised. The device was placed on the dorsal tail, and the cannula was advanced towards the dark line visible against the bright background. If the artery was not well visualised due to pigmentation, pulse palpation was used. The success rate of arterial cannulation was compared between the groups using the chi-squared test. RESULTS Arterial cannulation was significantly more successful (p < 0.001) in the TSTECHNIQUE group (63/71 [88.7%]) than in the STECHNIQUE group (43/70 [61.4%]). LIMITATIONS The number of punctures attempted and the time to cannulation were not assessed, and the procedure was only performed by veterinarians experienced in arterial cannulation. CONCLUSIONS The transillumination allows for a more accurate approach to the coccygeal artery, improving the success of arterial cannulation when combined with pulse palpation.
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Affiliation(s)
- Hyunseok Kim
- Ian Animal Diagnostic Imaging Center, Seoul, Republic of Korea
| | - Kyoungsoo Park
- Ian Animal Diagnostic Imaging Center, Seoul, Republic of Korea
| | - Junhyup Lee
- Ian Animal Diagnostic Imaging Center, Seoul, Republic of Korea
| | - Donghwi Shin
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Won-Gyun Son
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Inhyung Lee
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
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Sharma A, Goyal S, Kumari K, Rathod D, Meshram T, Goel AD, Sethi P, Bhatia P, Kothari N. A randomized controlled trial comparing ultrasound-guided versus traditional palpatory methods of posterior tibial artery cannulation in adult patients. J Vasc Access 2023:11297298231152280. [PMID: 36719045 DOI: 10.1177/11297298231152280] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The palpation method of posterior tibial artery cannulation has not yet been compared to ultrasound-guided posterior tibial artery cannulation in adults. This research examined whether using ultrasound to cannulate the posterior tibial artery enhances first-pass cannulation success and lowers total procedure time. METHODS In this randomized controlled experiment, 76 adult patients were included who were undergoing surgery under general anesthesia and required artery cannulation. Cannulation of the posterior tibial artery was performed utilizing either an ultrasound-assisted method (group U) or a palpation method (group P). Data were analyzed for cannulation success on the first attempt, number of cannulation attempts, assessment time, cannulation time, and total procedure time. RESULTS The P group had a considerably shorter mean assessment time than the U group [14.29 ± 2.79 s vs 20.89 ± 2.70 s; p < .001]. Moreover, cannulation time was substantially longer in the P (29.20 ± 12.60 s) than in the U group (15.90 ± 6.50 s) (p < .001). The total procedure time remained statistically more in the P group than in the U group (p = 0.007). The rate of successful posterior tibial artery cannulation on the first attempt was comparable between the two groups (63.2% in the U and 55.3% in the P group, respectively; p = .484)]. CONCLUSIONS The posterior tibial artery may be a suitable alternative to arterial cannulation for individuals with multiple failed attempts or difficult access. The application of ultrasound during posterior tibial artery cannulation in adult patients is safe and feasible and accompanied by a reduction in cannulation and total procedure time. The rate of first-attempt successful posterior tibial artery cannulation was comparable between the two groups.
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Affiliation(s)
- Ankur Sharma
- Department of Trauma & Emergency (Anaesthesiology), All India Institute of Medical Sciences, Jodhpur, India
| | - Shilpa Goyal
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | - Kamlesh Kumari
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | - Darshana Rathod
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | - Tanvi Meshram
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | - Akhil Dhanesh Goel
- Department of Community & Family medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Priyanka Sethi
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | - Pradeep Bhatia
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | - Nikhil Kothari
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences, Jodhpur, India
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