The Optimal Puncture Time Point Of Prolonged Occlusion Flow-mediated Dilatation In Radial Artery Catheterization

Objective:This study aimed to evaluate the degree and duration of the radial artery dilation after prolonged occlusion flow-mediated dilatation(PO-FMD),and the time point at which the radial artery diameter is expanded to the maximum.Subsequently,the aim of this study was to explore the efficacy of PO-FMD on the success rate of the first puncture in radial artery catheterization.Methods:(1)According to the Chinese guideline on the primary prevention of cardiovascular diseases(CVD),142 patients awaking from general anesthesia were divided into two groups:low-risk(LR)group and high-risk(HR)group.Firstly,the baseline radial artery diameter was measured on the left wrist using ultrasound in both groups.Subsequently,the radial artery diameters were obtained continuously at the same location for 5 minutes after PO-FMD.The baseline radial artery diameter,the maximum radial artery diameter,and the duration of radial artery dilation in the two groups were recorded.(2)To verify whether the optimal puncture time point is clinically meaningful,84 patients who undergoing general Anesthesia and requiring radial artery catheterization were included and were randomly allocated into pulse palpation group(PP group)or PO-FMD group,with 42 cases in each group.For the patients in PP group,palpation method was used to determine the location of the radial artery puncture.For the patients in PO-FMD group,a blood pressure cuff was placed on the left upper arm above the antecubital fossa.It was inflated to 30 mmHg above the patient’s systolic blood pressure for 10 minutes after which the cuff was deflated and traditional palpation pulsation approach was commenced.The first and total success rate of radial artery puncture,puncture attempts and complications was recorded.Result:(1)There were no statistically significant differences in gender,age,body mass index,triglycerides,high-density lipoprotein,smoking and baseline radial artery diameter between the two groups.The time point at which the radial artery diameter is expanded to the maximum in the LR group and HR group was 26.49±11.69s and 46.27±12.03s,respectively(P<0.01).The time of radial artery dilation and the percentage changes in arterial diameter in HR group were significantly lower than LR group(duration time:mean[mean ± standard]:136.65±31.55s vs.168.98 ±33.27s;percentage changes:median[interquartile range]10.5[8.6,12.9]%vs.15.2[12.4,19.0]%).(2)There were no statistically significant differences in gender,age,body mass index and cardiovascular diseases between the two groups.The success rate of the first puncture in the PP group and the PO-FMD group was 34.4%and 65.6%,respectively(P<0.05).There were fewer attempts and complications in the PO-FMD group as compared with PP group.However,there was no significant difference in the total success rate of radial puncture between the two groups.Conclusions:In this study,the optimal puncture time point after PO-FMD in low-risk group was 26s and the high-risk group was 46s.The application of PO-FMD for radial artery puncture with higher success rate of the first puncture,less attempts of puncture and lower incidence of complications compared with palpation method,which is worthy of clinical research and promotion.