Abstract
Radial artery cannulation, which is a useful procedure for anesthetic management, is often challenging in elderly patients. Recently, the dynamic needle tip positioning (DNTP) technique was introduced to facilitate ultrasound-guided vascular catheterization. Therefore, we performed this prospective, parallel group, randomized, controlled trial to compare the ultrasound-guided DNTP technique with the palpation method in elderly patients. For this study, 256 patients aged 65 years or older were randomly allocated to the ultrasound-guided DNTP technique group (DNTP group) or the palpation method group (palpation group). The primary outcome was first-attempt success rate. The secondary outcomes were overall success rate, numbers of attempts and redirections, cannulation time, and incidence of complications. The first-attempt success rate (85.9% vs. 72.3%; relative risk [RR], 1.47; 95% CI 1.25-1.72; P<0.001) and the overall success rate (99.2% vs. 93.0%; RR, 1.07; 95% CI 1.02-1.12; P = 0.01) were significantly higher in the DNTP group compared to the palpation group. The numbers of attempts [1 (1,1) vs. 1 (1,3), P<0.001] and redirections [0 (0,1) vs. 2 (0,4), P<0.001] were significantly lower in the DNTP group. The cannulation time for successful attempts was 42 (32,55) seconds in the DNTP group and 53 (36,78) seconds in the palpation group (P<0.001). The incidence of hematoma was significantly lower in the DNTP group (7% vs. 24.2%; RR, 0.29; 95% CI, 0.14-0.59; P<0.001). Ultrasound-guided radial artery cannulation with the DNTP technique improved the efficiency of radial artery cannulation in elderly patients by increasing the success rate while minimizing complications.
Highlights
Arterial cannulation is a procedure often performed for repetitive blood tests and real-time monitoring of patient blood pressure during surgery [1]
The first-attempt success rate (85.9% vs. 72.3%; relative risk [RR], 1.47; 95% CI 1.25–1.72; P
The incidence of hematoma was significantly lower in the DNTP group (7% vs. 24.2%; RR, 0.29; 95% CI, 0.14–0.59; P
Summary
Arterial cannulation is a procedure often performed for repetitive blood tests and real-time monitoring of patient blood pressure during surgery [1]. The SAX-OOP approach offers a better view of surrounding structures during a targeted vessel approach, the posterior wall puncture rate is significantly higher [7, 8]. This is because the needle is visualized only as a dot in the SAX-OOP approach, and the plane of the ultrasound may pass through the shaft rather than the tip of the needle [8]. The dynamic needle tip positioning (DNTP) technique was introduced to facilitate ultrasound-guided vascular catheterization We performed this prospective, parallel group, randomized, controlled trial to compare the ultrasound-guided DNTP technique with the palpation method in elderly patients
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