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Hamilton GW, Sharma V, Yeoh J, Yudi MB, Raman J, Clark DJ, Farouque O. Ultrasound Guidance for Transradial Access in the Cardiac Catheterisation Laboratory: A Systematic Review of the Literature and Meta-Analysis. Heart Lung Circ 2024:S1443-9506(24)00617-6. [PMID: 38871531 DOI: 10.1016/j.hlc.2024.04.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Although ultrasound (US) guidance for vascular access has been widely adopted, its use for transradial access (TRA) in the cardiac catheterisation laboratory is rare. There is a perception that US guidance does not offer a clinically relevant benefit over traditional palpation-guided TRA, amplified by inconsistent findings of individual studies. METHOD A systematic review of MEDLINE, EMBASE and the Cochrane Library identified studies comparing US to palpation-guided TRA for cardiac catheterisation. Studies evaluating radial artery (RA) cannulation for any other reason were excluded. Event rates and risk ratios (RRs) were pooled for meta-analysis. Access failure was the primary outcome. A random-effects model was used for analysis. RESULTS Of the 977 records screened, four studies with a total of 1,718 patients (861 US-guided and 864 palpation-guided procedures) were included in the meta-analysis. Most procedures were elective. The pooled analysis showed US guidance significantly lowered the risk of access failure (RR 0.45; 95% confidence interval [CI] 0.21-0.97; p=0.04). Heterogeneity was moderate (I2=51.2%; p=0.105). There was a strong trend to improved first-pass success with US (RR 1.29; 95% CI 1.00-1.66; p=0.05; I2=83.8%), although no differences were found in rates of difficult access (RR 0.29; 95% CI 0.07-1.18; p=0.09; I2=88.3%). Salvage US guidance was successful in 30/41 (73.2%) patients following failed palpation-guided TRA. No differences were found in already low complication rates including RA spasm (RR 1.18; 95% CI 0.70-1.99; p=0.53; I2=0.0%) and bleeding (RR 1.32; 95% CI 0.46-3.80; p=0.60; I2=0.0%). CONCLUSIONS US guidance was found to improve TRA success in the cardiac catheterisation laboratory. Further investigation is necessary to determine whether routine, selective, or salvage use of US confers the most RA protection, patient satisfaction, and overall clinical benefit. (PROSPERO registration: CRD42022332238).
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Affiliation(s)
- Garry W Hamilton
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia.
| | - Varun Sharma
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia; Brian F. Buxton Cardiac Surgical Unit, Austin Health, Melbourne, Vic, Australia
| | - Julian Yeoh
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia
| | - Jaishankar Raman
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia; Brian F. Buxton Cardiac Surgical Unit, Austin Health, Melbourne, Vic, Australia; Department of Cardiac Surgery, St Vincent's Hospital, Melbourne, Vic, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia
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Romo-Miguel P, Ballesteros-Peña S. Ultrasound-guided puncture vs conventional technique for arterial blood gas analysis sampling in adults: A systematic review. ENFERMERIA INTENSIVA 2024:S2529-9840(23)00071-X. [PMID: 38453623 DOI: 10.1016/j.enfie.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/14/2023] [Accepted: 10/02/2023] [Indexed: 03/09/2024]
Abstract
AIM To compare the efficacy of conventional puncture versus ultrasound-guided puncture for arterial blood gas sampling in adults. METHOD A search protocol was developed and applied to three databases (Medline, Cochrane, and Dialnet). Clinical trials published between January 2013 and January 2023, in Spanish or English, were considered. Outcomes in terms of first-attempt success, number of attempts until success, time taken, self-reported iatrogenic pain, and patient or professional experience were collected. The risk of bias for each included study was assessed. RESULTS Five randomized clinical trials were selected, with sample sizes ranging from 50 to 238 adult patients treated in emergency settings. Three out of four studies showed higher first-attempt success rates when using ultrasound, and 2 out of 4 studies reported a decrease in iatrogenic pain. Discrepant findings were observed among the studies in terms of time taken and the number of attempts required for success. CONCLUSIONS Although current evidence is limited and the findings are heterogeneous, ultrasound-guided arterial puncture may have advantages over conventional puncture in terms of first-attempt success and in reducing iatrogenic pain.
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Affiliation(s)
- P Romo-Miguel
- Unidad de Cuidados Intensivos, Osakidetza, Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, Spain
| | - S Ballesteros-Peña
- Biobizkaia Health Research Institute, Barakaldo, Vizcaya, Spain; Dirección de Enfermería, Osakidetza, Hospital Santa Marina, Bilbao, Vizcaya, Spain; Universidad del País Vasco/Euskal Herriko Unibertsitatea, Leioa, Spain.
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Sun J, Lu B, Shan J, Pan Z, Sun J. Optimal insertion site for ultrasound-guided radial artery catheterization utilizing the dynamic needle tip positioning technique: A prospective randomized controlled study. J Vasc Access 2024:11297298241233713. [PMID: 38390724 DOI: 10.1177/11297298241233713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The dynamic needle tip positioning technique represents an advanced version of the short-axis out-of-plane ultrasound-guided approach employed for radial artery catheterization. The study aimed to explore the most effective insertion site capable of expeditiously and accurately executing the procedure in a clinical setting. METHODS A prospective randomized controlled study encompassed 246 elective surgery patients necessitating invasive arterial monitoring. Participants were randomly assigned to three distinct groups: Site 1 (targeting the radial styloid process), Site 2 (midway between Sites 1 and 3), and Site 3 (distal one-third of the forearm). The dynamic needle tip positioning technique was implemented across all groups. Crucial parameters, such as first-attempt success rate, time to success, overall success rate, total catheterization time, number of attempts, and complications, were meticulously documented and compared. RESULTS The Site 2 cohort presented a significantly heightened first-attempt success rate compared to Site 1 (97.5% vs 80%, p = 0.003) and Site 3 (97.5% vs 81.25%, p = 0.006). Moreover, Site 2 displayed a reduced time to success in contrast to Site 1 (31.5 vs 38, p = 0.003) and Site 3 (31.5 vs 40, p = 0.006). Total catheterization time was significantly shorter in Site 2 compared to Site 1 (32 vs 42.5, p < 0.001) and Site 3 (32 vs 43.5, p < 0.001). Site 2 necessitated fewer attempts than Site 1 (p = 0.02) and Site 3 (p = 0.03). Male gender and puncture at Site 2 were associated with expedited time to success. Adverse events manifested more frequently in the Site 3 group compared to the Site 1 group (15% vs 3.75%, p = 0.03) and the Site 2 group (15% vs 2.5%, p = 0.01). CONCLUSIONS The optimal insertion site for ultrasound-guided radial artery catheterization utilizing the dynamic needle tip positioning technique in adult patients is situated midway between the radial styloid process and the distal one-third of the forearm.
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Affiliation(s)
- Jiahui Sun
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Bo Lu
- Department of Anesthesiology, Ningbo No.2 Hospital, Ningbo, China
| | - Jianbo Shan
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Zhihao Pan
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Jianliang Sun
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Sung JM, Jun YE, Jung YD, Kim KN. Comparison of an Ultrasound-Guided Dynamic Needle Tip Positioning Technique and a Long-Axis In-Plane Technique for Radial Artery Cannulation in Older Patients: A Prospective, Randomized, Controlled Study. J Cardiothorac Vasc Anesth 2023; 37:2475-2481. [PMID: 37741770 DOI: 10.1053/j.jvca.2023.08.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/08/2023] [Accepted: 08/20/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVES The authors compared the dynamic needle tip positioning (DNTP) technique and the long-axis in-plane (LAIP) technique in older patients. DESIGN This was a prospective randomized controlled study. SETTING The study was conducted at a single institution (Hanyang University hospital). PARTICIPANTS One hundred sixty patients participated in this study. INTERVENTIONS This study was conducted on patients aged 75 years or older who underwent general anesthesia requiring placement of an arterial catheter. A total of 160 patients were allocated randomly to the DNTP group or the LAIP group. The primary outcome was the success rate of the first attempt. Additionally, overall success rate, cannulation time, number of total redirections and attempts, and occurrence of complications were investigated. MEASUREMENTS AND MAIN RESULTS In the DNTP group, the success rate of the first attempt (85% v 48.8%, p < 0.001, relative risk = 1.74, 95% CI 1.37-2.22) and the overall success rate (97.5% v 86.3%, p = 0.01, relative risk = 1.13, 95% CI 1.03-1.24) were significantly higher than in the LAIP group. Fewer redirections (p < 0.001) and attempts (p < 0.001), and a decreased cannulation time (58.8 ± 22.4 s v 89.6 ± 37.9 s, p < 0.001) were detected in the DNTP group. A decreased occurrence of hematoma in the DNTP group also was detected (7.5% v 18.8%, p = 0.035, relative risk = 0.40, 95% CI = 0.16-0.98). CONCLUSIONS The DNTP technique has better efficiency and safety than the LAIP technique for radial artery catheterization in the older population.
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Affiliation(s)
- Jeong Min Sung
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Young Eun Jun
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Yun Do Jung
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Kyu Nam Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, College of Medicine, Seoul, Republic of Korea.
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Maitra S, Baidya DK, Ray BR, Chowhan G, Bhattacharjee S. Comparison of ultrasound guided dorsal radial artery cannulation and conventional radial artery cannulation at the volar aspect of wrist: A pilot randomized controlled trial. J Vasc Access 2023; 24:1463-1468. [PMID: 35470717 DOI: 10.1177/11297298221093953] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Distal radial artery cannulation at the "anatomical snuffbox" carries several theoretical advantages over conventional radial arterial cannulation at the wrist. However, these two techniques have not been evaluated in perioperative settings. METHODS In this randomized controlled trial, n = 200 patients requiring arterial cannulation for perioperative monitoring were recruited. Patients were randomized to either ultrasound guided distal radial artery cannulation group (group D) or ultrasound guided conventional radial artery cannulation group (group W). Primary outcome of this study was first attempt cannulation success rate. RESULTS First attempt cannulation success rate was significantly lower in distal radial artery cannulation (57% in group D and 77% in group W; p = 0.003). Use of alternative cannulation site was significantly higher in group D when compared to group W (p = 0.015) and number of attempts for successful cannulation was significantly higher in group D when compared to group W (p = 0.015). None of the patients in any group developed thrombosis and related complications and intraoperative catheter dislodgement. Time to puncture the artery (p < 0.0001), total cannulation time (p < 0.0001), and actual catheter insertion time (p < 0.0001) were significantly higher in group D in comparison to group W. CONCLUSION Distal radial artery cannulation was associated with lower first attempt cannulation success rate and requires longer time to perform. As distal radial artery is a new technique, further studies are required in different clinical settings.
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Affiliation(s)
- Souvik Maitra
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim K Baidya
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Bikash R Ray
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ganesh Chowhan
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sulagna Bhattacharjee
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Rakhi Krishna CM, Mishra SK, Jha AK, Senthilnathan M, Parida S. Ultrasound-Guided Radial Arterial Catheterization in Patients With Regurgitant and Stenotic Left-Sided Cardiac Valvular Lesions. Semin Cardiothorac Vasc Anesth 2023; 27:153-161. [PMID: 37269115 DOI: 10.1177/10892532231181481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Background. The pulse characteristics of arterial circulation might affect radial artery catheterization's success rate. Therefore, we hypothesized that the success rate of radial artery catheterization would be lower in the left-sided severe stenotic valvular lesion group than severe regurgitant valvular lesion group. Methods. This prospective study was conducted among patients with left-sided cardiac valvular lesions undergoing cardiac and non-cardiac surgery. The patients with left-sided severe valvular stenosis and left-sided severe valvular regurgitation were included in the study. Radial artery cannulation was performed using an ultrasound-guided out-of-plane short-axis approach. The outcome measures were success rate, number of attempts, and cannulation time. Result. One hundred fifty-two patients were recruited for the study, and all were eligible for final analysis. The first attempt success rate was non-significantly higher in the stenotic valvular lesion group than the regurgitant group (69.7% vs 56.6%; P = .09). Furthermore, the number of attempts (median; 95% CI) was significantly higher in the regurgitant group (1; 1.2-1.43 vs 1; 1.38-1.67; P = .04). However, it may not be of clinical relevance. Moreover, the cannulation time and the number of redirections of the cannula were comparable. Heart rate was significantly higher in the regurgitant group (91.8 ± 13.9 vs 82.26 ± 15.92 beats/min; P = .00), while the incidence of atrial fibrillation was significantly higher in the stenotic lesion (P = .00). No failure was reported, and the incidence of periarterial hematoma was comparable. Conclusion. The success rate of ultrasound-guided radial arterial catheterization is comparable in left-sided stenotic valvular and regurgitant lesion groups.
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Affiliation(s)
- C M Rakhi Krishna
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sandeep Kumar Mishra
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ajay Kumar Jha
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Satyen Parida
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Buchanan C, Burt A, Moureau N, Murray D, Nizum N. Registered Nurses' Association of Ontario (RNAO) best practice guideline on the assessment and management of vascular access devices. J Vasc Access 2023:11297298231169468. [PMID: 37125815 DOI: 10.1177/11297298231169468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION Vascular access is the most common invasive procedure performed in health care. This fundamental procedure must be performed in a safe and effective manner. Vascular access devices (VADs) are often the source of infections and other complications, yet there is a lack of clear guidance on VADs for health providers across different settings. A Best Practice Guideline (BPG) was developed by the Registered Nurses' Association of Ontario (RNAO) to provide evidence-based recommendations on the assessment and management of VADs. METHODS RNAO BPGs are based on systematic reviews of the literature following the GRADE approach. Experts on the topic of vascular access were selected to form a panel. Systematic reviews were conducted on six research areas: education, vascular access specialists, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. A search for relevant research studies published in English limited to January 2013 was applied to eight databases. All studies were independently assessed for eligibility and risk of bias by two reviewers based on predetermined inclusion and exclusion criteria. The GRADE approach was used to determine certainty of the evidence. RESULTS Over 65,000 articles were screened related to the six priority research questions. Of these, 876 full-text publications were examined for relevance, with 174 articles designated to inform nine recommendations in the BPG on the subject areas of: comprehensive health teaching, practical education for health providers, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. In June 2021, the RNAO published the BPG on vascular access, which included the recommendations and other supporting resources. CONCLUSION The vascular access BPG provides high quality guidance and updated recommendations, and can serve as a primary resource for health providers assessing and managing VADs.
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Affiliation(s)
| | - Amy Burt
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Nancy Moureau
- PICC Excellence, Hartwell, GA, USA; Griffith University, Brisbane, QLD
| | | | - Nafsin Nizum
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
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Zou Q, Jiang J, Shi C, Wu B, Gui B, Zhou X. Single and double developing lines improve ultrasound-guided radial artery catheterization in obese patients: A randomized controlled trial. Anaesth Crit Care Pain Med 2023; 42:101166. [PMID: 36306989 DOI: 10.1016/j.accpm.2022.101166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arterial catheterization is challenging in obese patients. The present study tested the hypothesis that ultrasound guidance with acoustic shadowing improves the success rate of radial artery catheterization in obese patients. METHODS 240 obese patients were enrolled and were randomly assigned to three groups: control group, single developing line group, or double developing lines group. Patients underwent radial artery catheterization guided by acoustic shadowing ultrasound with none, single or double developing lines. The primary outcome was the first-attempt success rate. The secondary outcomes included the procedure time and complication rate. RESULTS In the single or double developing lines group, the success rate of radial artery catheterization at the first attempt was higher than in the control group (control vs. single vs. double, 71% vs. 90% vs. 91%, P = 0.001). Besides, the single and double developing lines groups had a shorter procedure time to success at the first attempt and a lower overall complication (vasospasm and hematoma) rate than the control group (procedure time: control vs. single vs. double, 63 s vs. 54 s vs. 40 s, P < 0.001; overall complication rate: control vs. single vs. double, 29% vs. 10% vs. 9%, P = 0.001). There was no significant difference in the first-attempt success rate, the procedure time to success within the first attempt, or overall complications' rate between the single and double developing lines groups. CONCLUSION Single and double developing lines improve first-attempt success rate and reduced the overall complications' rate of ultrasound-guided radial artery catheterization in obese patients.
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Affiliation(s)
- Qi Zou
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jindi Jiang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chonglong Shi
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bianliang Wu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bo Gui
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xuelong Zhou
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Chen T, Yu X, Song R, Li L, Cai G. Application of ultrasound in cardiovascular intervention via the distal radial artery approach: New wine in old bottles? Front Cardiovasc Med 2022; 9:1019053. [PMID: 36588545 PMCID: PMC9799162 DOI: 10.3389/fcvm.2022.1019053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
The distal radial artery (DRA) approach has emerged as a new approach in cardiovascular intervention. In recent years, ultrasound has been widely used in cardiovascular intervention via the DRA approach. This article systematically discusses the progress of ultrasound in the preoperative vascular assessment, intraoperative guided puncture and postoperative observation of complications via the DRA approach.
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Affiliation(s)
- Tao Chen
- Changzhou Key Laboratory of Molecular Diagnostics and Precision Cancer Medicine, Department of Cardiology, Wujin Institute of Molecular Diagnostics and Precision Cancer Medicine of Jiangsu University, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Xiaolong Yu
- Department of Ultrasonics, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Ruixiao Song
- Department of Ultrasonics, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Lamei Li
- Changzhou Key Laboratory of Molecular Diagnostics and Precision Cancer Medicine, Department of Cardiology, Wujin Institute of Molecular Diagnostics and Precision Cancer Medicine of Jiangsu University, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Gaojun Cai
- Changzhou Key Laboratory of Molecular Diagnostics and Precision Cancer Medicine, Department of Cardiology, Wujin Institute of Molecular Diagnostics and Precision Cancer Medicine of Jiangsu University, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
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Flumignan RL, Trevisani VF, Lopes RD, Baptista-Silva JC, Flumignan CD, Nakano LC. Ultrasound guidance for arterial (other than femoral) catheterisation in adults. Cochrane Database Syst Rev 2021; 10:CD013585. [PMID: 34637140 PMCID: PMC8507521 DOI: 10.1002/14651858.cd013585.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Arterial vascular access is a frequently performed procedure, with a high possibility for adverse events (e.g. pneumothorax, haemothorax, haematoma, amputation, death), and additional techniques such as ultrasound may be useful for improving outcomes. However, ultrasound guidance for arterial access in adults is still under debate. OBJECTIVES To assess the effects of ultrasound guidance for arterial (other than femoral) catheterisation in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, LILACS, and CINAHL on 21 May 2021. We also searched IBECS, WHO ICTRP, and ClinicalTrials.gov on 16 June 2021, and we checked the reference lists of retrieved articles. SELECTION CRITERIA Randomised controlled trials (RCTs), including cross-over trials and cluster-RCTs, comparing ultrasound guidance, alone or associated with other forms of guidance, versus other interventions or palpation and landmarks for arterial (other than femoral) guidance in adults. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, extracted data, assessed risk of bias, and assessed the certainty of evidence using GRADE. MAIN RESULTS We included 48 studies (7997 participants) that tested palpation and landmarks, Doppler auditory ultrasound assistance (DUA), direct ultrasound guidance with B-mode, or any other modified ultrasound technique for arterial (axillary, dorsalis pedis, and radial) catheterisation in adults. Radial artery Real-time B-mode ultrasound versus palpation and landmarks Real-time B-mode ultrasound guidance may improve first attempt success rate (risk ratio (RR) 1.44, 95% confidence interval (CI) 1.29 to 1.61; 4708 participants, 27 studies; low-certainty evidence) and overall success rate (RR 1.11, 95% CI 1.06 to 1.16; 4955 participants, 28 studies; low-certainty evidence), and may decrease time needed for a successful procedure (mean difference (MD) -0.33 minutes, 95% CI -0.54 to -0.13; 4902 participants, 26 studies; low-certainty evidence) up to one hour compared to palpation and landmarks. Real-time B-mode ultrasound guidance probably decreases major haematomas (RR 0.35, 95% CI 0.23 to 0.56; 2504 participants, 16 studies; moderate-certainty evidence). It is uncertain whether real-time B-mode ultrasound guidance has any effect on pseudoaneurysm, pain, and quality of life (QoL) compared to palpation and landmarks (very low-certainty evidence). Real-time B-mode ultrasound versus DUA One study (493 participants) showed that real-time B-mode ultrasound guidance probably improves first attempt success rate (RR 1.35, 95% CI 1.11 to 1.64; moderate-certainty evidence) and time needed for a successful procedure (MD -1.57 minutes, 95% CI -1.78 to -1.36; moderate-certainty evidence) up to 72 hours compared to DUA. Real-time B-mode ultrasound guidance may improve overall success rate (RR 1.13, 95% CI 0.99 to 1.29; low-certainty evidence) up to 72 hours compared to DUA. Pseudoaneurysm, major haematomas, pain, and QoL were not reported. Real-time B-mode ultrasound versus modified real-time B-mode ultrasound Real-time B-mode ultrasound guidance may decrease first attempt success rate (RR 0.68, 95% CI 0.55 to 0.84; 153 participants, 2 studies; low-certainty evidence), may decrease overall success rate (RR 0.93, 95% CI 0.86 to 1.01; 153 participants, 2 studies; low-certainty evidence), and may lead to no difference in time needed for a successful procedure (MD 0.04 minutes, 95% CI -0.01 to 0.09; 153 participants, 2 studies; low-certainty evidence) up to one hour compared to modified real-time B-mode ultrasound guidance. It is uncertain whether real-time B-mode ultrasound guidance has any effect on major haematomas compared to modified real-time B-mode ultrasound (very low-certainty evidence). Pseudoaneurysm, pain, and QoL were not reported. In-plane versus out-of-plane B-mode ultrasound In-plane real-time B-mode ultrasound guidance may lead to no difference in overall success rate (RR 1.00, 95% CI 0.96 to 1.05; 1051 participants, 8 studies; low-certainty evidence) and in time needed for a successful procedure (MD -0.06 minutes, 95% CI -0.16 to 0.05; 1134 participants, 9 studies; low-certainty evidence) compared to out-of-plane B-mode ultrasound up to one hour. It is uncertain whether in-plane real-time B-mode ultrasound guidance has any effect on first attempt success rate or major haematomas compared to out-of-plane B-mode ultrasound (very low-certainty evidence). Pseudoaneurysm, pain, and QoL were not reported. DUA versus palpation and landmarks DUA may lead to no difference in first attempt success rate (RR 1.01, 95% CI 0.90 to 1.14; 666 participants, 2 studies; low-certainty evidence) or overall success rate (RR 0.99, 95% CI 0.92 to 1.07; 666 participants, 2 studies; low-certainty evidence) and probably increases time needed for a successful procedure (MD 0.45 minutes, 95% CI 0.20 to 0.70; 500 participants, 1 study; moderate-certainty evidence) up to 72 hours compared to palpation and landmarks. Pseudoaneurysm, major haematomas, pain, and QoL were not reported. Oblique-axis versus long-axis in-plane B-mode ultrasound Oblique-axis in-plane B-mode ultrasound guidance may increase overall success rate (RR 1.27, 95% CI 1.05 to 1.53; 215 participants, 2 studies; low-certainty evidence) up to 72 hours compared to long-axis in-plane B-mode ultrasound. It is uncertain whether oblique-axis in-plane B-mode ultrasound guidance has any effect on first attempt success rate, time needed for a successful procedure, and major haematomas compared to long-axis in-plane B-mode ultrasound. Pseudoaneurysm, pain, and QoL were not reported. We are uncertain about effects in the following comparisons due to very low-certainty evidence and unreported outcomes: real-time B-mode ultrasound versus palpation and landmarks (axillary and dorsalis pedis arteries), real-time B-mode ultrasound versus near-infrared laser (radial artery), and dynamic versus static out-of-plane B-mode ultrasound (radial artery). AUTHORS' CONCLUSIONS Real-time B-mode ultrasound guidance may improve first attempt success rate, overall success rate, and time needed for a successful procedure for radial artery catheterisation compared to palpation, or DUA. In addition, real-time B-mode ultrasound guidance probably decreases major haematomas compared to palpation. However, we are uncertain about the evidence on major haematomas and pain for other comparisons due to very low-certainty evidence and unreported outcomes. We are also uncertain about the effects on pseudoaneurysm and QoL for axillary and dorsalis pedis arteries catheterisation. Given that first attempt success rate and pseudoaneurysm are the most relevant outcomes for people who underwent arterial catheterisation, future studies must measure both. Future trials must be large enough to detect effects, use validated scales, and report longer-term follow-up.
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Affiliation(s)
- Ronald Lg Flumignan
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Virginia Fm Trevisani
- Emergency Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
- Rheumatology, Universidade de Santo Amaro, São Paulo, Brazil
| | - Renato D Lopes
- Division of Cardiology, Duke University Medical Center, Durham, USA
| | - Jose Cc Baptista-Silva
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
- Evidence-based Medicine, Cochrane Brazil, São Paulo, Brazil
| | - Carolina Dq Flumignan
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luis Cu Nakano
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
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