Evaluation of the factors related to difficult ultrasound-guided radial artery catheterization in children under two years old: a prospective observational study

Abstract

Introduction Although ultrasound guidance has significantly improved the success rate of radial artery catheterization, the failure rate in small children is still high. For the further improvement of success rate, we prospectively evaluated the factors that make ultrasound-guided radial artery catheterization difficult in small children under two years old. Methods From October 2018 to September 2019, patients under two years old who required radial artery catheterization for surgery were enrolled. After collecting the anatomical characteristics of the radial artery using ultrasound at the puncture site, ultrasound-guided radial artery catheterization was performed by one experienced anesthesiologist and recorded as a movie clip for further analysis. The primary outcome was to identify the factors related to the first attempt failure. The factors associated with the total duration of the procedure until success were also evaluated. Results A total of 183 children were included in the analysis. A radial artery cross-sectional area of 1 mm2 or less (OR [95% CI]: 5.26 [2.48–11.18], P Discussion A radial artery cross-sectional area of 1 mm2 or less, and the presence of an anomalous radial artery branch significantly increased the difficulty of ultrasound-guided radial artery catheterization in small children under two years old. In patients of these ages, pre-procedural ultrasound scanning to find an optimal site for catheterization may increase the first-attempt success rate. However, further studies are needed to verify the usefulness of pre-procedural scanning.