Effect of bevel direction on the success rate of ultrasound-guided radial arterial catheterization.

Sung-Won Min,Woo Hee Choi,Hee-Pyoung Park,Hyong-Rae Cho,Young-Tae Jeon,Ah-Young Oh,Chun Woo Yang,Byung-Gun Kim

doi:10.1186/s12871-016-0202-5

Abstract

BackgroundThis study assessed the effect of bevel direction on the success rate of ultrasound guided radial artery catheterization.MethodsA total of 204 patients requiring radial artery catheterization were randomly divided into bevel-up (n = 102) and bevel-down (n = 102) groups. Success rate, cannulation time, and number of attempts were compared groups.ResultsIn the bevel-down group, an arterial line was placed on the first attempt in 86 of 102 (84.3 %; 95 % confidence interval [CI] = 76 % to 90 %) patients versus 73 of 102 (71.6 %; 95 % CI = 62.1 % to 79.4 %) in the bevel-up group (p = 0.028). In the bevel-down group, the mean time to a successful radial arterial cannulation was 33.3 ± 6.3 seconds (95 % CI = 32.1-34.6) versus 35.9 ± 7.6 seconds (95 % CI = 34.4-37.2) in the bevel-up group (p = 0.011). The median score was 33.2 and interquartile range [IQR] was 10.9 (30.3-41.2) for the mean cannulation time in the bevel-up group. In the bevel-down group, the mean score was 32.3 (IQR 3.90, 30–33.9) for mean cannulation time. In the bevel-down group, 11 of 102 (7 %; 95 % CI = 0 to 16 %) patients developed a posterior wall puncture versus 22 of 102 ((21.6 %; 95 % CI = 14.7 to 17.2 %) in the bevel-up group.ConclusionThe bevel-down approach during ultrasound-guided radial artery catheterization exhibited a higher success with fewer complications compared to the bevel-up approach.Trial registrationClinical Research Information Service is Korean Clinical Trials Registry (KCT0001836). It was registered retrospectively 30th Nov 2015.

Highlights

This study assessed the effect of bevel direction on the success rate of ultrasound guided radial artery catheterization
Recent evidence suggests that ultrasound (US)-guided radial artery cannulation can improve the success rate of cannula insertion and decrease the incidence of complications compared to the traditional palpation method [1,2,3]
In the bevel-down group, an arterial line was placed on the first attempt in 86 of 102 (84.3 %; 95 % confidence interval [CI] = 76 % to 90 %) patients versus 73 of 102 (71.6 %; 95 % CI = 62.1 % to 79.4 %) in the bevel-up group

Summary

Introduction

This study assessed the effect of bevel direction on the success rate of ultrasound guided radial artery catheterization. Recent evidence suggests that ultrasound (US)-guided radial artery cannulation can improve the success rate of cannula insertion and decrease the incidence of complications compared to the traditional palpation method [1,2,3]. Puncture needle placement with US guidance can be performed using either a short-axis (out-of-plane) or a long-axis (in-plane) approach to visualize the needle as it is advanced toward the radial artery [5]. For US-guided radial artery catheterization, the short-axis approach is associated with a lower first-attempt success rate compared to the long-axis method (51 % vs 76 %) [6]. We hypothesised that using a bevel-down approach with the puncture needle can improve the success of the short-axis approach during US-guided radial artery catheterization. We compared differences between the bevel-down and bevel-up approaches with regard to number of insertion attempts, insertion time, and complication rate

Methods

Results

Discussion

Conclusion