The Study Of Ultrasound-guided Radial Artery Cannulation

Objective:Ultrasonic technology is widely used in arterial catheterization. The primary purpose is to observe the radial artery and adjacent anatomic structures using ultrasound machine. A secondary purpose is to compare the effect of in-plane and out-of-plane technology on the arterial catheterization in different subcutaneous distance.Methods:Part one:20patients scheduled for radial artery catheterization and180common patients were recruited in the Second Hospital Affiliated to Suzhou University. We gained the optimum ultrasound image of the radial artery and adjacent anatomic structures through a portable ultrasound systems with a linear6～13MHz transducer. We measured radial artery minimal subcutaneous distance, radial artery maximal subcutaneous distance, the diameter of radial arterial at the point with the minimal subcutaneous distance, The diameter of radial arterial at the point with the maximal subcutaneous distance, The diameter of radial arterial and ulnar artery at the wrist, the flow velocity of radial arterial and ulnar artery at the wrist. Radial artery catheterization was guided by ultrasound in20patients. Part two:120patients scheduled for radial artery catheterization were randomly divided into four groups:GroupAl (subcutaneous distance≥2.8mm, in-plane), Group A2(subcutaneous distance≥2.8mm, out-of-plane), GroupB1(subcutaneous distance<2.8mm, in-plane), GroupB2(subcutaneous distance<2.8mm, out-of-plane). Each group was cannulated under corresponding diverse ways. We recorded the total time of puncture, puncture attempts, the first successful cases and the first successful puncture time. The diameter and peak systolic velocity of radial arterial and blood pressure were measured before cannulation and30min after catheter removal.Results:Part one:The ultrasound image of radial artery and adjacent anatomic structures was demonstrated in all patients. Radial artery showed round or oval in transection with thick and uniform wall including three layers:intima, media,adventitia.In longitudinal section, the wall showed linear high echo image, vascular cavity showed even low echo image. The spectrum showed image of five phases or three phases or two phases.(1) Radial artery minimal subcutaneous distance:left:0.9±0.24mm; right:0.9±0.21mm.(2) Radial artery maximal subcutaneous distance:left:5.2±0.62mm; right:5.1±0.59mm.(3) The diameter of radial arterial at the point with the minimal subcutaneous distance:left:1.8±0.26mm; right:1.7±0.23mm.(4) The diameter of radial arterial at the point with the maximal subcutaneous distance:left:3.7±0.45mm; right:3.8±0.42mm.(5) The diameter of radial arterial and ulnar artery at the wrist:left:radial,1.6±0.32mm; ulnar,1.4±0.25mm; right:radial,1.7±0.35mm, ulnar,1.3±0.26mm.(6) The flow velocity of radial arterial and ulnar artery at the wrist:left:radial,45.3±13.6cm/s, ulnar,38.6±10.4cm/s; right:radial,42.6±14.5cm/s, ulnar,36.7±13.1cm/s. The diameter of radial arterial at the point with the minimal and maximal subcutaneous distance had a medial correlation with minimal and maximal subcutaneous distance in the right hand. Part two:(1) The first puncture success rate of group A2was higher than that of group A1and group B2(P<0.05), the first successful puncture time was lower than that of group A1and group B2(P<0.05). The first puncture success rate of group B1was lower than that of group A1and group B2(P<0.05), the first successful puncture time was longer than that of group Al and group B2(P<0.05).(2) T here was no statistical difference in each group in blood pressure before cannulation and30min after catheter removal. T here was no statistical difference between groups in blood pressure before cannulation and30min after catheter removal. The diameter of radial artery30min after catheter removal was smaller than before cannulation in each group (P<0.05).(3) The peak systolic velocity of radial arterial30min after catheter removal was higher than that before cannulation (P<0.05).Conclusion:The high-resolution sonography can provide good quality ultrasound images of radial artery and adjacent anatomic structures. From the wrist to the lower edge of the brachioradialis muscle, subcutaneous distance of radial artery increases gradually. The color Doppler spectrum can effectively capture the radial artery blood flow signal, the spectrum showed image of three phases or five phases or two phases. Blood vessels and the puncture needle can be imaged in the process of cannulation guided by ultrasound. Ultrasound-guided radial artery cannulation can be performed easily when subcutaneous distance is greater than2.8mm, compared with in-plane technology, radial artery cannulation guided by out of plane technology needs less time with higher first success rate.