Technique For Arterial Cannulation Research Articles

Meta-analysis of central and peripheral cannulation for type A aortic dissection.

Acute type A aortic dissection necessitates rapid and effective arterial cannulation techniques for optimal outcomes. This meta-analysis compares the safety and effectiveness of direct aortic cannulation (AoC) with peripheral cannulation (PC) via the femoral or axillary arteries in aortic surgery for acute type A aortic dissection. A systematic review following PRISMA guidelines identified 10 retrospective studies encompassing 2518 patients (961 AoC, 1557 PC). Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated to analyze perioperative characteristics, short-term mortality rates, and postoperative complications including stroke and acute kidney injury. Short-term mortality did not significantly differ between AoC and PC (OR [95% CI] = 0.78 [0.61-1.01], p = .06). Likewise, postoperative stroke (OR [95% CI] = 0.86 [0.63-1.17], p = .33) nor acute kidney injury (OR [95% CI] = 1.11 [0.89-1.37], p = .35) showed no significant differences. AoC exhibited shorter operation time whereas there were no significant differences in aortic cross clamp time and cardiopulmonary bypass time between both groups. Our meta-regression analysis, considering the distal extent of aortic replacement, indicated that variations in aortic replacement rates did not significantly impact the observed outcomes. AoC is a viable alternative to PC for acute type A aortic dissection. While both approaches offer comparable outcomes, AoC's advantage in shorter operation time warrants thoughtful consideration in clinical practice.

Direct Right Axillary Artery Cannulation as First Choice Strategy during Aortic Surgery Procedures: Results from a Single Experienced Surgical Centre

Objectives: Since early nineties axillary artery has been proposed as alternative to femoral artery for peripheral arterial cannulation during cardiopulmonary bypass (CPB) in aortic surgery. The aim of this study is to report our single-centre experience using direct axillary artery cannulation during aortic surgery. Methods: One hundred consecutive patients, undergoing aortic surgery using direct axillary artery cannulation were enrolled. Patient population ranged between 29 to 87 years and mean age was 65 ± 13 years. Seventy-seven patients (77%) underwent scheduled complex surgical procedure and 23 patients (23%) underwent emergent surgical procedure. Sixteen patients, furthermore, have had a previous cardiac surgery procedure. Results: CPB management using direct axillary artery cannulation was satisfactory in all cases. No case of malperfusion (cerebral and/or visceral) was reported. Out of 100 patients undergoing direct cannulation of axillary artery, no major complications related to the site or the technique of the cannulation were recorded. Local minor complications were reported in 6 patients (6%). In all 6 patients such complications were transitory and there was no residual compromission at the discharge. Overall 30-days mortality was 16%. Twenty-two patients (22%) conversely were discharged directly from intensive care unit (ICU) to chronic rehabilitation center. Sixty-seven patients (67%) were successfully discharged home. Conclusions: Our experience clearly shows that direct axillary artery cannulation is a safe, effective and reproducible technique for arterial cannulation during complex surgical procedures involving thoracic aorta. We do support such approach as a first choice strategy in such circumstances.

Improving Circulatory Support in Cases of Acute DeBakey Type I Aortic Dissection: A Novel Arterial Cannulation Approach and Its Effects on Perfusion and Minimizing Complications

Objective. Proposing a novel arterial cannulation technique for acute DeBakey type I aortic dissection with severe aortic arch and branch involvement to enhance CPB effectiveness and reduce organ malperfusion complications. Methods. The technique involves retrograde insertion of an arterial perfusion tube into the aortic arch through the left common carotid artery. Extracorporeal circulation is established, and total aortic arch replacement with deep hypothermic systemic circulation and a frozen elephant trunk stent placement are performed to restore lower body perfusion. Results. Six patients with severe aortic arch and branch involvement underwent the new arterial cannulation technique. All patients had smooth postoperative recoveries without significant complications. Conclusion. The novel arterial cannulation technique shows promise in managing acute DeBakey type I aortic dissection with extensive vascular involvement, reducing complications, and enhancing patient outcomes. Further validation with a larger patient cohort is needed to confirm its effectiveness and safety. If successful, this technique could become a valuable addition to treatment strategies for improved outcomes.

Letter: Comment on the comparison between ultrasound-guided dynamic needle tip positioning and acoustic shadowing technique with palpation technique for radial arterial cannulation

Letter: Comment on the comparison between ultrasound-guided dynamic needle tip positioning and acoustic shadowing technique with palpation technique for radial arterial cannulation

A retrospective observational study of real-time ultrasound-guided peripheral arterial cannulation in infants.

To examine first attempt success and overall success of real-time ultrasound guided peripheral arterial cannulation in infants. Retrospective review of 477 ultrasound guided peripheral arterial cannulations in infants less than 1 year of age. Procedural and patient characteristics were evaluated to better understand factors related to procedural success. Ultrasound guided peripheral arterial cannulation had a first attempt success rate of 65% and an overall success rate of 86%. Success rates significantly differed by arterial location (p < 0.001). First attempt success and overall success were highest in the radial artery (72%, 91%) and lowest in the posterior tibial artery (44%, 71%). Success was more likely with greater age and greater weight (p = 0.006, p = 0.002). Success rates are high when using a real-time ultrasound-guided technique for peripheral arterial cannulation in infants. An infant's weight and selected artery are strong predictors of success when performing peripheral arterial cannulation. The use of procedural ultrasound may reduce unnecessary attempts and minimize procedure-related harm.

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.

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. 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. 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. 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.

Comparison between the long-axis in-plane and short-axis out-of-plane approaches for ultrasound-guided arterial cannulation: a meta-analysis and systematic review

BackgroundThe two most common methods for ultrasound-guided arterial cannulation are the long-axis in-plane (LA-IP) and short-axis out-of-plane (SA-OOP) approaches. However, it is uncertain which method is more advantageous. We conducted a meta-analysis of reported randomized clinical trials (RCTs) comparing the two techniques in terms of success rate, cannulation time, and complications.MethodsWe systematically searched PubMed, Embase, and the Cochrane Library database for RCTs comparing the LA-IP and SA-OOP techniques for ultrasound-guided arterial cannulation published from inception through April 31, 2022. The Cochrane Collaboration’s Risk of Bias Tool was used to evaluate the methodological quality of each RCT. Review Manager 5.4 and Stata/SE 17.0 were used to analyze the two primary outcome measures (first-attempt success rate and total success rate) and two secondary outcome measures (cannulation time and complications).ResultsA total of 13 RCTs with 1,377 patients were included. There were no significant differences in first-attempt success rate (risk ratio [RR], 0.93; 95% confidence interval [CI], 0.78–1.12; P = 0.45; I2 = 84%) and overall success rate (RR, 0.99; 95% CI, 0.95–1.02; P = 0.48; I2 = 57%). When compared with the LA-IP technique, the SA-OOP technique was associated with an increased incidence of posterior wall puncture (RR, 3.01; 95% CI, 1.27–7.14; P = 0.01; I2 = 79%) and hematoma (RR, 2.15; 95% CI, 1.05–4.37; P = 0.04; I2 = 63%). There was no significant difference in the incidence of vasospasm between techniques (RR, 1.26; 95% CI, 0.37–4.23; P = 0.07; I2 = 53%).ConclusionsThe present results suggest that the SA-OOP technique is associated with a higher incidence of posterior wall puncture and hematoma than the LA-IP technique, whereas success rates are similar for the two ultrasound-guided arterial cannulation techniques. These findings should be experimentally evaluated in a more rigorous manner due to high inter-RCT heterogeneity.

A Prospective Comparison of Ultrasound Guided Versus Palpation Method for Radial Artery Catheter Placement

Objectives: The objective of this study was to assess the effectiveness of ultrasound guided vs. conventional palpation method for radial artery cannulation in the operating room for patients undergoing elective open-heart operations. Methodology: This prospective observational study was carried at the National Institute of Cardiovascular Disease (NICVD) in Karachi and Sukkur. All cannulation procedures were performed by anesthesia residents (R-1). Two equal sized independent groups of patients based on radial artery cannulation technique, either ultrasound guided (USG) or conventional palpation method (CPM) were recruited. Artery cannulation success along with number of attempts, total duration, number of additional operators, need for change of site, and complications were recorded. Results: A total of 70 patients were recruited in each of the group, mean patient age was 52.43±13.53 years vs. 50.71 ± 14.1 years; p=0.605 with proportion of male patients as 65.7% (46) vs. 77.1% (54); p=0.290, for USG and CPM, respectively. Artery cannulation success rate was 74.3% (52) vs. 80% (56); p=0.569, mean number of attempts was 1.71±1.05 vs. 1.51±0.89; p=0.391, mean total duration was 7.76±3.78 minutes vs. 5.42 ± 8.2 minutes; p=0.131, mean number of additional operators was 0.74±0.44 vs. 0.89±0.32; p=0.128, need for change of site was 11.4% (8) vs. 2.9% (2); p=0.356, and complications were observed in 8.6% (6) vs. 2.9% (2); p=0.614 for USG and CPM, respectively. Conclusion: In this observational study, no significant differences were observed in the effectiveness of USG and CPM for radial artery cannulation when performed by newly inducted anesthesia residents.

Ultrasound-guided radial artery cannulation: A report of a simple and low-cost model for training

IntroductionPracticing models for invasive procedure have proven useful in achieving better rates of success for physicians in training. Often, these models are not easy to get because of its expensive price. Radial artery cannulation is a common practice and its performance with ultrasonographic guidance has proven to be more efficient than traditional ways. We developed a low-cost practicing model that may aid physicians in training to master the ultrasound-guided radial artery cannulation technique and achieve better rates of success when performing this procedure. MethodsUsing ordinary materials such as a piece of pork ham and rubber torniquets, we were able to build a 3-vessel artery model with pulsatile flow. ResultsUltrasonographic imaging revealed a vessel-like material embedded inside the piece of ham. This material resembles an artery which can be punctured with an in-plane or out-of-plane technique and cannulated afterwards, either with a Seldinger or a modified Seldinger technique. Once cannulated, pulsatile flow can be obtained through the catheter used. ConclusionOur model building time was 30 minutes, and its price doesn’t exceed more than $7.50 USD. This model can be used by physicians in training to practice the cannulation of a radial artery using ultrasonographic guidance.

Ultrasound-Guided Radial Artery Cannulation Technique in Elderly Patients Undergoing Non-cardiac Surgery: A Randomized Controlled Trial

<p id="p00005">In elderly patients, radial arterial cannulation is challenging and time-consuming. With ultrasound guidance, the success rate of this procedure can be increased, the associated complications can be reduced, and the procedure can be completed more quickly. A comparison was made between ultrasound-guided radial artery cannulation and traditional palpation techniques in elderly patients. In this randomized controlled trial, ninety elderly patients undergoing non-cardiac surgery were randomly divided into ultrasound-guided and palpation groups and then had arterial cannulation using either method by anesthesia residents. In this study, the primary outcomes were the success rate of cannulation at the first attempt, the overall success rate, and the time necessary to perform cannulation, and the secondary outcome was the incidence of cannulation-related complications. Also, eighty-nine elderly patients were analyzed in the present study. It was found that the ultrasound-guided group (84.09%) had a significantly higher first-attempt success rate than the palpation group (55.5%, P = 0.003). The ultrasound-guided group (45.7 ± 11.0s) had a considerably shorter cannulation time than the palpation group (54.2 ± 16.2s, P = 0.000). Furthermore, in the ultrasound-guided group, fewer attempts were made than in the palpation group. However, there was no significant difference between the two groups when it came to overall success rates and cannulation-related complications. Ultrasound-guided arterial cannulation is preferred for elderly patients compared to traditional palpation, as it achieves a higher success rate of cannulation and has fewer complications.

Epiaortic Ultrasound-Guided True Lumen Cannulation of Ascending Aorta in Acute Aortic Dissection Type A

Background: The choice of arterial inflow for acute Stanford type A aortic dissection repair remains controversial. The axillary artery should be considered as first choice for cannulation, but this technique is time-consuming. The ascending aortic cannulation provides antegrade perfusion and can be performed rapidly but there are several concerns such as aortic rupture, extension of dissection, and false lumen cannulation. Objective: To compare the establishment time of cardiopulmonary bypass (CPB) and postoperative outcomes of the two cannulation techniques that provide antegrade perfusion, which was direct true lumen cannulation on the dissected ascending aorta using epiaortic ultrasound-guided and axillary artery cannulation in Siriraj Hospital. Materials and Methods: The authors retrospectively reviewed all the 30 cases of acute aortic dissection type A using two different cannulation methods performed between February 2011 and May 2017. Direct true lumen ascending aortic cannulation was performed using the epiaortic ultrasound-guide with Seldinger technique in 12 patients, and axillary artery cannulation was performed in 18 patients. Results: The direct true lumen ascending aortic cannulation was safely performed in all patients. None of them had aortic rupture. Skin incision to CPB time was significantly faster in the epiaortic ultrasound-guided ascending aortic cannulation group at 29±8 versus 49±14 minutes (p&lt;0.001). The 30-day mortality and postoperative adverse events, such as ischemic stroke, acute kidney injury, visceral organ and limb malperfusion showed no statistically significant difference from the axillary artery cannulation method. Conclusion: Epiaortic ultrasound-guided true lumen cannulation of ascending aorta in the treatment of acute aortic dissection type A is safe and feasible. Skin incision to CPB time can be performed faster and provided good outcome compared to the axillary artery cannulation technique. Keywords: Acute aortic dissection, Ascending cannulation, Epiaortic ultrasound

Comparison of high aortic arch and other arterial cannulation types in ascending aortic pathologies

Background/Aim: Various cannulation techniques are used for different aortic pathologies during aortic surgery. High aortic arch cannulation is an easy technique which does not require a second incision. The aim of this study is to compare high aortic arch cannulation with other arterial cannulation techniques and assess its safety and risks profile. Methods: This retrospective study included sixty consecutive patients (23 female and 37 male) who underwent elective surgery for ascending aortic aneurysm between July 2011 and June 2014. Patients were divided into Group 1 (aortic arch cannulation) and Group 2 (femoral artery, axillary artery, innominate artery cannulations) according to the location of arterial cannulation. Preoperative, operative, and postoperative data of patients with or without arch cannulation were compared. Results: Ascending aorta was replaced with a graft in all patients. High aortic arch cannulation was performed in thirty-eight patients (63.3%) while the cannulation site was axillary artery in 9 (15%), femoral artery in 8 (13.3%) and innominate artery in 5 (8.3%) patients. There were no differences between the two groups in terms of preoperative demographic factors, concomitant cardiac pathologies, additional surgical procedures, and intraoperative parameters (P>0.05). Moreover, there was no difference between postoperative complications with the one exception of complications related to the cannulation site which was significantly more frequent in cannulation techniques other than arch cannulation (P=0.04). We observed no complications related to the cannulation site in patients with arch cannulation. Conclusion: Our study showed that high aortic arch cannulation in patients with ascending aortic aneurysms is an easy, fast, and safe technique with low complication rates. It can be the technique of first choice for those with ascending aortic aneurysms limited to ascending aorta with no place for cannulation, cross clamp and anastomosis but still can be repaired with single cross-clamping without total circulatory arrest.

Dynamic needle tip positioning versus the angle-distance technique for ultrasound-guided radial artery cannulation in adults: a randomized controlled trial

BackgroundUltrasound guidance can increase the success rate and reduce the incidence of complications of arterial cannulation. There are few studies on the utility of the dynamic needle tip positioning (DNTP) technique versus the angle-distance (AD) technique for ultrasound-guided radial arterial cannulation in adult surgical patients. We assessed and compared the success rates and incidences of complications of these two short-axis out-of-plane techniques.MethodsA total of 131 adult surgical patients were randomized into DNTP and AD groups to undergo ultrasound-guided radial artery cannulation. The primary outcome was first-pass success without posterior wall puncture. The secondary outcomes included the first-pass success rate, 10-min overall success rate, cannulation time, posterior wall puncture, and the number of skin punctures.ResultsThe first-pass success rates without posterior wall puncture were 53.8% in the DNTP group and 44.6% in the AD group (RR = 1.22, 95% CI: 0.86–1.72; P = 0.26). The cannulation time was significantly longer (P = 0.01) in the DNTP group [79.65 (54.3–109.4) seconds] than in the AD group [47.6 (24.9–103.8) seconds]. The posterior wall puncture rate was significantly lower (P = 0.002) in the DNTP group (29.2%) than in the AD group (56.1%; RR = 0.56, 95% CI: 0.42–0.82).ConclusionsThere were no significant differences in the first-pass success rate, with or without arterial posterior wall puncture, or in the 10-min overall success rate between the DNTP and AD groups. However, the cannulation time was longer and the posterior wall puncture rate was lower in the DNTP group.Trial registrationThe trial was registered at www.clinicaltrials.gov (No: NCT03656978). Registered 4 September 2018.

Resuscitating the Chimney Graft to Innominate Artery for Straightforward Cannulation During Infancy

Arterial cannulation with a chimney polytetrafluoroethylene graft to the innominate artery is commonly used for antegrade cerebral perfusion during neonatal aortic arch surgery. When properly retained and prepared before sternal closure, resuscitation of the polytetrafluoroethylene graft to innominate artery can be performed months later during sternal reentry. It is a safe and reproducible technique for expeditious arterial cannulation at stage II palliation in single-ventricle patients or complete intracardiac repair of biventricular lesions. We report our experience utilizing this technique successfully during reoperation in 90 of 92 patients, with no adverse thromboembolic events identified.

Modified long-axis in-plane ultrasound technique versus conventional palpation technique for radial arterial cannulation: A prospective randomized controlled trial.

A low first-pass success rate of radial artery cannulation was obtained when using the conventional palpation technique (C-PT) or conventional ultrasound-guided techniques, we; therefore, evaluate the effect of a modified long-axis in-plane ultrasound technique (M-LAINUT) in guiding radial artery cannulation in adults. We conducted a prospective, randomized and controlled clinical trial of 288 patients undergoing radial artery cannulation. Patients were randomized 1:1 to M-LAINUT or C-PT group at Fujian Medical University Union Hospital between 2017 and 2018. Radial artery cannulation was performed by 3 anesthesiologists with different experience. The outcome was the first and total radial artery cannulation success rates, the number of attempts and the cannulation time, and incidence of complications. Two hundred eighty-five patients were statistically analyzed. The success rate of first attempt was 91.6% in the M-LAINUT group (n = 143) and 57.7% in the C-PT group (n = 142; P < .001) (odds ratio, 7.9; 95% confidence interval, 4.0-15.7). The total success rate (≤5 minutes and ≤3 attempts) in the M-LAINUT group was 97.9%, compared to 84.5% in the palpation group (P < .001) (odds ratio, 8.5; 95% confidence interval, 2.5-29.2). The total cannulation time was shorter and the number of attempts was fewer in the M-LAINUT group than that in the C-PT group (P < .05). The incidence of hematoma in the C-PT group was 19.7%, which was significantly higher than the 2.8% in the M-LAINUT group (P < .001). Modified long-axis in-plane ultrasound-guided radial artery cannulation can increase the first and total radial artery cannulation success rates, reduce the number of attempts, and shorten the total cannulation time in adults.

Direct true lumen versus conventional cannulation for acute type-A aortic dissection.

Acute type-A aortic dissection is a surgical emergency and has a high rate of short-term mortality. Aortic dissection is highly under-reported in Pakistan. With the technological developments in its management, arterial cannulation technique of direct true lumen cannulation has emerged with improved outcomes. We aimed to compare the mortality and morbidity outcomes between direct true lumen and conventional cannulation techniques for arterial access in patients with acute type- A aortic dissection under a single-centre retrospective review from 2007 to 2017. Mean age of the participants was 43.3±11.6 vs 45±12.4 years with males being dominant in both groups. Frequency of overall morbidity was high in conventional cannulation group (Group-B), though it did not attain statistical significance, (p>0.999). Mortality rate was also high in Group-B (10% vs 30%), (p=0.582). Direct true lumen cannulation is an equally reliable option for establishing cardiopulmonary bypass due to reduced mortality and morbidity and may be given preference when dissection is extending into femoral and innominate arteries.

A novel Technique for Arterial Cannulation in Neonates: Angulation of Arterial Cannula

A novel Technique for Arterial Cannulation in Neonates: Angulation of Arterial Cannula

Ultrasound-Guided Artery Cannulation Technique Versus Palpation Technique in Adult Patients in Pre-Anesthesia Room: A Randomized Controlled Trial.

BackgroundThe ultrasonography-guided technique is superior to the traditional palpation technique for artery cannulation. However, considering the complexity of assembling the ultrasonography machine, this technique has not been extensively used. Here, we compared the ultrasonography-guided technique with the traditional palpation technique in adult patients in the pre-anesthesia room.Material/MethodsA total of 66 patients were enrolled and divided into 2 groups: the ultrasonography group and the palpation group. Anesthesiologists then cannulated the radial artery via either method. The primary outcomes included the first-attempt success and total success rates, as well as the cannulation duration and total procedure duration. The secondary outcome was the rate of complications attributable to cannulation.ResultsOverall, 60 patients were analyzed in the present study. The first-attempt success rate in the ultrasonography group (96.6%) was significantly higher than that in the palpation group (73.3%; P=0.03). There was no significant difference in the cannulation duration and the total procedure duration between the 2 groups. The rate of complications caused by cannulation in 2 groups was similar.ConclusionsThe ultrasonography-guided radial artery cannulation technique is more efficient for arterial cannulation in the pre-anesthesia room compared with the traditional palpation method.

No-Air Direct Innominate Artery Cannulation Technique for Aortic Arch Surgery

No-Air Direct Innominate Artery Cannulation Technique for Aortic Arch Surgery

Ultrasound-Guided Dynamic Needle Tip Positioning Technique Versus Palpation Technique for Radial Arterial Cannulation in Adult Surgical Patients: A Randomized Control Trial: Kiberenge RK, Ueda K, Rosauer B. Anesth Analg 2018;126:120-126

Ultrasound-Guided Dynamic Needle Tip Positioning Technique Versus Palpation Technique for Radial Arterial Cannulation in Adult Surgical Patients: A Randomized Control Trial: Kiberenge RK, Ueda K, Rosauer B. Anesth Analg 2018;126:120-126