Ultrasound-guided radial artery cannulation using dynamic needle tip positioning versus conventional long-axis in-plane techniques in cardiac surgery patients: a randomized, controlled trial.

Abstract

A novel ultrasound imaging technique, dynamic needle tip positioning (DNTP), enables continuous visualization of the needle tip during ultrasound-guided cannulation. The purpose of this study was to compare the rate of successful first-attempt radial artery cannulations between DNTP and the conventional long-axis in-plane (LAX-IP) technique. Adult patients undergoing cardiac surgery requiring radial artery cannulation were included and randomly allocated into either a DNTP or LAX-IP group. Radial artery cannulation was performed by a single experienced practitioner. The primary outcome was the first-attempt success rate of radial artery cannulation. Secondary outcomes included the length of time needed for cannulation and overall incidence of complications. A total of 136 patients were studied. The first-attempt success rate of cannulation was 94% in the DNTP group (N.=70) and 68% in the LAX-IP group (N.=66; OR 7.70, 95% CI 2.48-24.94, P<0.001). The total procedure time was also shorter in the DNTP group (median [IQR]; 87 [72-108] seconds) versus the LAX-IP group (118 [93-182] seconds; P<0.001). During cannulation, vasospasm occurred less often in the DNTP (4%) group compared to the LAX-IP group (17%; P=0.018). The DNTP technique had a greater first-attempt success rate of radial artery cannulation compared to the conventional LAX-IP technique. Also, DNTP required significantly less time for cannulation and had fewer complications.