| PART ONE A Comparative Study of Effects in Ultrasound-guided and Conventional Radial Artery CannulationObjective:The objective of the study was to compare the clinical effects of ultrasound-guided radial arterial cannulation verse the traditional palpation technique in patients receiving radial arterial cannulation.Methods:One hundred and twenty patients from emergency department intensive care unit ward needed to line the radial artery blood pressure measurement and gas analysis were enrolled in the present study. All patients or their families have signed informed consent. They were equally randomized into two groups, the traditional touch positioning group with 60 patients (group A) and ultrasound-guided radial artery catheterization group with 60 patients (group B), by using a random number table. The main endpoints included the success rate of cannulation, the puncture failure rate, the total operating time, the total number of puncture and puncture-related complication rates. In our study, sonographers who had at least 5 years of experience in performing interventional puncture completed all the operations. Statistical analysis was performed using SPSS 17.0 software. All data were expressed as mean+standard deviation (mean ± SD). In addition, difference of enumeration data and measurement data was compared with chi-square test and single factor analysis of variance (t test). A value of P<0.05 was considered statistically significant.Results:All patients completed the clinical trial and nobody did quit or lost during our trial. There was no significant difference in terms of characteristics of the patients between the two groups. Group B with the first success rate of 86% was significantly higher compared to group A with the success rate of 65%(P=0.006), as well as shorter puncture time [(15.1± 4.5) s vs. (17.6±6.8) s, P=0.02], less number of puncture [(1.8 ± 0.6) vs. (2.1 ± 0.5), P=0.004], lower puncture related complications (6.7% vs.20%, P=0.03).Conclusion:This study suggested that compared to the traditional palpation puncture technique, ultrasound-guided radial artery catheterization has a high first success rate, shorter puncture time, less number of puncture, and low puncture related complications, which suggested that ultrasound-guided radial artery catheterization is an effective and security technique.PART TWO A Comparative Study of Effects in In-Plane and Out-of-Plane Techniques During Ultrasound-guided Radial Artery CannulationObjective:The objective of the study was to compare the clinical effects of the in-plane and out-of-plane approaches in patients receiving ultrasound-guided radial artery catheterization.Methods:One hundred and twenty patients receiving ultrasound-guided radial artery catheterization from emergency department intensive care unit ward were enrolled in the present study. All patients or their families have signed informed consent. They were equally randomized into two groups, the in-plane group with 60 patients (group C) and out-of-plane group with 60 patients (group D), by using a random number table. The outcomes included characteristics of the patients, dimensional ultrasound images and color of radial artery, on both sides of the radial artery at the wrist crease distance from the skin of the front wall, the left radial artery puncture point and right away the transverse carpal front lines at the same radial distance from the skin of the front wall and the inner diameter of the distance,30min inner diameter of the left radial artery puncture point after extubation, after extubation 30min before puncture and left radial artery systolic blood flow velocity at the point of puncture, puncture and 30min after extubation noninvasive blood pressure, on both sides of the radial, ulnar artery diameter wrist stripes at the first time of puncture, the success rate of cannulation (including the first attempt, the second attempt, and the third attempt), the puncture failure rate, the total operating time, the total number of puncture and puncture-related complication rates. In our study, sonographers who had at least 5 years of experience in performing interventional puncture completed all the operations. Statistical analysis was performed using SPSS 17.0 software. All data were expressed as mean+standard deviation (mean±SD). In addition, difference of enumeration data and measurement data was compared with chi-square test and single factor analysis of variance (t test). A value of P<0.05 was considered statistically significant.Results:All patients completed the clinical trial and nobody did quit or lost during our trial. There was no significant difference in terms of characteristics of the patients between the two groups. All patients were satisfied with the ultrasound images. There was no significant difference with respect to the front wall of the distance from the skin on both sides of the radial artery at the wrist stripes [left side (2.8±0.4) mm vs. the right (2.7±0.5) mm] (P=0.23). There was no significant difference with respect to the left radial artery puncture point and right from the wrist crease at the same radial distance from the front wall from the skin [left side (4.2±0.4) mm vs. the right (4.1 ±0.5) mm] (P=0.23). There was no significant difference with respect to both sides of the inner diameter of the radial artery at the wrist stripes [left side (1.8±0.3) mm vs. the right (1.8±0.2) mm] (P> 0.05). There was no statistically significant with respect to both sides of the ulnar artery diameter at the wrist stripes [left side (1.5±0.2) mm vs. the right (1.5±0.3) mm] (P> 0.05). There was no statistically significant with respect to the left radial artery puncture point and right from the wrist crease equal distance radial artery diameter [left side (3.0±0.2) mm vs. the right (3.0±0.1) mm] (P=1). There was no statistically significant with respect to both sides of the radial artery peak systolic velocity [left side (47.5±9.7) cm/s vs. the right (46.4±8.9) cm/s] (P=0.52). There was no statistically significant with respect to both sides of the ulnar artery systolic blood flow velocity peaks [left side (39.2±7.5) cm/s vs. the right (38.9±9.4) cm/s] (P=0.85). There was no statistically significant with respect to the total operation time [(15.9±5.5) s vs. (16.7±6.0) s] and the total number of punctures [(1.4±0.5) s vs. (1.3±0.6) s] (P> 0.05) between the two groups. There was significantly shorter in terms of the first successful puncture time [(8.5±2.8) s vs. (10.7±3.5) s] as well as higher the first success rate (90% vs.78%) and lower puncture related complications (6.7% vs.0%) for the group D compared with the group C (P<0.05). In addition, there was not statistically significant for blood pressure either before the puncture or after extubation 30min between the two groups (P> 0.05). There was significantly shorter for radial artery diameter after extubation 30min than that before (P<0.05), and higher for the radial artery peak systolic blood flow velocity in front puncture after extubation 30min than that before (P<0.05).Conclusion:This study showed that the out-of-plane approach was superior to the in-plane approaches during ultrasound-guided radial artery catheterization. However, the most appropriate choose should be based on clinical setting, which could provide more effectively technical support for the clinics. Considering the advantages and disadvantages of each technology, the combination of the two technologies should help improve the success rate as well as others clinical effects, but further research is needed to confirm this. |
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