Ultrasound-guided Radial Artery Cannulation Research Articles

Longitudinal axis approach versus longitudinal oblique axis approach for ultrasound-guided radial artery cannulation in adult patients: A comparative study

Abstract Background and Aims: Ultrasonography (USG)-guided arterial cannulation is a frequently performed procedure in the operating room and intensive care unit. Conventionally, longitudinal/in-plane and transverse/out-of-plane approaches are used for cannulation. Recently, a longitudinal oblique approach has been described with the advantage of wide visualization area. Hence, the present study was designed to compare the success of USG-guided radial artery cannulation in longitudinal oblique axis (LOA) and longitudinal axis (LA). Material and Methods: Seventy patients requiring radial artery cannulation were randomly allocated into two groups: group L (USG-guided radial artery cannulation in LA) and group O (USG-guided radial artery cannulation in LOA). Primary outcome was to assess cannulation success in the first attempt, while the secondary outcomes were to assess the number of attempts, failure rate, total cannulation time, and associated complications. Results: First-attempt success was higher in group O (80%) compared to group L (54.3%), with a P value of 0.022. In group L, 31.4% required two attempts and 5.7% had three attempts, while in group O, 14.3% had two attempts and 2.9% required three attempts. Group L failure rate was 8.6%, while it was 2.9% in group O. The mean total cannulation time (sec) for group L was 146.83 ± 89.37 and group O was 63.89 ± 26.277. No complication was observed with group O, while in group L, 9% had hematoma formation. Conclusion: The LOA approach for USG-guided radial artery cannulation has higher first-pass success rate, total success rate, and requires less cannulation time compared to the LA approach.

Comparative Study of Periarterial Infiltration of Nitroglycerine with Lignocaine vs Lignocaine Alone for Ultrasound Guided Radial Artery Cannulation in ICU Patients

Background: Radial arterial cannulation is a commonly done procedure in ICU. Multiple cannulation attempts can lead to radial artery spasm resulting in low pulse volume, decreased pulse palpability and cannulation failure. This study evaluates the effects of periarterial nitroglycerine infiltration with lignocaine vs lignocaine alone in USG guided radial artery cannulation in ICU patients.
 Methods: A total of 60 ICU patients in age group 18-65 years who required radial artery cannulation for ABG analysis and invasive blood pressure monitoring were enrolled. They were randomly allocated to Group LN (periarterial infiltration with 0.2ml nitroglycerine+0.8 ml lignocaine 2%) and Group L (periarterial infiltration with 1ml of lignocaine 2%) of 30 patient each. Both groups were compared with respect to radial artery dimensions before and after infiltration of drug, pulse palpability score, no of attempts, time of cannulation and failure rates.
 Results: There was significantly greater increase in radial artery dimensions in group LN as compared to group L after intervention. Pulse palpability score was also better in group LN. Mean time required for cannulation, number of attempts and insertion failure were significantly lesser in group LN as compared to another group. No hemodynamic adverse effect was reported in either group.
 Conclusion: Periarterial infiltration with lignocaine and nitroglycerine combination increase radial artery dimension with improved cannulation success rate.

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.

Comparison of two ultrasound-guided techniques for radial arterial cannulation in adults - Observational cross-sectional study.

Short axis, out of plane (SAOOP) and long axis, in-plane (LAIP) are two approaches employed under ultrasound-guided radial arterial cannulation. Dynamic needle tip positioning (DNTP) is a recently introduced approach which integrates the features of both. A total of 114 adult patients from American Society of Anaesthesiologists (ASA) I-IV were studied in this hospital-based cross-sectional study after getting Institutional Ethical approval, CTRI registration and prior written informed consent. The primary objective was to compare the success rates among LAIP and DNTP techniques. The radial arterial diameter and its depth were correlated to the success rates in both. Statistical analysis was done using SPSS version 23.0. Success rates were similar in both (P value-0.094). Ultrasonographic location time (in seconds) was shorter in DNTP (4.351 ± 0.9727) compared to LAIP (7.140 ± 1.0763) (P value-0.0001). The mean overall diameter and depth of radial artery (in mm) were found to be 2.36 ± 0.02 and 2.51 ± 0.12, respectively. Pearson's correlation coefficient between cannulation time and diameter was found to be -0.602 (P value-0.0001) and with depth of the radial artery was 0.034 (P value 0.723). The success rates were similar in both techniques. Ultrasonographic location time of the radial artery was more in LAIP although cannulation time was similar in both. Cannulation time decreased with an increase in the diameter of radial artery but was unaffected by the depth of the radial artery.

Median nerve block increases the success rate of radial artery cannulation in women with gestational hypertension undergoing cesarean section

BackgroundThe radial artery cannulation helps to maintain the stability of maternal hemodynamics and reduce complications, however, it is difficult for women with gestational hypertension. Ultrasound-guided median nerve block can cause arterial vasodilation, which may improve the success rate of radial artery cannulation.MethodsNinety-two women with gestational hypertension and risks of intra-operative bleeding undergoing cesarean section following failed ultrasound-guided cannulation were identified and randomized into the median nerve block group and control group. Median nerve block was performed under the guidance of ultrasound in the middle forearm and 5 ml of 0.5% lidocaine was injected. Subcutaneous local block was administered in the control group. The ultrasound-guided radial artery cannulation was performed ten minutes after blocking. Baseline measurements (T1) were performed after 10 minutes of rest. All variables were measured again at 10 (T2) and 30 (T3) minutes after median nerve block or local block. The primary outcome was the success rate of radial artery cannulation within 10 minutes after blocking. The puncture time, number of attempts, the overall complications, and ultrasonographic measurements including radial artery diameter and cross-sectional area were recorded before (T1), 10 minutes (T2) after, and 30 minutes (T3) after block.ResultsA total of 92 pregnant women were identified and completed the follow-up. As compared to control group, the first-attempt success rate of radial artery cannulation was significantly higher (95.7% vs78.3%, p = 0.027) and procedure time to success was significantly shorter (118 ± 19 s vs 172 ± 66 s, p < 0.001) in median nerve group. Median nerve group also had a significantly less overall number of attempts (p = 0.024). Compared with control group, the diameter and cross-sectional area of radial artery increased significantly at the T2 and T3 points in median nerve group (p < 0.001), as well as percentage change of radial artery diameter and CSA. No difference was observed in the overall complication at chosen radial artery, which including vasospasm (21.7% vs 28.3%; p = 0.470) and hematoma (4.3% vs 8.7%; p = 0.677).ConclusionsUltrasound-guided median nerve block can increase the first-attempt success rate of chosen radial artery cannulation in women with gestational hypertension and risks of intra-operative bleeding undergoing cesarean section following failed radial artery cannulation, and especially for those anesthesiologists with less experienced in radial artery cannulation.Trial registrationChiCTR2100052862; http://www.chictr.org.cn, Principal investigator: MEN, Date of registration: 06/11/2021.

Ultrasound-guided Radial Artery Cannulation

Arterial cannulation can be used to monitor blood pressure in real time and facilitate frequent arterial blood gas analysis.It is one of the commonly used clinical techniques in anesthesia,emergency,and intensive care units.Studies have demonstrated that ultrasound guidance can increase the success rate of arterial cannulation and reduce the incidence of related complications.In recent years,ultrasound guidance technology has developed rapidly and is increasingly used in clinical practice.This article reviews the latest advances in the application of ultrasound guidance in radial artery cannulation.

Observation on Application Effect of Arterial Puncture and Catheterization under Guidance of Intelligent Medical Care Ultrasound in Clinical Anesthesia.

In clinical anesthesia and the rescue of critically ill patients, arterial puncture and catheterization are the most commonly chosen ways to establish central arterial access for patients. Invasive arterial puncture and catheterization facilitate the grasp of real-time vital sign information of patients during surgery, which strengthens patient monitoring during surgery and improves safety. However, the traditional method of arterial puncture and cannulation through palpation of the radial artery is often prone to complications related to mechanical injury, such as hemorrhage, hematoma, and accidental perforation of the artery. Studies have shown that ultrasound-guided radial artery puncture and cannulation can shorten the puncture cannulation time, reduce the incidence of complications related to puncture cannulation, and improve the success rate of puncture cannulation. In order to verify it, this paper uses the experimental group and the control group to conduct comparative experiments and uses the neural network method to evaluate the effects of the two methods. As a more mature method of artificial intelligence, BP neural network is widely used in a wide range of applications and has the characteristics of strong generalization ability and fast convergence, so we choose it as the base model. The specific work of this paper is as follows: (1) in-depth study of the relevant theory of BP neural network (BPNN), focusing on the structure of BPNN and the working principle of algorithm; the problems to be solved in the clinical anesthesia effect evaluation have laid a theoretical foundation for the establishment of an improved BPNN evaluation model in the following chapters. (2) introduce the basic principle of genetic neural network, analyze the benefits of combining genetic neural network and BPNN; introduce in detail the process of genetic algorithm to optimize the weights and thresholds of BPNN, and establish a GA-BP evaluation model. The test proves the feasibility and superiority of the model.

Comparison of Success Rates of Different Methods of Ultrasound-Guided Radial Artery Cannulation (Short-Axis and Long-Axis Methods) Against the Traditional Palpatory Method: A Prospective Randomized Study.

ObjectiveRecent meta-analysis comparing the success rates of various methods of arterial cannulation in adult patients found heterogeneity in the available data. Hence, we did this study to evaluate and compare the success rate of palpatory method with that of ultrasound guided methods of radial artery cannulation. The aim is to compare the first-attempt success rate of the palpatory method with that of ultrasound-guided radial artery cannulation techniques, namely, the short-axis out-of-plane and the long-axis in-plane methods.MethodsThis is a prospective, randomized, parallel-arm study. Ninety patients aged from 18 to 50 years (presenting for various surgeries requiring radial artery cannulation for invasive blood pressure monitoring or frequent arterial blood gas analysis) were divided into 3 groups. Each group had one of the 3 techniques of radial arterial cannulation, namely palpatory, short-axis ultrasound method, and long-axis ultrasound method. The parameters analyzed were first-attempt success rate, number of attempts needed, cannulation time, need for crossover of technique, and incidence of complications. Multivariate analysis was done with one-way ANOVA, with Tukey's post hoc test. For categorical data, the chi-square test was used. The probability value of .05 was considered as a significant level.ResultsThe first-attempt success rate was 76.7% in the long-axis method, 86.7% in the short-axis method, and 56.7% in the palpatory method. The short-axis method has been shown to have a shorter cannulation time, fewer attempts needed for successful cannulation, and lower need for crossover of techniques when the first 2 attempts fail.Conclusions: We conclude that the ultrasound-guided short-axis method of radial artery cannulation is associated with higher first-attempt success rate compared to the traditional palpatory method.

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.

A comparison of the success rate of radial artery cannulation between the ultrasound-guided and conventional palpation techniques in elderly patients undergoing cardiothoracic surgery.

Ultrasound-guided (USG) radial artery cannulation against the standard palpation technique increases the first attempt rate in both pediatric and adult patients. The objective of this study was to evaluate the benefits of USG versus the palpation technique in improving the first attempt rate in elderly patients. The patients over 65 years of age were randomized to the USG or Palpation group. The radial artery identification in the USG group was performed with the aid of the Sonimage HS 1. In the Palpation group, the radial artery was identified by manual palpation. The operators were cardiothoracic anesthesiologists. Overall success was defined as cannulation completed within 10 min. Eighty patients (40 in each group) were recruited. The respective first attempt and overall success rate for the USG group were similar to the Palpation group (P &gt; 0.999 and P = 0.732). The time to the first attempt and overall success were also similar (P = 0.075 and P = 0.636). The number of attempts, number of catheters used, and failure rates were similar between the groups (P = 0.935, P = 0.938, and P = 0.723). The number of successful cannulations within 10 min was similar for both the groups as categorized by the radial artery diameter (P = 0.169). The USG did not increase the first attempt or overall success rate of radial artery cannulation in the elderly patients undergoing cardiothoracic surgery. The time to first attempt and overall success were similar between both the groups. The number of attempts and number of catheters used were similar between both groups.

Modified long-axis in-plane ultrasound-guided radial artery cannulation in adult patients: A randomized controlled trial

IntroductionFor adults with small radial arteries, ultrasound-guided radial artery cannulation remains challenging and the relevant data is currently lacking. The study aimed to test the hypothesis that modified long-axis in-plane ultrasound guidance (M-LAIP) would improve success rates of radial artery cannulation in this population. Patients and methodsThis was a prospective, randomised, and controlled clinical study that enrolled 201 adult patients with diameters of the radial artery less than 2.2 mm. Patients were randomised to M-LAIP, short-axis out-of-plane (SAOP), or conventional palpation (C-P) group according to different approaches of radial artery cannulation (M-LAIP, SAOP, and C-P). Outcome measurements included the success rate, cannulation time, and cannulation-related adverse events. ResultsThe cannulation success rate was significantly higher in the M-LAIP group than in the SAOP or C-P groups (first success rate: 80.3% vs. 53.8% or 33.8%; P < 0.001; total success rate: 93.9% vs. 78.5% or 50.8%; P < 0.001). Total cannulation time in the M-LAIP group was shorter than that in the SAOP group (P = 0.002) or the C-P group (P < 0.001). The rates of posterior wall puncture and haematoma in the M-LAIP group were lower than that in the SAOP group or C-P group (P < 0.008). ConclusionThe use of the M-LAIP approach significantly improved the success rate of radial artery cannulation, shortened procedure time, and lowered the rates of posterior wall puncture and haematoma in adults with radial artery diameters less than 2.2 mm, compared with that achieved by the SAOP or C-P approach.

Preferred display size and visual distance for ultrasound-guided radial artery cannulation

Introduction: In-line positioning of an ultrasound image provides higher success rates and less time to completion for radial arterial cannulation. But preferable size and distance of ultrasound display has not been previously discussed.&#x0D; Objective: To assess the ideal visual distance and display size when using a smart phone or tablet as the ultrasound image display.&#x0D; Methods: Four smart phones or tablets were used as ultrasound displays in six different configurations in a simulated radial artery puncture. In a questionnaire, 116 anaesthesiologists working in Ibaraki Prefecture, Japan, were asked which of the six configurations was preferable for radial artery cannulation.&#x0D; Results: Sixty anaesthesiologists answered the questionnaire. About half (53%) preferred the smaller display (4- or 5.5-inch) fixed at a distance of 30 to 40 cm, and most of the rest (44%) preferred the larger display (7.9- or 9.7-inch) placed posterior to the probe with a visual distance of 45 to 60 cm.&#x0D; Conclusions: Among the anaesthesiologists, the preferable size and visual distance for ultrasound-guided radial artery cannulation varied using a smart phone or tablet for in-line display.

Ultrasound-guided radial artery cannulation in pediatric surgical patients &lt;24 months of age

Ultrasound-guided radial artery cannulation in pediatric surgical patients &lt;24 months of age

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.

Oblique versus longitudinal axis/in-plane approaches for ultrasound-guided radial arterial cannulation: A randomised controlled trial.

Oblique versus longitudinal axis/in-plane approaches for ultrasound-guided radial arterial cannulation: A randomised controlled trial.

Simulation-based training using a vessel phantom effectively improved first attempt success and dynamic needle-tip positioning ability for ultrasound-guided radial artery cannulation in real patients: An assessor-blinded randomized controlled study.

We evaluated whether a simulation-based training with a vessel phantom improves the basic skills of a novice required for ultrasound-guided radial artery cannulation in real patients. In addition, we analysed whether repeated simulation training sets with an inter-training interval would accelerate the learning curve. From March 2019 to July 2019, twenty-one anesthesiology residents were randomized into either a simulation group (n = 11) or control group (n = 10). Residents performed a total of 84 ultrasound-guided radial artery cannulations in real patients. The simulation group participated in two sets of simulation training on a vessel phantom (10 sessions per set) with a one-month inter-training interval. Trainee's performance proficiency was scored using a developed checklist, and a learning curve for each training set was constructed. To evaluate the effectiveness of our training curriculum in skill transfer, each resident performed four ultrasound-guided radial artery cannulations in real patients. The primary outcome was first attempt success rate and the secondary outcome was dynamic needle-tip positioning ability in real patients. The first attempt success rate and dynamic needle-tip positioning ability by ultrasound transducer were significantly higher in the simulation group than the control group (81.8% vs. 50%, P = 0.002 and 68.2% vs. 7.5%, P < 0.001, respectively). A reduced number of sessions was required to reach a plateau score on the learning curve in the repeated training set compared in the first-set (7 (5-8) vs. 3 (2-4), P = 0.003, respectively). Simulation-based training using a vessel phantom effectively improved the first attempt success rate for ultrasound-guided radial artery cannulation in real patients and the dynamic needle-tip positioning ability by ultrasound transducer in novice anesthesiology residents. In addition, repeated training curriculum accelerated the learning curve for recall skill proficiency and reduced inter-individual variability for skill acquisition. Clinical Research Information Service (KCT0003471, Principle investigator: Jeong Jin Min, Date of registration: 06/March/2019).

Subcutaneous Nitroglycerin for Radial Arterial Catheterization in Pediatric Patients: A Randomized Controlled Trial.

Pediatric radial artery cannulation is challenging because of the small vessel size. Nitroglycerin is a potent vasodilator and facilitates radial artery cannulation by increasing the internal diameter and preventing the vasospasm in adult patients. The authors hypothesize that subcutaneous nitroglycerin injection will improve the success rate of pediatric radial artery cannulation. This double-blind, randomized, controlled, single-center study enrolled pediatric patients (n = 113, age less than 2 yr) requiring radial artery cannulation during general anesthesia. The participants were randomized into the nitroglycerin group (n = 57) or control group (n = 56). After inducing general anesthesia, nitroglycerin solution (5 μg/kg in 0.5 ml), or normal saline (0.5 ml) was subcutaneously injected above the chosen radial artery over 10 s with ultrasound guidance. Three minutes later, the ultrasound-guided radial artery cannulation was performed. Radial artery diameter was measured before and after the subcutaneous injection and after cannulation. The primary outcome was the first-attempt successful cannulation rate. The secondary outcomes included the diameter of the radial artery and the overall complication rate including hematoma and vasospasm. A total of 113 children were included in the analysis. The nitroglycerin group had a higher first-attempt success rate than the control group (91.2% [52 of 57] vs. 66.1% [37 of 56]; P = 0.002; odds ratio, 5.3; 95% CI, 1.83 to 15.6; absolute risk reduction, -25.2%; 95% CI, -39.6 to -10.7%). Subcutaneous nitroglycerin injection increased the diameter of the radial artery greater than normal saline (25.0 ± 19.5% vs. 1.9 ± 13.1%; 95% CI of mean difference, 16.9 to 29.3%; P < 0.001). Overall complication rate was lower in the nitroglycerin group than in the control group (3.5% [2 of 57] vs. 31.2% [18 of 56]; P = 0.001; odds ratio, 0.077; 95% CI, 0.017 to 0.350; absolute risk reduction, 28.6%; 95% CI, 15.5 to 41.8%). Subcutaneous nitroglycerin injection before radial artery cannulation improved the first-attempt success rate and reduced the overall complication rates in pediatric patients.

Factors Contributing Successful Ultrasound-guided Radial Artery Cannulation and Its Complications When Using the Short-axis Out-of-plane Procedure

Objective To identify the possible factors that may influence the success and the complications of ultrasound-guided out-of-plane radial arterial cannulation. Methods Multivariate Logistic regression analysis was used to analyze the clinical data of 131 patients undergoing elective surgery and ultrasound-guided out-of-plane radial artery cannulation,dynamic needle tip positioning(DNTP) technique or angular distance(AD) technique and to find out the factors associated with the one-attempt success rate,overall success rate,posterior arterial wall perforation,and local hematoma. Results The depth of the anterior arterial wall≥3 mm was the factor associated with posterior arterial wall perforation(OR=0.314,95%CI:0.143-0.691,P=0.004) and local hematoma(OR=0.250,95%CI:0.107-0.585,P=0.001).The use of DNTP method was significantly associated with posterior arterial wall perforation(OR=0.303,95%CI:0.138-0.667,P=0.003). Conclusions During ultrasound-guided out-of-plane radial cannulation,puncture at the arterial anterior wall sites with a depth of≥3 mm can reduce the incidence of posterior arterial wall perforation and local hematoma.Compared with AD,DNTP can lower the incidence of posterior arterial wall perforation.

A novel method for ultrasound-guided radial artery cannulation in neonates by trainee anaesthesiologists: A randomised controlled trial.

The modified dynamic needle tip positioning (MDNTP) technique for ultrasound-guided radial artery cannulation (MDNTP-US technique) in neonates can be technically challenging for trainee anaesthesiologists. We hypothesised that by associating the MDNTP-US technique with hypodermic 0.9% sodium chloride (Saline MDNTP-US technique), which increases the subcutaneous radial artery depth, the procedure would become easier for trainee anaesthesiologists. To compare the Saline MDNTP-US technique, with the MDNTP-US technique for radial artery catheterisation in neonates by trainee anaesthesiologists with limited experience. Randomised controlled trial. Ninety-six neonates scheduled to undergo major abdominal surgery requiring continuous arterial pressure monitoring between May 2018 and December 2018 at the Children's Hospital of Chongqing Medical University were enrolled. Neonates with signs of skin erosions or haematomas at or near the insertion site, as well as those with low noninvasive blood pressure values, were excluded. Neonates were randomised to the Saline MDNTP-US and MDNTP-US groups in a 1 : 1 ratio. Twelve trainees performed the cannulation procedures. Duration of procedure, first attempt success rate, rate of success within 10 min, and the incidence of haematoma and thrombosis. The median [IQR] time to perform cannulation was less for the Saline MDNTP-US technique than for the MDNTP-US technique: 203 [160 to 600] vs. 600 s [220 to 600]; P = 0.005. The rate of success within 10 min, 72.9 vs. 47.9%; P = 0.012, was higher in the Saline MDNTP-US group than in the MDNTP-US group. The incidence of haematoma on postoperative day 1 was lower in the Saline MDNTP-US group than in the MDNTP-US group: 8.3 vs. 22.9%; P = 0.049. Trainee anaesthesiologists can achieve higher success rates by using the Saline MDNTP-US technique instead of the MDNTP-US technique for radial artery catheterisation in neonates, taking less time with a lower incidence of complications. ChiCTR-IOR-17014119 (Chinese Clinical Trial Registry).

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.