A Clinical Study Of Ultrasound-guided Out-of-plane Radial Artery Puncture And Catheterization

Background For ultrasound-guided arterial cannulation,the traditional short-axis technique,that is,the angle-distance(AD)method,is accurate in positioning,which is convenient for novices to master.Earlier studies suggested that AD technique can significantly improve the success rate of cannulation.However,although this technique has the advantages of the short-axis technique,such as accurately positioning the puncture point and visualizing the relevant perivascular structures,the posterior wall puncture of the target artery may not be avoided.A modified ultrasound-guided short-axis technique,dynamic needle tip positioning(DNTP)technique,may reduce the risk of the posterior wall penetration.However,there have been rare studies comparing the success rate and the incidence of complications between DNTP technique and AD technique.Therefore,we try to compare these two techniques to find out the strengths and weaknesses of each technique.Methods Adult patients having nonemergent operations in Peking Union Medical College Hospital from September 2018 to February 2019 who required a radial arterial cannulation were enrolled.They were randomized into DNTP group and AD group undergoing ultrasound-guided radial artery cannulation.The primary outcome was first-pass success without posterior wall puncture.Secondary outcomes included first-pass success,overall success rate within 10 minutes,cannulation time,posterior wall puncture,and number of skin punctures.Statistical analysis was conducted on an intention to treat analysis.Results One hundred and thirty-one patients were included.For primary outcome,first-pass success rate without posterior wall puncture was 53.8%in the DNTP group as opposed to 44.6%in the AD group(RR=1.22,95%CI 0.86-1.72,P-0.26).For secondary outcomes,first-pass success rate was 53.9%in the DNTP group as opposed to 59.1%patients in the AD group(RR=0.90,95%CI 0.63-1.27,P=0.54).The overall success rate was 86.2%in the DNTP group compared to 80.3%in the AD group(RR=1.22,95%CI 0.82-1.81,P=0.37).The cannulation time was 79.65(54.3-109.4)seconds in the DNTP group,significantly higher than in the AD group,47.6(24.9-103.8)seconds,(P=0.01).The posterior wall puncture rate of the DNTP group was 29.2%,which was significantly lower than that of the AD group(56.1%)(RR=0.56,95%CI.42-0.82,P=0.002).In addition,there was no statistically difference of number of skin punctures between the two groups.Conclusion There are no statistically significant differences of first-pass success rate with or without arterial posterior wall puncture and overall success rate within 10 minutes in adult patients between DNTP group and AD group.However,there is longer cannulation time and lower posterior wall puncture rate in DNTP group than in AD group.Background Ultrasound-guided out-of-plane techniques have been used for radial arterial cannulation,which can increase the success rate and reduce the incidence of complications.Researchers have been continuously improving existing techniques to further increase the success rate and reduce the incidence of complications.We conducted a single-center randomized controlled study(RCT).On this basis,these data were further analyzed to find out the factors related to the success of ultrasound-guided out-of-plane radial artery cannulation and possible complications in order to provide more references for clinical practice.Methods Multivariate Logistic regression analysis was used to analyze the data of 131 patients undergoing elective surgery who required radial artery cannulation using out-of-plane technique under dynamic ultrasound guidance,with dynamic needle tip positioning(DNTP)and angle-distance(AD)technique.We tried to identify factors related to one-time success,overall success,arterial posterior wall penetration,and local hematoma.Results This study found that the depth of the anterior wall of the artery ?3 mm was the related factor of posterior wall puncture(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 DNTP method was the related factor for posterior wall puncture(OR=0.303,95%CI 0.138-0.667,P=0.003).Conclusion When ultrasound-guided out-of-plane radial cannulation is performed,puncture at the depth of the arterial anterior wall ? 3 mm can reduce the occurrence of posterior wall puncture and local hematoma;compared with the AD method,the DNTP method can reduce the occurrence of posterior wall puncture.