Ultrasound-guided Artery Cannulation Research Articles

How does ultrasound-guided arterial cannulation compare with palpation or Doppler guidance in children and adolescents undergoing major surgery with planned arterial catheterization?

How does ultrasound-guided arterial cannulation compare with palpation or Doppler guidance in children and adolescents undergoing major surgery with planned arterial catheterization?

Ultrasound-guided arterial cannulation: Is the game over for the palpation technique?

Ultrasound-guided arterial cannulation: Is the game over for the palpation technique?

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.

Ultrasound-guided arterial cannulation: Is the game over for the palpation technique?

Ultrasound-guided arterial cannulation: Is the game over for the palpation technique?

Arterial cannulation in adult critical care patients: A comparative study between ultrasound guidance and palpation technique

ObjectiveTo compare first attempt success rate for ultrasound-guided (USG) versus direct palpation (DP) for radial, femoral, and dorsalis pedis artery cannulations in adult intensive care unit (ICU) patients. DesignProspective randomized clinical trial. SettingMixed adult ICU of a University Hospital. ParticipantsAdult patients (≥18 years) admitted to the ICU requiring invasive arterial pressure monitoring were included. Exclusion criteria were patients with a pre-existing arterial line and cannulated with other than a 20-gauge cannula for radial and dorsalis pedis artery. InterventionComparison of arterial cannulation by USG versus palpation technique in radial, femoral and dorsalis pedis arteries. Main variables of interestPrimary outcome was first attempt success rate, secondary outcomes were assessing time for cannulations, number of attempts, overall success rate, complications, and comparison of two techniques on patients requiring vasopressor. Results201 patients were enrolled in study, with 99 randomized to DP group and 102 to USG group. Arteries (radial, dorsalis pedis, femoral) cannulated in both groups were comparable (P = .193). Arterial line was placed on first attempt in 85 (83.3%) in USG group versus 55 (55.6%) in DP group (P = .02). Cannulation time in USG group was significantly shorter compared to DP group. ConclusionsIn our study, USG arterial cannulation, compared to palpatory technique, had a higher success rate at first attempt and a shorter cannulation time. Clinical Trial Registry of India numberCTRI/2020/01/022989.

Comparison of the Success Rate of Radial Arterial Cannulation with Palpation Techniques and Ultrasound Guidance in Patients Undergoing Major Surgery with General Anesthesia

Background: Ultrasound-guided arterial cannulation has the potential to increase the total success rate and first attempt and reduce complications compared to conventional landmark palpation methods. This study aims to compare the success rate of radial artery cannula with palpation techniques and ultrasound guidance in patients undergoing major surgery under general anesthesia.
 Methods: This study is a randomized controlled trial singly. The inclusion criteria for this study were patients who underwent both emergency and elective surgery under general anesthesia, aged >18 years, with ASA I and II physical status. The study sample (60 people) was randomized by computer and divided into two groups (ultrasound guidance and palpation technique). The study will assess the success of the first insertion of the radial artery cannula in both groups. Data analysis was performed with SPSS 25 univariate and bivariate.
 Results: There is a significant relationship with the success of the first attempt at an ultrasound-guided cannula trial with a p-value of 0.045 with an odds ratio of 3.33 with a 95% confidence interval (0.998 – 11.139).
 Conclusion: Ultrasound-guided arterial cannulation has a better success rate and fewer complications than conventional palpation techniques.

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.

Ultrasound-guided arterial cannulation or by pulse palpation in the intensive care unit

IntroductionUltrasound (US) guidance increases the success rate and decreases complications during central venous catheterisation (CVC). The benefits of US guidance in arterial catheterisation are less clear. The aim of this study is to compare the outcomes of US-guided arterial catheterisation with the traditional landmark (LM) technique in critically ill children. MethodsA prospective multicentre study was carried out in 18 Paediatric Intensive Care units in Spain during a 6-months period. Ultrasound guided and landmark techniques were compared in terms of cannulation technical success and immediate mechanical complications. ResultsA total of 161 procedures were performed on 128 patients (78 procedures in the US group and 83 in the LM groups).. The median (interquartile range) age and weight of the cohort was 11 months (2–52), and 10 kg (4–17) respectively. More than half (59.6%) were male. US was used mainly in high-volume-high-complexity hospitals (cardiac surgery program 76.9% vs. 25.6%, P < .001) as well as in smaller children [weight 5.7 kg (3.8−13) vs 11.5 kg (4.9−22.7), P < .001]. Almost half (49.7%) of the procedures were performed by an inexperienced operator (paediatric resident, or staff with less than 5 years of clinical experience in the PICU), and only 24.4% had performed more than 50 US-guided vascular access procedures before the study. There were no significant differences between US and LM techniques in terms of first-attempt success (35.8% vs 33.7%, P = .773), overall success (75.6% vs 71.1%, P = .514), number of puncture attempts [2 (1−4) vs 2 (1−3), P = .667] and complications (16.6% vs 25.6%, P = .243). Adjustment by potential confounders using multivariate regression models did not modify these results. Subgroup analyses showed that US outperformed LM technique in terms of overall success (83.7% vs 62.7%, P = .036) and complications (10.8% vs 32.5%, P = .020) only when procedures where performed by less-experienced operators. ConclusionsIn this prospective observational multicentre study, US did not improve arterial cannulation outcomes compared to the traditional LM technique in critically ill children. US-guided arterial cannulation may offer advantages when cannulation is performed by inexperienced operators.

Arterial insertion method: A new method for systematic evaluation of ultrasound-guided radial arterial catheterization.

Peripheral arterial catheter insertion is a common procedure for critically ill patients requiring frequent blood gas sampling and continuous blood pressure monitoring. There are clear advantages of ultrasound-guided arterial cannulation, which have shown to be more effective in reducing complications, time to successful cannulation, number of attempts, and overall first-time success rates. Evidence suggests that using palpation alone has a first-time success rate of less than 70% yet is still a widely performed technique. A systematic evaluation may be required to reduce variations in arterial catheterization practices. The arterial insertion method is a systematic evaluation to aid in arterial catheter insertion with ultrasound guidance, intended to improve the procedural approach. The process of arterial insertion method ensures appropriate choice of zone selection to optimize catheter longevity and performance in patients requiring arterial access. Moving the insertion site proximally 4 cm from the red zone into the green zone may reduce mechanical complications and preserve catheter performance and dwell time. The standardization of ultrasound guidance in arterial catheterization promotes vessel health and patient safety through device and site optimization. The arterial insertion method systematic evaluation may be utilized to reduce variation in practice and promote the use of ultrasound as a standard for the insertion of radial arterial catheters.

Comparison of Ultrasound-Guided Vs Traditional Arterial Cannulation by Emergency Medicine Residents.

IntroductionWe sought to determine whether ultrasound-guided arterial cannulation (USGAC) is more successful than traditional radial artery cannulation (AC) as performed by emergency medicine (EM) residents with standard ultrasound training.MethodsWe identified 60 patients age 18 years or older at a tertiary care, urban academic emergency department who required radial AC for either continuous blood pressure monitoring or frequent blood draws. Patients were randomized to receive radial AC via either USGAC or traditional AC. If there were three unsuccessful attempts, patients were crossed over to the alternative technique. All EM residents underwent standardized, general ultrasound training.ResultsThe USGAC group required fewer attempts as compared to the traditional AC group (mean 1.3 and 2.0, respectively; p<0.001); 29 out of 30 (96%) successful radial arterial lines were placed using USGAC, whereas 14 out of 30 (47%) successful lines were placed using traditional AC (p<0.001). There was no significant difference in length of procedure or complication rate between the two groups. There was no difference in provider experience with respect to USGAC vs traditional AC.ConclusionEM residents were more successful and had fewer cannulation attempts with USGAC when compared to traditional AC after standard, intern-level ultrasound training.

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.

Ultrasound-guided arterial cannulation for paediatrics.

Arterial line cannulation in paediatric patients is traditionally performed by palpation or with Doppler auditory assistance in locating the artery before catheterization. It is not clear whether ultrasound guidance offers benefits over these methods. To assess first attempt success rates and complication rates when ultrasound guidance is used for arterial line placement in the paediatric population, as compared with traditional techniques (palpation, Doppler auditory assistance), at all potential sites for arterial cannulation (left or right radial, ulnar, brachial, femoral or dorsalis pedis artery). We searched CENTRAL, MEDLINE (Ovid) and Embase (Ovid). We also searched databases of ongoing trials (ClinicalTrials.gov (www.clinicaltrials.gov/), Current Controlled Trials metaRegister (www.controlled-trials.com/), the EU Clinical Trials register (www.clinicaltrialsregister.eu/) and the WHO International Clinical Trials Registry Platform (http://apps.who.int/trialsearch/). We tried to identify other potentially eligible trials by searching the reference lists of retrieved included trials and related systematic or other reviews. We searched until January 2016. We included randomized controlled trials (RCTs) comparing ultrasound guidance versus palpation or Doppler auditory assistance to guide arterial line cannulation in paediatrics. Two review authors independently assessed the risk of bias of included trials and extracted data. We used standard Cochrane meta-analytical procedures, and we applied the GRADE method to assess the quality of evidence. We included five RCTs reporting 444 arterial cannulations in paediatric participants. Four RCTs compared ultrasound with palpation, and one compared ultrasound with Doppler auditory assistance.Risk of bias varied across studies, with some studies lacking details of allocation concealment. It was not possible to blind practitioners in all of the included studies; this adds a performance bias that is inherent to the type of intervention studied in our review. Only two studies reported the rate of complications.Meta-analysis showed that ultrasound guidance produces superior success rates at first attempt (risk ratio (RR) 1.96, 95% confidence interval (CI) 1.34 to 2.85, 404 catheters, four RCTs, moderate-quality evidence) and fewer complications, such as haematoma formation (RR 0.20, 95% CI 0.07 to 0.60, 222 catheters, two RCTs, moderate-quality evidence). Our results suggest, but do not confirm, that a possible advantage of ultrasound guidance for the first attempt success rate over other techniques is more pronounced in infants and small children than in older children. Similarly, our results suggest, but do not confirm, the possibility of a positive influence of expertise in the use of ultrasound on the first attempt success rate. We also found improved success rates within two attempts (RR 1.78, 95% CI 1.25 to 2.51, 134 catheters, two RCTs, moderate-quality evidence) with ultrasound guidance compared with other types of guidance. No studies reported data about ischaemic damage. We rated the quality of evidence for all outcomes as moderate owing to imprecision due to wide confidence intervals, modest sample sizes and limited numbers of events. We identified moderate-quality evidence suggesting that ultrasound guidance for radial artery cannulation improves first and second attempt success rates and decreases the rate of complications as compared with palpation or Doppler auditory assistance. The improved success rate at the first attempt may be more pronounced in infants and small children, in whom arterial line cannulation is more challenging than in older children.

Short-axis/out-of-plane or long-axis/in-plane ultrasound-guided arterial cannulation in children: A randomised controlled trial.

Even with ultrasound guidance, arterial cannulation in children can be challenging. To compare the short-axis/out-of-plane (SAX) with the long-axis/in-plane (LAX) technique for ultrasound-guided arterial cannulation in children. A randomised controlled trial. A tertiary university hospital, from 5 January 2015 to 21 April 2015. 101 children, American Society of Anesthesiologists' physical status 1 or 2 and younger than 5 years of age. All were randomised into one of four groups according to age and ultrasound guidance technique: infants with SAX technique (n = 25), infants with LAX technique (n = 25), children with SAX technique (n = 25) and children with LAX technique (n = 26). Ultrasound-guided arterial cannulation was performed under general anaesthesia via the radial or posterior tibial artery, depending on individual position and operative field. The primary outcome was the total time to successful cannulation. Secondary outcomes included diameter and depth of the artery, time variables (imaging time, time to first successful puncture and time between first successful puncture and cannulation), number of puncture attempts, success rates (first puncture and final cannulation), posterior wall puncture rate and complications. Ultrasound-guided arterial cannulation was successful in 97 children (96.0%). There were no significant differences in the total time to successful cannulation between the two groups. Ultrasound imaging time was significantly longer in the LAX group than in the SAX group (46.5 ± 39.2 vs 16.0 ± 17.6 s; 95% confidence interval of mean difference, -42.7 to -18.3; P = 0.000). However, the posterior wall puncture rate was significantly higher in the SAX group than in the LAX group (95.7% vs 18.0%; P = 0.000; odds ratio 0.01; 95% confidence interval, 0.002 to 0.048). There were no statistically significant differences in other secondary outcomes. Despite the longer imaging time with the LAX approach, there was no significant difference in the total time to successful cannulation between the two techniques. The posterior wall puncture rate was lower in the LAX group than in the SAX group. Clinicaltrials.gov (identifier: NCT02333786).

Ultrasound-guided arterial cannulation

Ultrasound-guided arterial cannulation

Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations

Consistent anatomic accessibility, ease of cannulation, and a low rate of complications have made the radial artery the preferred site for arterial cannulation. Radial artery catheterization is a relatively safe procedure with an incidence of permanent ischemic complications of 0.09%. Although its anatomy in the forearm and the hand is variable, adequate collateral flow in the event of radial artery thrombosis is present in most patients. Harvesting of the radial artery as a conduit for coronary artery bypass grafting, advances in plastic and reconstructive surgery of the hand, and its use as an entry site for cardiac catheterization has provided new insight into the collateral blood flow to the hand and the impact of radial arterial instrumentation. The Modified Allen's Test has been the most frequently used method to clinically assess adequacy of ulnar artery collateral flow despite the lack of evidence that it can predict ischemic complications in the setting of radial artery occlusion. Doppler ultrasound can be used to evaluate collateral hand perfusion in an effort to stratify risk of potential ischemic injury from cannulation. Limited research has demonstrated a beneficial effect of heparinized flush solutions on arterial catheter patency but only in patients with prolonged monitoring (>24 h). Conservative management may be equally as effective as surgical intervention in treating ischemic complications resulting from radial artery cannulation. Limited clinical experience with the ultrasound-guided arterial cannulation method suggests that this technique is associated with increased success of cannulation with fewer attempts. Whether use of the latter technique is associated with a decrease in complications has not yet been verified in prospective studies. Research is needed to assess the safety of using the ulnar artery as an alternative to radial artery cannulation because the proximity and attachments of the ulnar artery to the ulnar nerve may potentially expose it to a higher risk of injury.

Ultrasound-guided arterial cannulation in infants improves success rate

In small children, the placement of arterial catheters can be technically challenging for even the most experienced anaesthetist. We investigated whether ultrasound imaging would improve the success rate and reduce time demand and complications of radial artery cannulation. In this prospective randomized study, we performed radial artery cannulation in 30 small children (age 40 +/- 33 months) using two different techniques for localization of the vessel. In Group 1 (n = 15), the traditional palpation method was used, while in Group 2 (n = 15) cannulation was directed by vascular ultrasound imaging. In addition, we used ultrasound to determine the cross-sectional area of the radial artery with and without dorsiflexion. For statistical analysis, the non-parametric U-test for non-paired data and the Wilcoxon signed rank sum test for paired data were used. Differences were considered significant, when P < 0.05. Ultrasound-guided puncture was successful in all children of Group 2 compared to only 12 of 15 (80%) children in Group 1. Fewer attempts with the imaging technique were required than with the traditional technique (20 vs. 34, P < 0.05). Dorsiflexion significantly reduced the mean cross-sectional area of the artery by 19%. The current pilot study suggests that ultrasound guidance is appropriate for radial artery catheter insertion, sharing many of the benefits of ultrasound-guided central vein catheter insertion.