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Hixson R, Jensen KS, Melamed KH, Qadir N. Device associated complications in the intensive care unit. BMJ 2024; 386:e077318. [PMID: 39137947 DOI: 10.1136/bmj-2023-077318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Invasive devices are routinely used in the care of critically ill patients. Although they are often essential components of patient care, devices such as intravascular catheters, endotracheal tubes, and ventilators are a common source of complications in the intensive care unit. Critical care practitioners who use these devices need to use strategies for risk reduction and understand approaches to management when adverse events occur. This review discusses the identification, prevention, and management of complications of vascular, airway, and mechanical support devices commonly used in the intensive care unit.
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Affiliation(s)
- Roxana Hixson
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
| | - Kristin Schwab Jensen
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
| | - Kathryn H Melamed
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
| | - Nida Qadir
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
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Soni KD. Ultrasound-guided Arterial Cannulation: What are We Missing and Where are We Headed? Indian J Crit Care Med 2024; 28:632-633. [PMID: 38994264 PMCID: PMC11234131 DOI: 10.5005/jp-journals-10071-24757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
How to cite this article: Soni KD. Ultrasound-guided Arterial Cannulation: What are We Missing and Where are We Headed? Indian J Crit Care Med 2024;28(7):632-633.
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Affiliation(s)
- Kapil Dev Soni
- Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Mishra L, Rath C, Wibrow B, Anstey M, Ho K. Acoustic Shadowing to Facilitate Ultrasound Guided Arterial Cannulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2024; 28:677-685. [PMID: 38994254 PMCID: PMC11234128 DOI: 10.5005/jp-journals-10071-24751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/26/2024] [Indexed: 07/13/2024] Open
Abstract
Aim and background Ultrasound-guided arterial catheterization is a frequently performed procedure. Additional techniques such as acoustic shadowing-assisted ultrasound may be useful in improving success rate. This systematic review aimed to assess the efficacy of acoustic shadowing assisted ultrasound for arterial catheterization. Materials and methods PubMed, Medline, EMBASE, Cochrane Library, EMCARE, and MedNar were searched in January 2024. Randomized controlled trials comparing the first attempt success rate of arterial catheterization using acoustic shadowing ultrasound vs unassisted ultrasound were included. Data were pooled for risk ratios (RRs) using the random-effects model. Subgroup analysis was conducted based on a single or double acoustic line. Sensitivity analysis was undertaken after excluding pediatric data. The certainty of evidence (COE) was assessed using the GRADE framework. Results Six randomized controlled trials (n = 777) were included. A meta-analysis found the first attempt success rate is significantly higher in the acoustic ultrasound group (n = 6, RR: 0.47, 95% CI: 0.34-0.66, p ≤ 0.00001). Hematoma formation was significantly less in the acoustic ultrasound group (n = 6, RR: 0.52, 95% CI: 0.34-0.80, p = 0.003). First attempt success was significantly higher in the single acoustic line ultrasound (USG) group compared to the unassisted ultrasound group (n = 3, RR: 0.41, 95% CI: 0.28-0.59, p ≤ 0.00001). Sensitivity analysis after excluding pediatric data was similar to the primary analysis (n = 5, RR: 0.50, 95% CI: 0.33-0.70, p ≤ 0.00001). Certainty of evidence was "Moderate" for the first attempt cannulation. Conclusions Acoustic shadowing-assisted ultrasound improved first-attempt arterial catheterization success rate and was associated with reduced hematoma formation. How to cite this article Mishra L, Rath C, Wibrow B, Anstey M, Ho K. Acoustic Shadowing to Facilitate Ultrasound Guided Arterial Cannulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2024;28(7):677-685.
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Affiliation(s)
- Lipi Mishra
- Intensive Care Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia
| | - Chandra Rath
- Neonatology, Perth Children's Hospital, Nedlands, Western Australia
- Neonatology, King Edward memorial Hospital, Subiaco, Western Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia
| | - Bradley Wibrow
- Intensive Care Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia
| | - Matthew Anstey
- Intensive Care Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia
| | - Kwok Ho
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia
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Eley V, Peters N, Woods C, Llewellyn S, Derboghossian T, Ogg M, Rickard CM, Chin A. Perioperative arterial catheterization: A prospective evaluation of ultrasound, infection, and patient-focused outcomes. J Vasc Access 2024:11297298241246300. [PMID: 38659089 DOI: 10.1177/11297298241246300] [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: 04/26/2024] Open
Abstract
BACKGROUND There is little information regarding complications of arterial catheterization in modern clinical care. We aimed to determine the incidence of abnormal duplex vascular ultrasound and catheter related infections following perioperative arterial catheterization. METHODS Patients requiring arterial catheterization for elective surgery were included and insertion details collected prospectively. Duplex ultrasound evaluation was performed 24 h after catheter removal. Symptomatic patients were identified by self-reported questionnaire. On Day 7, patients answered questions by telephone, related to the insertion site, pain, and function. Results of catheter tip and blood culture analyses were sought. Univariate associations of patient and surgical characteristics with abnormal ultrasound were assessed with p < 0.05 considered significant. RESULTS Of 339 catheterizations, 105 (40%) had ultrasound evaluation. Catheters were indwelling for median (IQR, range) duration of 6.0 h (4.4-8.2, 1.8-28) with no catheter-related infections. There were 16 (15.2%, 95% CI 9.0%-23.6%) abnormal results, including 14 radial artery thromboses, one radial artery dissection, and one radial vein thrombosis. Those with abnormal ultrasound results were more likely to have had Arrow catheters inserted (68.8% vs 27%, p = 0.023) and more than one skin puncture (37.5% vs 26.8%, p = 0.031). Two of the 16 (12.5%) patients with abnormal ultrasound results reported new symptoms related to the hand compared with nine of the 88 (10.2%) with normal results (p = 0.1). No patients required urgent referral for management. CONCLUSIONS Thrombosis was the most common abnormality and was usually asymptomatic. There were no infections, few post-operative symptoms, and minimal functional impairment following arterial catheterization.
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Affiliation(s)
- Victoria Eley
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Nathan Peters
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Christine Woods
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Stacey Llewellyn
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD, Australia
| | - Teal Derboghossian
- Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
| | - Murray Ogg
- Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
| | - Claire M Rickard
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Diseases Institute, Metro North Health, Herston, Brisbane, QLD, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, Brisbane, QLD, Australia
| | - Adrian Chin
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Wang SY, Qiu Q, Shen X, Shen QH. Development and validation of a nomogram for predicting difficult radial artery cannulation in adult surgical patients. Heliyon 2024; 10:e24524. [PMID: 38312632 PMCID: PMC10835244 DOI: 10.1016/j.heliyon.2024.e24524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 12/16/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
Background Radial artery cannulation is an invasive procedure commonly performed in patients in the perioperative time, in the intensive care unit, and in other critical care settings. The current study aimed to explore the preoperative risk factors associated with difficult radial artery cannulation and develop a nomogram model for adult patients undergoing major surgery. This nomogram may optimize preoperative clinical decision-making, thereby reducing the number of puncture attempts and preventing associated complications. Methods This was a single-center prospective cohort study. Between December 2021 and May 2022, 530 adult surgical patients were enrolled. The patients were randomized into the training and validation cohorts at a ratio of 8:2. Radial artery cannulation was performed before the induction of anesthesia. Univariate and multivariate logistic regression analyses were performed to identify variables that were significantly associated with difficult radial artery cannulation. These variables were then incorporated into the nomogram. The discrimination and calibration abilities of the nomogram were assessed. Results One hundred and seventy-three (41.7 %) patients in the training cohort had difficult radial artery cannulation. Based on multivariate analysis, the independent risk factors were wrist circumference, anatomical abnormalities, BMI <18.5 kg/m2, grade II hypertension, hypotension, and history of chemotherapy and stroke. The concordance indices were 0.765 (95 % confidence interval [CI]: 0.719-0.812) and 0.808 (95 % CI: 0.725-0.890) in the training and validation cohorts, respectively. The calibration curve showed good agreement between the actual and predicted risks. Conclusions A preoperative predictive model for difficult radial artery cannulation in adult patients undergoing surgery was developed and validated. This model can provide reliable data for optimizing preoperative clinical decision-making.
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Affiliation(s)
- Sheng-Yan Wang
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Qing Qiu
- Department of Anesthesiology, Zhejiang Chinese Medical University, China
| | - Xu Shen
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Qi-Hong Shen
- Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
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Karan P, Sharma A, Mukesh A, Goyal S, Rathod D, Kumari K, Meshram T, Kothari N, Bhatia P. Comparison of procedural time with two different ultrasound-guided approaches for dorsalis pedis artery cannulation in adult patients: A randomized trial. J Vasc Access 2024:11297298231219431. [PMID: 38197213 DOI: 10.1177/11297298231219431] [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: 01/11/2024] Open
Abstract
BACKGROUND In adult patients, there has never been an evaluation of short-axis out-of-plane versus long-axis in-plane approaches of ultrasound-guided dorsalis pedis artery cannulation. This research was conducted to compare these two techniques to cannulate the dorsal pedis artery. METHODS In this trial, 128 adult patients undergoing surgery and necessitating arterial cannulation were examined. Dorsalis pedis artery cannulation was performed utilizing an ultrasound by long-axis in-plane approach (group L) or short-axis out-of-plane (group S) techniques. RESULTS Group S had a higher first attempt success rate than group L (46.9% vs 28.6%, p = 0.039). The S group had a lower assessment time than the L group (11.48 ± 3.07 vs 19.68 ± 2.79 s; p = 0.000). Cannulation time was higher in the S group (18.91 ± 1.92 s) compared to the L group (12.48 ± 1.61 s; p = 0.000). Nevertheless, the total procedure time was comparable between the L group and the S group (32.16 ± 2.95 vs 30.42 ± 4.07 s; p = 0.107). CONCLUSIONS In adults, both views of ultrasonography can be used to guide DPA cannulation. The cannulation time for the DPA in L group was less than the S group, whereas the assessment time was less in S group. The total procedure time, however, was similar between both the groups.
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Affiliation(s)
- Priyabrat Karan
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Ankur Sharma
- Department of Trauma & Emergency (Anaesthesiology and Critical Care), All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Arun Mukesh
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Shilpa Goyal
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Darshna Rathod
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Kamlesh Kumari
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Tanvi Meshram
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Nikhil Kothari
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Pradeep Bhatia
- Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
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Culjat M, Dzaja D, Colangelo H, Gardiner J, Lee KS, Whyte H. Implementation of an ultrasound-guided approach for arterial line placements in neonates-quality improvement project. J Perinatol 2023:10.1038/s41372-023-01860-9. [PMID: 38145989 DOI: 10.1038/s41372-023-01860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Our goal was to improve placement success rates for peripheral arterial line (PAL) placements by introducing an ultrasound-guided (USg) approach. Our aim was to maintain success rates over 70% within 18 months. STUDY DESIGN Interventions included development of a training curriculum, and procedure standardization. Among 302 patients, 115 underwent USg catheter placement; the traditional method was used in 187 patients. Outcome measures were first-attempt and overall success rates. Process measures were proportion of PALs placed under US guidance, trainer availability, and trainee sign-off. Line complications were balancing measures. Statistical process control charts were used to monitor metrics. RESULTS Sustained improvement was seen with the USg approach. The USg approach had first and overall attempt success by the trainers (i.e., independent users) of 83.7% (77/92) and 96.5% (111/115), compared to 50.3% (82/163) and 73.8% (138/187) with the traditional approach. CONCLUSION Introducing the USg approach had a significant impact on PAL placement success in neonatal patients.
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Affiliation(s)
- Marko Culjat
- Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
- Acute Care Transport Services, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Domagoj Dzaja
- Department of Anatomy, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Heather Colangelo
- Acute Care Transport Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jill Gardiner
- Acute Care Transport Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - Kyong-Soon Lee
- Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Acute Care Transport Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - Hilary Whyte
- Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Acute Care Transport Services, The Hospital for Sick Children, Toronto, ON, Canada
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Yanko FM, Rivera A, Cheon EC, Mitchell JD, Ballard HA. Patient and Technical Factors Associated with Difficult Arterial Access and Ultrasound Use in the Operating Room. CHILDREN (BASEL, SWITZERLAND) 2023; 11:21. [PMID: 38255335 PMCID: PMC10814054 DOI: 10.3390/children11010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Arterial catheterization enables continuous hemodynamic monitoring but has been shown to cause severe complications, especially when multiple attempts are required. The aim of this study was to explore what factors were associated with multiple attempts and ultrasound use in the operating room. We performed a retrospective analysis of patients who had arterial catheters inserted at a tertiary care children's hospital from January 2018 to March 2022, identifying clinical factors that were associated with both outcomes. A total of 3946 successful arterial catheter insertions were included. Multivariable analysis showed multiple attempts were associated with noncardiac surgery: pediatric (OR: 1.79, 95% CI: 1.30-2.51), neurologic (OR: 2.63, 95% CI: 1.89-3.57), orthopedic (OR: 3.23, 95% CI: 2.27-4.55), and non-radial artery placement (OR: 5.00, 95% CI: 3.33-7.14) (all p < 0.001). Multivariable analysis showed ultrasound use was associated with neonates (OR: 9.6, 95% CI: 4.1-22.5), infants (OR: 6.98, 95% CI: 4.67-10.42), toddlers (OR: 6.10, 95% CI: 3.8-9.8), and children (OR: 2.0, 95% CI: 1.7-2.5) compared to teenagers, with cardiac surgery being relative to other specialties-pediatric (OR: 0.48, 95% CI: 0.3-0.7), neurologic (OR: 0.27, 95% CI: 0.18-0.40), and orthopedic (OR: 0.38, 95% CI: 0.25-0.58) (all p < 0.001). In our exploratory analysis, increased odds of first-attempt arterial catheter insertion success were associated with cardiac surgery, palpation technique, and radial artery placement. Younger patient age category, ASA III and IV status, cardiac surgery, and anesthesiologist placement were associated with increased odds of ultrasound use.
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Affiliation(s)
- Frank M. Yanko
- Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (F.M.Y.); (E.C.C.)
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Adovich Rivera
- Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (F.M.Y.); (E.C.C.)
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Eric C. Cheon
- Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (F.M.Y.); (E.C.C.)
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | | | - Heather A. Ballard
- Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (F.M.Y.); (E.C.C.)
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
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Men X, Wang Q, Chen P, Hu WS, Chai Y, Shou HY, Zhou ZF. Subcutaneous nitroglycerin increased the success rate of radial artery cannulation in women with gestational hypertension undergoing cesarean section : A randomized controlled trial. DIE ANAESTHESIOLOGIE 2023; 72:28-35. [PMID: 36884054 PMCID: PMC10692033 DOI: 10.1007/s00101-023-01264-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/06/2022] [Accepted: 11/20/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Radial artery cannulation helps to maintain the stability of maternal hemodynamics and reduce complications; however, it is difficult for women with gestational hypertension. Subcutaneous nitroglycerin was found to improve the first attempt success rate of radial artery cannulation in pediatric patients. Therefore, this study evaluated the effect of subcutaneous nitroglycerin on the radial artery diameter and area, blood flow rate and the success rate of radial artery cannulation in women with pregnancy-induced hypertension. METHODS A total of 94 women with gestational hypertension and risk of intraoperative bleeding undergoing cesarean section were identified and randomized into the subcutaneous nitroglycerin group and control group. The primary outcome was the success rate of left radial artery cannulation within 3 min after subcutaneous injecting (T2). The puncture time, number of attempts, the overall complications, and ultrasonographic measurements including radial artery diameter, cross-sectional area and depth were also recorded before subcutaneous injection (T1), 3 min after subcutaneous injection (T2) and immediately after radial artery cannulation (T3). RESULTS The first attempt success rate of radial artery cannulation was significantly higher (97.9% vs. 76.6%, p = 0.004) and procedure time to success was significantly shorter (111 ± 18 s vs. 171 ± 70 s, p < 0.001) in the subcutaneous nitroglycerin group as compared to the control group. The subcutaneous nitroglycerin group also had a significantly less overall number of attempts as 1/2/3 attempts (n), 46/1/0 vs. 36/7/4 (p = 0.008). Compared with the control group, the diameter and cross-sectional area of radial artery increased significantly at the T2 and T3 points in the subcutaneous nitroglycerin group (p < 0.001), as well as percentage change of radial artery diameter and CSA. Vasospasm (6.4% vs. 31.9%; p = 0.003) was significantly lower in the subcutaneous nitroglycerin group; however, no difference was found in hematoma (2.1% vs. 12.8%; p = 0.111). CONCLUSION Subcutaneous nitroglycerin along with the routine local anesthetic preparation before radial artery cannulation increased the first attempt success rate of radial artery cannulation and decreased the overall number of cannulation attempts in women with gestational hypertension and risks of intraoperative bleeding undergoing cesarean section, it also decreased cannulation times and overall number of vasospasms.
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Affiliation(s)
- Xin Men
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China
| | - Qian Wang
- Department of Anesthesiology, The Affiliated ZheJiang Hospital, School of Medicine, Zhejiang University, 315014, Hangzhou, China
| | - Pei Chen
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China
| | - Wen-Sheng Hu
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China
| | - Yun Chai
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China
| | - Hong-Yan Shou
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China
| | - Zhen-Feng Zhou
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), 315014, Hangzhou, China.
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Liu Y, Dong Y, Liu Y, Xu L. A novel track guidance ultrasound facilitates radial arterial cannulation: A prospective randomized controlled trial. J Vasc Access 2023:11297298231209382. [PMID: 37997017 DOI: 10.1177/11297298231209382] [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: 11/25/2023] Open
Abstract
BACKGROUND Ultrasound guidance for radial arterial cannulation is currently considered a best practice approach despite its clear advantages over the blind and palpation technique, the success rate is related to several factors, including clinician's experience and technical ability. The study aimed to explore the use of a novel track guidance ultrasound that may increase the success rate of radial arterial cannulation. METHODS A randomized controlled trial was conducted, in which 80 adults scheduled for elective surgery requiring radial arterial cannulation were recruited and randomly assigned to either the experimental group, which utilized novel track ultrasound guidance (group T, n = 40), or the control group, which utilized traditional ultrasound guidance (group U, n = 40). The novel track guidance ultrasound comprises a positioning track and a guided track. The radial artery could be positioned at the center of the positional track on the ultrasound image, and the direction and angle of needle are fixed and toward the center of the positioning track. The primary endpoint of the study was the first-pass cannulation success rate, while the secondary endpoints included the failure rate of cannulation, the number of radial artery punctures, the time of cannulation, and the incidence of hematoma. RESULTS The success rate of cannulation at the first attempt in group T (35 of 40 (87.5%)) was significantly higher than that in group U (23 of 40 (57.5%); p = 0.003). Although seven patients in Group U (7 of 40 (17.5%)) experienced failed cannulation compared to one in Group T (1 of 40 (2.5%)), the difference in failure rate between the two groups did not reach statistical significance (p = 0.06). CONCLUSIONS The implementation of novel track ultrasound guidance has demonstrated a notable improvement in the success rates at the first attempt while reducing the frequency of punctures and cannulation times.
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Affiliation(s)
- Yongzhe Liu
- Department of Anesthesiology, the Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuyan Dong
- Department of Anesthesiology, Yuncheng Central Hospital, Yuncheng, China
| | - Yi Liu
- Department of Anesthesiology, the Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Longhe Xu
- Department of Anesthesiology, the Third Medical Center of Chinese PLA General Hospital, Beijing, China
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Cao L, Tan YT, Wei T, Li H. Comparison between the long-axis in-plane and short-axis out-of-plane approaches for ultrasound-guided arterial cannulation: a meta-analysis and systematic review. BMC Anesthesiol 2023; 23:120. [PMID: 37055775 PMCID: PMC10100252 DOI: 10.1186/s12871-023-02076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/03/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND The two most common methods for ultrasound-guided arterial cannulation are the long-axis in-plane (LA-IP) and short-axis out-of-plane (SA-OOP) approaches. However, it is uncertain which method is more advantageous. We conducted a meta-analysis of reported randomized clinical trials (RCTs) comparing the two techniques in terms of success rate, cannulation time, and complications. METHODS We systematically searched PubMed, Embase, and the Cochrane Library database for RCTs comparing the LA-IP and SA-OOP techniques for ultrasound-guided arterial cannulation published from inception through April 31, 2022. The Cochrane Collaboration's Risk of Bias Tool was used to evaluate the methodological quality of each RCT. Review Manager 5.4 and Stata/SE 17.0 were used to analyze the two primary outcome measures (first-attempt success rate and total success rate) and two secondary outcome measures (cannulation time and complications). RESULTS A total of 13 RCTs with 1,377 patients were included. There were no significant differences in first-attempt success rate (risk ratio [RR], 0.93; 95% confidence interval [CI], 0.78-1.12; P = 0.45; I2 = 84%) and overall success rate (RR, 0.99; 95% CI, 0.95-1.02; P = 0.48; I2 = 57%). When compared with the LA-IP technique, the SA-OOP technique was associated with an increased incidence of posterior wall puncture (RR, 3.01; 95% CI, 1.27-7.14; P = 0.01; I2 = 79%) and hematoma (RR, 2.15; 95% CI, 1.05-4.37; P = 0.04; I2 = 63%). There was no significant difference in the incidence of vasospasm between techniques (RR, 1.26; 95% CI, 0.37-4.23; P = 0.07; I2 = 53%). CONCLUSIONS The present results suggest that the SA-OOP technique is associated with a higher incidence of posterior wall puncture and hematoma than the LA-IP technique, whereas success rates are similar for the two ultrasound-guided arterial cannulation techniques. These findings should be experimentally evaluated in a more rigorous manner due to high inter-RCT heterogeneity.
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Affiliation(s)
- Lei Cao
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yu-Ting Tan
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Ting Wei
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Hong Li
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, China.
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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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Raphael CK, El Hage Chehade NA, Khabsa J, Akl EA, Aouad-Maroun M, Kaddoum R. Ultrasound-guided arterial cannulation in the paediatric population. Cochrane Database Syst Rev 2023; 3:CD011364. [PMID: 36866968 PMCID: PMC9983299 DOI: 10.1002/14651858.cd011364.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND In arterial line cannulation in children and adolescents, traditional methods of locating the artery include palpation and Doppler auditory assistance. It is unclear whether ultrasound guidance is superior to these methods. This is an update of a review originally published in 2016. OBJECTIVES To evaluate the benefits and harms of ultrasound guidance compared with traditional techniques (palpation, Doppler auditory assistance) for assisting arterial line placement at all potential sites in children and adolescents. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and Web of Science from inception to 30 October 2022. We also searched four trials registers for ongoing trials, and we checked the reference lists of included studies and relevant reviews for other potentially eligible trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing ultrasound guidance versus other techniques (palpation or Doppler auditory assistance) to guide arterial line cannulation in children and adolescents (aged under 18 years). We planned to include quasi-RCTs and cluster-RCTs. For RCTs with both adult and paediatric populations, we planned to include only the paediatric population data. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the risk of bias of included trials and extracted data. We used standard Cochrane meta-analytical procedures, and we applied the GRADE method to assess the certainty of evidence. MAIN RESULTS We included nine RCTs reporting 748 arterial cannulations in children and adolescents (under 18 years of age) undergoing different surgical procedures. Eight RCTs compared ultrasound with palpation, and one compared ultrasound with Doppler auditory assistance. Five studies reported the incidence of haematomas. Seven involved radial artery cannulation and two involved femoral artery cannulation. The people performing arterial cannulation were physicians with different levels of experience. The risk of bias varied across studies, with some studies lacking details of allocation concealment. It was not possible to blind practitioners in any case; this adds a performance bias that is inherent to the type of intervention studied in our review. Compared to traditional methods, ultrasound guidance probably causes a large increase in first-attempt success rates (risk ratio (RR) 2.01, 95% confidence interval (CI) 1.64 to 2.46; 8 RCTs, 708 participants; moderate-certainty evidence) and probably causes a large reduction in the risk of complications such as haematoma formation (RR 0.26, 95% CI 0.14 to 0.47; 5 RCTs, 420 participants; moderate-certainty evidence). No studies reported data about ischaemic damage. Ultrasound guidance probably improves success rates within two attempts (RR 1.78, 95% CI 1.25 to 2.51; 2 RCTs, 134 participants; moderate-certainty evidence) and overall rate of successful cannulation (RR 1.32, 95% CI 1.10 to 1.59; 6 RCTs, 374 participants; moderate-certainty evidence). In addition, ultrasound guidance probably reduces the number of attempts to successful cannulation (mean difference (MD) -0.99 attempts, 95% CI -1.15 to -0.83; 5 RCTs, 368 participants; moderate-certainty evidence) and duration of the cannulation procedure (MD -98.77 seconds, 95% CI -150.02 to -47.52, 5 RCTs, 402 participants; moderate-certainty evidence). More studies are needed to confirm whether the improvement in first-attempt success rates is more pronounced in neonates and younger children compared to older children and adolescents. AUTHORS' CONCLUSIONS We identified moderate-certainty evidence that ultrasound guidance for arterial cannulation compared with palpation or Doppler auditory assistance improves first-attempt success rate, second-attempt success rate and overall success rate. We also found moderate-certainty evidence that ultrasound guidance reduces the incidence of complications, the number of attempts to successful cannulation and the duration of the cannulation procedure.
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Affiliation(s)
- Christian K Raphael
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nour A El Hage Chehade
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marie Aouad-Maroun
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Roland Kaddoum
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
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Muacevic A, Adler JR, Talawar P, Gupta P, Waindeskar V, Jain A, Karna ST, Kumari S. A Randomized Trial to Compare Ultrasound-Guided Dorsalis Pedis Versus Posterior Tibial Artery Cannulation in Neurosurgical Patients. Cureus 2023; 15:e33514. [PMID: 36779138 PMCID: PMC9904750 DOI: 10.7759/cureus.33514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/09/2023] Open
Abstract
Introduction Dorsalis pedis or posterior tibial artery is selected as an alternative to radial artery cannulation when there is no access or unsuccessful cannulation of a radial artery. This study aimed to compare the two major arteries of the foot (dorsalis pedis and posterior tibial) in terms of their ultrasound (USG)-guided cannulation characteristics in patients posted for elective neurosurgical procedures. Methods All consenting patients, 18-65 years of age, scheduled for elective neurosurgical procedures under general anesthesia requiring arterial cannulations were enrolled. The first-pass success rate, assessment time, cannulation time, total procedural time, and the number of cannulation attempts for both procedures were estimated. Results A total of 90 patients were included in the study. The assessment time, cannulation time, and total time for arterial cannulation were significantly greater in the dorsalis pedis artery group than in the posterior tibial artery group (p < 0.001). Successful arterial cannulation in the first attempt was 73.3% in the dorsalis pedis, whereas it was 80% in the posterior tibial group but comparable (p = 0.455). The successful cannulation outcome was slightly more in the posterior tibial artery group but comparable (p = 1.00). Conclusion First-pass successful cannulation rates in the posterior tibial and the dorsalis pedis artery are comparable. However, the assessment time, cannulation time, and total procedural time are higher and statistically significant for dorsalis pedis artery cannulation compared to the posterior tibial artery group.
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Lan-Pak-Kee V, Ackland GL, Egan TC, Abbott TEF, Elsheikh F, Gooneratne M, May SM, Mitchard M, O'Neill T, Overend J, Abbott TEF, Pang CL, Radhakrishnan A, Reynolds T, Vadher M, Verma P, Wikner M, Wood A. Arterial cannulation with ultrasound: clinical trial protocol for a randomised controlled trial comparing handheld ultrasound versus palpation technique for radial artery cannulation. BJA OPEN 2022; 4:None. [PMID: 36561483 PMCID: PMC9763126 DOI: 10.1016/j.bjao.2022.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/06/2022] [Accepted: 10/21/2022] [Indexed: 11/24/2022]
Abstract
Background Early intraoperative hypotension is associated with acute kidney and myocardial injury in patients undergoing noncardiac surgery. Precise arterial blood pressure measurement before and during the induction of general anaesthesia may avert early intraoperative hypotension. However, rapid arterial cannulation in anxious, conscious patients can be challenging. We describe the protocol for a randomised controlled trial designed to test the hypothesis that readily available, handheld ultrasound-guided arterial cannulation is the optimal method in conscious patients undergoing noncardiac surgery. Methods Participants >45 yr undergoing noncardiac surgery expected to last >120 min and requiring an overnight hospital stay will be eligible. We will randomly allocate participants to undergo cannulation of the radial artery in the non-dominant arm before the induction of general or regional anaesthesia using either handheld ultrasound-guided dynamic needle position technique or palpation. The primary outcome is first-pass successful arterial cannulation, analysed by intention-to-treat. Secondary outcomes include adequacy/characteristics of the arterial waveform and complications within 24 h of cannulation. We will require 118 patients to demonstrate a doubling of successful first-pass arterial cannulation, from ∼30% using the palpation approach (α=0.05; 1-β=0.1). Results This study has been approved by the NHS Health Research Authority and Health Care Research Wales (21/WA/0403) and commenced recruitment in May 2022. Conclusions This study will establish whether handheld ultrasound-guided arterial cannulation before the induction of anaesthesia should be the standard of care in patients at risk of developing perioperative organ injury after noncardiac surgery. Clinical trial registration NCT05249036.
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Affiliation(s)
- Valerie Lan-Pak-Kee
- Department of Anaesthesia and Perioperative Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Gareth L. Ackland
- Department of Anaesthesia and Perioperative Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK,Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK,Corresponding author.
| | - Timothy C. Egan
- Department of Anaesthesia and Perioperative Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Tom EF. Abbott
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Fatima Elsheikh
- University of East Anglia, Norwich Research Park, Norwich, UK
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16
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Sun XX, Lv M, Du WY, Liu Y, Zhang H, Wang YL. Comparison of out-of-plane short axis with in-plane long axis for ultrasound-guided radial arterial cannulation: A systematic review with trial sequential analysis of randomised controlled trials. Front Cardiovasc Med 2022; 9:983532. [PMID: 36312257 PMCID: PMC9596768 DOI: 10.3389/fcvm.2022.983532] [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: 07/01/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background It is controversial whether the short-axis out-of-plane or long-axis in-plane approach is a better needling technique for ultrasound-guidance radial artery cannulation. We aimed to compare the efficacy and safety of the two approaches for ultrasound-guided radial artery cannulation. Methods A systematic search of Medline, Embase, the Cochrane Library, and Web of Science for relevant articles published until 1 May 2021 was conducted. Randomised controlled trials comparing the long-axis in-plane with short-axis out-of-plane approaches were included. Review Manager software version 5.4, STATA version 14.2, and trial sequential analysis (TSA) version 0.9.5.10 Beta were used for statistical analysis. Risk of bias and methodological quality of all studies included in this review were assessed according to the Cochrane Collaboration tool for the risk of bias. Subgroup analyses and meta-regression were performed to explore sources of heterogeneity. Results The rate of cannula insertion success on the first attempt was similar between the short-axis out-of-plane and long-axis in-plane approaches (RR = 1.03; 95% CI: 0.83 to 1.28; P = 0.79; I 2 = 83.0%). No significant differences were observed in total time to successful cannulation between the two approaches (MD = -3.9; 95% CI:-18.30 to 10.49; P = 0.6; I 2 = 97%). However, the required information size for the success rate of the first attempt and total time to successful cannulation was not reached. Conclusion It remains inconclusive whether short-axis out-of-plane is a better choice for radial arterial cannulation than the long-axis in-plane approach. Inexperienced operators may need more attempts and longer ultrasound location time with the short-axis out-of-plane technique. Systematic review registration [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021236098].
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Affiliation(s)
- Xia-xuan Sun
- Graduate School, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China,Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Meng Lv
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Wen-ya Du
- Graduate School, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China,Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yi Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Haixia Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yue-lan Wang
- Graduate School, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China,Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China,*Correspondence: Yue-lan Wang,
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17
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Application of the dynamic needle tip positioning method for ultrasound-guided arterial catheterization in elderly patients: A randomized controlled trial. PLoS One 2022; 17:e0273563. [PMID: 36018883 PMCID: PMC9417032 DOI: 10.1371/journal.pone.0273563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Arterial cannulation in elderly patients is difficult because of age-related morphological changes. Applying dynamic needle tip positioning (DNTP) that guides the catheter to position inside the vessel sufficiently may aid in successful cannulation.
Methods
This prospective study enrolled patients aged over 70 years, who were scheduled for elective surgery under general anaesthesia with arterial cannulation. The patients were randomly assigned to the DNTP (group D, n = 76) or the conventional short-axis view(group C, n = 75) group. The arterial depth, diameter, and arterial conditions(calcification, segmental stenosis, and tortuosity) were evaluated using ultrasound, before puncture. We recorded the first attempt success, cannulation time, the number of attempts, and cannulation-related complications.
Results
A total of 151 patients were enrolled in this study. The first attempt success rate in group D was significantly higher than that in group C (89% versus 72%; P = 0.0168). The median cannulation time per last attempt in group D versus group C was 25 versus 30 sec(P = 0.0001), and the overall cannulation time was 25 versus 35 sec(P = 0.0001), respectively. Arterial cannulation per last attempt and overall cannulation time were shorter in group D. The number of attempts was higher in group C (P = 0.0038). The occurrence rate of hematoma was significantly lower in group D (16% versus 47%, relative risk = 3.0, P = 0.0001).
Conclusions
The DNTP method may improve the first attempt success rate of arterial cannulation and reduce complications in elderly patients over 70 years of age.
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Men X, Wang Q, Hu WS, Chai Y, Ni TT, Sho HY, Zhou ZF. Median nerve block increases the success rate of radial artery cannulation in women with gestational hypertension undergoing cesarean section. BMC Anesthesiol 2022; 22:248. [PMID: 35931948 PMCID: PMC9354365 DOI: 10.1186/s12871-022-01793-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/28/2022] [Indexed: 02/06/2023] Open
Abstract
Background The radial artery cannulation helps to maintain the stability of maternal hemodynamics and reduce complications, however, it is difficult for women with gestational hypertension. Ultrasound-guided median nerve block can cause arterial vasodilation, which may improve the success rate of radial artery cannulation. Methods Ninety-two women with gestational hypertension and risks of intra-operative bleeding undergoing cesarean section following failed ultrasound-guided cannulation were identified and randomized into the median nerve block group and control group. Median nerve block was performed under the guidance of ultrasound in the middle forearm and 5 ml of 0.5% lidocaine was injected. Subcutaneous local block was administered in the control group. The ultrasound-guided radial artery cannulation was performed ten minutes after blocking. Baseline measurements (T1) were performed after 10 minutes of rest. All variables were measured again at 10 (T2) and 30 (T3) minutes after median nerve block or local block. The primary outcome was the success rate of radial artery cannulation within 10 minutes after blocking. The puncture time, number of attempts, the overall complications, and ultrasonographic measurements including radial artery diameter and cross-sectional area were recorded before (T1), 10 minutes (T2) after, and 30 minutes (T3) after block. Results A total of 92 pregnant women were identified and completed the follow-up. As compared to control group, the first-attempt success rate of radial artery cannulation was significantly higher (95.7% vs78.3%, p = 0.027) and procedure time to success was significantly shorter (118 ± 19 s vs 172 ± 66 s, p < 0.001) in median nerve group. Median nerve group also had a significantly less overall number of attempts (p = 0.024). Compared with control group, the diameter and cross-sectional area of radial artery increased significantly at the T2 and T3 points in median nerve group (p < 0.001), as well as percentage change of radial artery diameter and CSA. No difference was observed in the overall complication at chosen radial artery, which including vasospasm (21.7% vs 28.3%; p = 0.470) and hematoma (4.3% vs 8.7%; p = 0.677). Conclusions Ultrasound-guided median nerve block can increase the first-attempt success rate of chosen radial artery cannulation in women with gestational hypertension and risks of intra-operative bleeding undergoing cesarean section following failed radial artery cannulation, and especially for those anesthesiologists with less experienced in radial artery cannulation. Trial registration ChiCTR2100052862; http://www.chictr.org.cn, Principal investigator: MEN, Date of registration: 06/11/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01793-4.
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Affiliation(s)
- Xin Men
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou, 315014, China
| | - Qian Wang
- Department of Anesthesiology, The Affiliated ZheJiang Hospital, School of Medicine, Zhejiang University, Hangzhou, 315014, China
| | - Wen-Shen Hu
- Department of Obstetrics, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou, 315014, China
| | - Yun Chai
- Department of Obstetrics, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou, 315014, China
| | - Ting-Ting Ni
- Department of Anesthesiology, Ningbo NO.7 Hospital, Ningbo, 320000, China
| | - Hong-Ye Sho
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou, 315014, China.
| | - Zhen-Feng Zhou
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, The Affiliated Women's Hospital of Hangzhou Normal University), Hangzhou, 315014, China.
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Scholten HJ, Hoever Y, Kanters E, Hoveling T, de Wild M, Korsten EHM, Bouwman RA. Ultrasound transducer with dynamic visual aid improves out-of-plane vascular access: a feasibility study. Br J Anaesth 2022; 129:e69-e71. [PMID: 35817614 DOI: 10.1016/j.bja.2022.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/04/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Harm J Scholten
- Department of Anaesthesiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Yomi Hoever
- Department of Anaesthesiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Anaesthesiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Elke Kanters
- Department of IGT and Ultrasound Devices & Systems, Philips Research, Eindhoven, the Netherlands
| | - Tamara Hoveling
- Department of IGT and Ultrasound Devices & Systems, Philips Research, Eindhoven, the Netherlands
| | - Marco de Wild
- Department of IGT and Ultrasound Devices & Systems, Philips Research, Eindhoven, the Netherlands
| | - Erik H M Korsten
- Department of Anaesthesiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of IGT and Ultrasound Devices & Systems, Philips Research, Eindhoven, the Netherlands
| | - R Arthur Bouwman
- Department of Anaesthesiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of IGT and Ultrasound Devices & Systems, Philips Research, Eindhoven, the Netherlands
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20
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Efficacy Assessment of Phentolamine Accompanied by Lidocaine Subcutaneously under Ultrasound Guidance on Radial Artery Catheterization in Pediatric Patients. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6554993. [PMID: 35757477 PMCID: PMC9225856 DOI: 10.1155/2022/6554993] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/29/2022] [Accepted: 05/11/2022] [Indexed: 12/02/2022]
Abstract
Objective Pediatric patients are facing greater difficulties in radial catheterization for anatomic variation and smaller diameter. This study is to investigate the efficacy of phentolamine accompanied by lidocaine subcutaneously under ultrasound guidance on radial catheterization in pediatric patients. Methods 66 pediatric patients were enrolled and randomly divided into saline group, phentolamine group, and phentolamine+lidocaine group. Baseline characteristics and surgical types were collected. Relevant solutions were subcutaneously injected, and catheterization was subsequently conducted under ultrasound guidance. Radial artery diameter and depth were measured, the success rate of catheterization and procedure time were calculated, and the complications were evaluated with ultrasonography. Results No significant differences were observed in age, sex, weight, American Society of Anesthesiologists' classification, systolic blood pressure, diastolic blood pressure, heart rate, hemoglobin, and surgical types among three groups. Subcutaneously, the diameter in phentolamine and phentolamine+lidocaine groups increased significantly compared with the saline group. Moreover, the diameter also increased significantly after injection compared with that before injection both in the phentolamine and phentolamine+lidocaine groups. The first-attempt success rates were significantly higher while the procedure times of cannulation were shorter in the phentolamine and phentolamine+lidocaine groups than that in the saline group. Kaplan–Meier analysis showed that the overall procedure time was shorter in the phentolamine and phentolamine+lidocaine groups than the saline group. Overall complications and vasospasm incidence were lower in the phentolamine and phentolamine+lidocaine groups than the saline group. Conclusion Phentolamine accompanied by lidocaine subcutaneous injection under ultrasound guidance improved the first-attempt success rate and reduced the complication of radial artery catheterization in pediatric patients.
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Imbrìaco G, Monesi A, Spencer TR. Preventing radial arterial catheter failure in critical care - Factoring updated clinical strategies and techniques. Anaesth Crit Care Pain Med 2022; 41:101096. [PMID: 35490863 DOI: 10.1016/j.accpm.2022.101096] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
Radial artery catheterization is a frequently performed procedure for critically ill patients. The correct function of arterial catheters is essential to provide accurate and continuous hemodynamic monitoring, facilitating intermittent blood sampling and helping to optimize the workload for critical care nurses and physicians. However, they are not without their own problems. This narrative practice review discusses several clinical aspects that are not frequently considered but may contribute to enhanced catheter functionality, less device-related failure and more acceptable dwell times. Ultrasound has demonstrated unequivocal efficacies and safety with the procedure, improving first attempt success rates with children, the obese or patients with unstable clinical vital signs and shock. Moreover, anatomic variations of the radial artery are not rare, and ultrasound-guided catheterization reduces the incidence of insertion-related complications such as hematoma, posterior wall puncture, intimal dissection, and radial nerve injury. Ultrasound guidance offers several immediate benefits by enhancing the most appropriate insertion techniques, allows for the correct catheter to vessel ratio measurements to be performed and reduces the angle of insertion, which may affect catheter failure due to inappropriate catheter length. A deeper and more proximal cannulation site at least 4 cm from wrist joint, avoiding the area of wrist flexion, reduces mechanical complications related to patient movements and may improve catheter functionality and dwell along with a better area for stabilization and securement.
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Affiliation(s)
- Guglielmo Imbrìaco
- Centrale Operativa 118 Emilia Est (Prehospital Emergency Medical Dispatch Centre), Helicopter Emergency Medical Service, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy; Critical Care Nursing Course, University of Bologna, Bologna, Italy.
| | - Alessandro Monesi
- Critical Care Nursing Course, University of Bologna, Bologna, Italy; Intensive Care Unit, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
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Ren G, Qiang X, Yu H. Observation on Application Effect of Arterial Puncture and Catheterization under Guidance of Intelligent Medical Care Ultrasound in Clinical Anesthesia. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6970274. [PMID: 35388318 PMCID: PMC8979703 DOI: 10.1155/2022/6970274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
In clinical anesthesia and the rescue of critically ill patients, arterial puncture and catheterization are the most commonly chosen ways to establish central arterial access for patients. Invasive arterial puncture and catheterization facilitate the grasp of real-time vital sign information of patients during surgery, which strengthens patient monitoring during surgery and improves safety. However, the traditional method of arterial puncture and cannulation through palpation of the radial artery is often prone to complications related to mechanical injury, such as hemorrhage, hematoma, and accidental perforation of the artery. Studies have shown that ultrasound-guided radial artery puncture and cannulation can shorten the puncture cannulation time, reduce the incidence of complications related to puncture cannulation, and improve the success rate of puncture cannulation. In order to verify it, this paper uses the experimental group and the control group to conduct comparative experiments and uses the neural network method to evaluate the effects of the two methods. As a more mature method of artificial intelligence, BP neural network is widely used in a wide range of applications and has the characteristics of strong generalization ability and fast convergence, so we choose it as the base model. The specific work of this paper is as follows: (1) in-depth study of the relevant theory of BP neural network (BPNN), focusing on the structure of BPNN and the working principle of algorithm; the problems to be solved in the clinical anesthesia effect evaluation have laid a theoretical foundation for the establishment of an improved BPNN evaluation model in the following chapters. (2) introduce the basic principle of genetic neural network, analyze the benefits of combining genetic neural network and BPNN; introduce in detail the process of genetic algorithm to optimize the weights and thresholds of BPNN, and establish a GA-BP evaluation model. The test proves the feasibility and superiority of the model.
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Affiliation(s)
- Guozhang Ren
- Department of Anesthesiology, Yantai Hospital of Traditional Chinese Medicine, Yantai 264000, Shandong, China
| | - Xiancheng Qiang
- Department of Anesthesiology, Qingdao Eighth Peolpe's Hospital, Qingdao 266100, Shandong, China
| | - Hui Yu
- Department of Anesthesiology, Qingdao Eye Hospital Affiliated to Shandong First Medical Universty, Qingdao, 266071, Shandong, China
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Ultrasound-guided selective lateral cutaneous nerve of forearm block: A novel technique of pain management during radial artery cannulation. J Clin Anesth 2021; 77:110635. [PMID: 34973569 DOI: 10.1016/j.jclinane.2021.110635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/20/2022]
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Roux J, Kohn MA, Sinskey J, Nguyen H, Boor M, Rouine-Rapp K. The ulnar artery: A site suitable for arterial cannulation in pediatric patients. Paediatr Anaesth 2021; 31:1357-1363. [PMID: 34644423 DOI: 10.1111/pan.14311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/01/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Historically, the ulnar artery has rarely been considered for arterial cannulation as it is less easily palpated than the radial artery. With the current routine use of ultrasound in pediatric patients, the ulnar is as accessible as the radial and could be viewed as an equivalent site for cannulation. AIMS The purpose of this study was to compare ulnar and radial artery suitability for arterial cannulation in pediatric patients using 2-dimensional ultrasound. METHODS We examined the ulnar and radial arteries of pediatric patients aged birth to 6 years who were scheduled to undergo general anesthesia. Following anesthesia induction, the investigators positioned the patient's wrist to 30-45 degrees of extension and obtained images of the ulnar and radial arteries in the transverse and longitudinal planes. Assessments of the arteries' anterior-posterior diameter, cross-sectional area and depth were made by visual inspection at the time of image acquisition and by electronic caliper measurement of recorded images. RESULTS In 108 patients, mean anterior-posterior diameter of the ulnar artery was larger than the radial artery in the transverse view, longitudinal view, and cross-sectional area in 63.6%, 59.4%, and 60.4% of patients (p = .002, .004, and .006, respectively). Mean ulnar artery size was, on average, larger than the radial artery by 7.7%, 8.1%, and 12.9% in the transverse AP diameter, longitudinal AP diameter, and cross-sectional area (95% CI 3.1-12.4%; 3.2-13.0%; 4.4-21.5%). The investigator's visual evaluation of vessel size at the bedside showed substantial agreement with the measured cross-sectional area (linear-weighted kappa of 0.73). In a subset of 13 patients age <24 months, the mean depth of the ulnar artery was 2.13 mm compared to 1.65 mm for the radial artery (difference -0.48 mm 95% CI 1.08-0.12). CONCLUSIONS The ulnar artery was larger than the radial artery in 60% of pediatric patients thus may offer an arterial cannulation site advantage due to its larger size. The use of 2-dimensional ultrasound examination allows accurate assessment of upper extremity distal arteries in order to optimize site selection for arterial cannulation in pediatric patients.
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Affiliation(s)
- Jennifer Roux
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA
| | - Michael A Kohn
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jina Sinskey
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA
| | - Hung Nguyen
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA
| | - Marjorie Boor
- Department of Pediatric Echocardiography, University of California, San Francisco, California, USA
| | - Kathryn Rouine-Rapp
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA
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Kathrada MIS, Jagga M, Mzoneli YN, Swanevelder J, Gibbs MW. Perioperative ultrasound among South African anaesthetists: a survey of current practice and availability. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.6.2636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- MIS Kathrada
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town,
South Africa
| | - M Jagga
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town,
South Africa
| | - YN Mzoneli
- Discipline of Anaesthesiology and Critical Care, University of KwaZulu-Natal,
South Africa
| | - J Swanevelder
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town,
South Africa
| | - MW Gibbs
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town,
South Africa
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Varnitha MS, Kumar A, Gupta P, Yadav V, Agarwal A, Darbari A. Comparison of Ultrasound-Guided Direct versus Ultrasound-Guided Dart Technique of Radial Artery Cannulation: A Randomized Control Study. Anesth Essays Res 2021; 15:20-25. [PMID: 34667343 PMCID: PMC8462409 DOI: 10.4103/aer.aer_61_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/23/2021] [Accepted: 05/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background: Three different types of cannulation method for radial artery are Direct technique, Seldinger technique, and modified Seldinger technique (Dart). Their comparative efficacy has been studied using palpatory method but not with ultrasound guidance. Aims: We compared the efficacy of ultrasound-guided Direct and ultrasound-guided Dart technique of arterial cannulation. Settings and Design: One hundred and sixty patients posted for elective surgeries were included in prospective randomized control, single-blind study in a tertiary care center. Materials and Methods: The study comprised of two groups: Direct method (n = 80) and Dart method (n = 80), which were compared for the rate of successful cannulation within 5 min. The secondary objectives were time for successful cannulation, number of attempts, and rate of complications (hematoma, posterior wall puncture, and needle reinsertion) between two groups. Statistical Analysis: The group comparison for continuously distributed data was compared using the independent sample t-test. The Chi-square test was used for the group comparison of categorical data. Binary logistic regression was conducted to ascertain significant predictors for successful cannulation in 5 min. Results: Cannulation success rate was similar in both Direct (57.5%) and Dart (55%) groups. There was no significant difference in time for successful cannulation, number of attempts, number of needle redirection, and posterior wall puncture. However, the incidence of hematoma (Direct 22.5% [18]; Dart 8% [10]) was significant. There was better success rate of cannulation (n = 90) in patients with normal pulse and bigger radial artery lumen. Conclusion: There was no significant difference between Dart and Direct technique with the use of ultrasound guidance.
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Affiliation(s)
- M S Varnitha
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ajay Kumar
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Priyanka Gupta
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vikas Yadav
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ankit Agarwal
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Anshuman Darbari
- Department of CTVS, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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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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Shi J, Shen J, Xiang Z, Liu X, Lu T, Tao X. Dynamic Needle Tip Positioning versus Palpation and Ultrasound for Arteriovenous Puncture: A Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2233-2242. [PMID: 33966894 DOI: 10.1016/j.ultrasmedbio.2021.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
At present, dynamic needle-tip positioning (DNTP) technology is applied in arteriovenous puncture, challenging the use of ultrasound technology alone and palpation. Our goals were to extract data from experimental DNTP, ultrasound and palpation studies, using Review Manager, Version 5.3, for data analysis, and to evaluate whether DNTP has certain advantages in puncture. PubMed, EMBASE, the Cochrane Library, CNKI and WanFang Data Knowledge Service Platform were searched for randomized and non-randomized studies that compared DNTP with conventional ultrasound-guided techniques, no DNTP or palpation. The risk ratio with 95% confidence interval was calculated using the model corresponding to the I² value. Studies were identified to compare clinical indexes. With respect to clinical indexes, DNTP is better in terms of first-attempt success, overall success and complications. However, in infants, first-attempt success, overall success and number of additional punctures did not indicate good efficacy for DNTP compared with palpation. Artery puncture was also not performed well under ultrasound. On the basis of the current evidence, the advantages of DNTP over palpation and ultrasound are reflected in the successful first attempt rate of all groups and in all subgroups except infants. Therefore, for emergencies in elderly patients, DNTP can be used as a general method. Given that some of the studies were of low quality, more trials of high quality should be conducted to further verify the findings.
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Affiliation(s)
- Jiaxiao Shi
- Department of Orthopaedics, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine (Cangzhou No. 2 Hospital), Hebei, Cangzhou, China.
| | - Jiaxin Shen
- Intensive Care Unit, Cangzhou Central Hospital, Cangzhou, China
| | - Ziqian Xiang
- Department of Orthopaedics, Qilu Hospital, Shandong University, Jinan, China
| | - Xudong Liu
- Department of Ultrasound, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine (Cangzhou No. 2 Hospital), Hebei, Cangzhou, China
| | - Tingting Lu
- Department of Paediatrics, Cangzhou Central Hospital, Cangzhou, China
| | - Xiaobing Tao
- Department of Orthopaedics, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine (Cangzhou No. 2 Hospital), Hebei, Cangzhou, China
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Deasy A, O’Neill T, Rawluk D, Deasy J. Digital ischemia following radial arterial cannulation. Clin Case Rep 2021. [DOI: 10.1002/ccr3.4187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alison Deasy
- Beaumont Hospital, Royal College of Surgeons Dublin Ireland
| | - Tanya O’Neill
- Beaumont Hospital, Royal College of Surgeons Dublin Ireland
| | - Daniel Rawluk
- Beaumont Hospital, Royal College of Surgeons Dublin Ireland
| | - Joseph Deasy
- Beaumont Hospital, Royal College of Surgeons Dublin Ireland
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Abdelbaser I, Mageed NA, Elmorsy MM, Elfayoumy SI. Ultrasound-Guided Long-Axis Versus Short-Axis Femoral Artery Catheterization in Neonates and Infants Undergoing Cardiac Surgery: A Randomized Controlled Study. J Cardiothorac Vasc Anesth 2021; 36:677-683. [PMID: 34148802 DOI: 10.1053/j.jvca.2021.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of the present study was to compare ultrasound-guided long-axis (LAX) and short-axis (SAX) femoral artery catheterization in neonates and infants undergoing cardiac surgery. DESIGN A single-center, prospective, randomized, single-blinded, controlled study. SETTING This study was conducted in the operating room and intensive care unit of the division of cardiac surgery, Mansoura University Children's Hospital, Egypt. PARTICIPANTS Ninety neonates and infants undergoing elective cardiac surgery were enrolled in this study and randomly allocated to ultrasound-guided LAX and SAX groups. INTERVENTIONS Ultrasound-guided femoral artery catheterization was done using either LAX (in-plane) or SAX (out-of-plane) technique. MEASUREMENTS AND MAIN RESULTS The primary outcome measure was the rate of a successful first puncture. The secondary outcome measures were the rates of mechanical complications, failure rate, time to a successful first, second, and third puncture, total time of catheterization, and imaging time. The first puncture success rate was significantly higher (p = 0.048) in the LAX group (34 of 41, 82.9%) than in the SAX group (25 of 41, 60.9%). The mean time to a successful first puncture was significantly shorter (p < 0.001) in the LAX group (153.1 ± 30.1 seconds) than in the SAX group (227.2 ± 48.8 seconds). The total catheterization time was significantly shorter in the LAX group than in the SAX group. There was no significant difference in the rate of complication. CONCLUSION With a single experienced operator performing the ultrasound-guided femoral artery cannulation, the LAX technique resulted in a higher first puncture success rate and shorter time to cannulation than the SAX technique.
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Affiliation(s)
- Ibrahim Abdelbaser
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Nabil A Mageed
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed M Elmorsy
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sherif I Elfayoumy
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Portsaid University, Portsaid, Egypt
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A novel method for ultrasound-guided radial artery cannulation in neonates by trainee anaesthesiologists: A randomised controlled trial. Eur J Anaesthesiol 2021; 37:91-97. [PMID: 31567592 DOI: 10.1097/eja.0000000000001089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The modified dynamic needle tip positioning (MDNTP) technique for ultrasound-guided radial artery cannulation (MDNTP-US technique) in neonates can be technically challenging for trainee anaesthesiologists. We hypothesised that by associating the MDNTP-US technique with hypodermic 0.9% sodium chloride (Saline MDNTP-US technique), which increases the subcutaneous radial artery depth, the procedure would become easier for trainee anaesthesiologists. OBJECTIVE To compare the Saline MDNTP-US technique, with the MDNTP-US technique for radial artery catheterisation in neonates by trainee anaesthesiologists with limited experience. DESIGN Randomised controlled trial. PATIENTS Ninety-six neonates scheduled to undergo major abdominal surgery requiring continuous arterial pressure monitoring between May 2018 and December 2018 at the Children's Hospital of Chongqing Medical University were enrolled. Neonates with signs of skin erosions or haematomas at or near the insertion site, as well as those with low noninvasive blood pressure values, were excluded. INTERVENTION Neonates were randomised to the Saline MDNTP-US and MDNTP-US groups in a 1 : 1 ratio. Twelve trainees performed the cannulation procedures. MAIN OUTCOME MEASURES Duration of procedure, first attempt success rate, rate of success within 10 min, and the incidence of haematoma and thrombosis. RESULTS The median [IQR] time to perform cannulation was less for the Saline MDNTP-US technique than for the MDNTP-US technique: 203 [160 to 600] vs. 600 s [220 to 600]; P = 0.005. The rate of success within 10 min, 72.9 vs. 47.9%; P = 0.012, was higher in the Saline MDNTP-US group than in the MDNTP-US group. The incidence of haematoma on postoperative day 1 was lower in the Saline MDNTP-US group than in the MDNTP-US group: 8.3 vs. 22.9%; P = 0.049. CONCLUSION Trainee anaesthesiologists can achieve higher success rates by using the Saline MDNTP-US technique instead of the MDNTP-US technique for radial artery catheterisation in neonates, taking less time with a lower incidence of complications. TRIAL REGISTRATION ChiCTR-IOR-17014119 (Chinese Clinical Trial Registry).
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Cho SA, Jang YE, Ji SH, Kim EH, Lee JH, Kim HS, Kim JT. Ultrasound-guided arterial catheterization. Anesth Pain Med (Seoul) 2021; 16:119-132. [PMID: 33866769 PMCID: PMC8107253 DOI: 10.17085/apm.21012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/14/2021] [Indexed: 11/17/2022] Open
Abstract
Ultrasonography facilitates arterial catheterization compared to traditional palpation techniques, especially in small arteries. For successful catheterization without complications, practitioners should be familiar with the anatomic characteristics of the artery and ultrasound-guided techniques. There are two approaches for ultrasound-guided arterial catheterization: the short-axis view out-of-plane approach and the long-axis view in-plane approach. There are several modified techniques and tips to facilitate ultrasound-guided arterial catheterization. This review deals with the anatomy relevant to arterial catheterization, several methods to improve success rates, and decrease complications associated with arterial catheterization.
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Affiliation(s)
- Sung-Ae Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Zetlaoui PJ, Benhamou D. Radial artery puncture and ultrasound imaging: Three reasons why. Anaesth Crit Care Pain Med 2021; 40:100844. [PMID: 33771752 DOI: 10.1016/j.accpm.2021.100844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Paul J Zetlaoui
- Département d'Anesthésie-réanimation, Hôpital Bicêtre AP-HP, Le Kremlin-Bicêtre Cedex, France.
| | - Dan Benhamou
- Département d'Anesthésie-réanimation, Hôpital Bicêtre AP-HP, Le Kremlin-Bicêtre Cedex, France
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Zhao W, Peng H, Li H, Yi Y, Ma Y, He Y, Zhang H, Li T. Effects of ultrasound-guided techniques for radial arterial catheterization: A meta-analysis of randomized controlled trials. Am J Emerg Med 2021; 46:1-9. [PMID: 33684726 DOI: 10.1016/j.ajem.2020.04.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate whether ultrasound-guided techniques are superior compared to traditional palpation techniques in patients undergoing radial artery catheterization (RAC). METHODS Electronic databases of PubMed, Embase, and the Cochrane Library were systematically searched to identify randomized controlled trials (RCTs). The relative risks (RRs) or weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) were used to calculate the pooled effect estimates using the random effects model for categories and continuous data, respectively. RESULTS A total of 19 RCTs comprising a total of 3220 individuals were selected for final analysis. The pooled RR suggested that ultrasound-guided techniques were associated with higher incidence of first attempt success than traditional palpation techniques (RR, 1.39; 95% CI, 1.21-1.59; P < 0.001). Moreover, we noted that ultrasound-guided techniques were associated with fewer mean attempts to success (WMD, -0.80 s; 95% CI, -1.35 to -0.25; P = 0.004) and a shorter mean time to success (WMD, -41.18 s; 95% CI, -75.43 to -6.93; P = 0.018) than traditional palpation techniques. Furthermore, individuals using ultrasound-guided techniques had a reduced risk of hematoma (RR, 0.40; 95% CI, 0.22-0.72; P = 0.003). CONCLUSIONS This study indicated that ultrasound-guided techniques were superior compared to traditional palpation techniques for RAC in terms of efficacy and complications.
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Affiliation(s)
- Wenli Zhao
- Catheter Lab, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan 450003, China
| | - Huizhen Peng
- Catheter Lab, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan 450003, China
| | - Haiyun Li
- Catheter Lab, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan 450003, China
| | - Yinping Yi
- CCU, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan 450003, China
| | - Yufeng Ma
- Catheter Lab, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan 450003, China
| | - Yingkun He
- Department of Cerebrovascular Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial Neurointerventional Engineering Research Center, Zhengzhou, Henan 450003, China
| | - Hongmei Zhang
- Nursing Department, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan 450003, China.
| | - Tianxiao Li
- Department of Cerebrovascular Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial Neurointerventional Engineering Research Center, Zhengzhou, Henan 450003, China.
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Hoshi T. Preferred display size and visual distance for ultrasound-guided radial artery cannulation. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.5554/22562087.e968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: In-line positioning of an ultrasound image provides higher success rates and less time to completion for radial arterial cannulation. But preferable size and distance of ultrasound display has not been previously discussed.
Objective: To assess the ideal visual distance and display size when using a smart phone or tablet as the ultrasound image display.
Methods: Four smart phones or tablets were used as ultrasound displays in six different configurations in a simulated radial artery puncture. In a questionnaire, 116 anaesthesiologists working in Ibaraki Prefecture, Japan, were asked which of the six configurations was preferable for radial artery cannulation.
Results: Sixty anaesthesiologists answered the questionnaire. About half (53%) preferred the smaller display (4- or 5.5-inch) fixed at a distance of 30 to 40 cm, and most of the rest (44%) preferred the larger display (7.9- or 9.7-inch) placed posterior to the probe with a visual distance of 45 to 60 cm.
Conclusions: Among the anaesthesiologists, the preferable size and visual distance for ultrasound-guided radial artery cannulation varied using a smart phone or tablet for in-line display.
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Oulego-Erroz I, Mayordomo-Colunga J, González-Cortés R, Sánchez-Porras M, Llorente-de la Fuente A, Fernández-de Miguel S, Balaguer-Gargallo M, Frías-Pérez M, Rodríguez-Nuñez A, Oulego-Erroz I, Mayordomo-Colunga J, González-Cortés R, Porras MS, Fuente ALDL, Miguel SFD, Balaguer-Gargallo M, Frías-Pérez M, Rodríguez-Nuñez A, Santos-Herraiz P, García-Soler P, Clavero-Rubio C, Menéndez-Suso J, Mirás-Veiga A, Fernández-Romero E, Pino-Velázquez M, Renter-Valdovinos L, Jiménez E, Ortiz-Pallarés M, Martínez-Antón A, González-Ojeda V, Torrús-Carmona S, Barba MG, Palanca-Arias D, Holanda-Peña MS, González-Miño C. Ultrasound-guided arterial cannulation or by pulse palpation in the intensive care unit. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.anpede.2019.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kalagara H, Coker B, Gerstein NS, Kukreja P, Deriy L, Pierce A, Townsley MM. Point-of-Care Ultrasound (POCUS) for the Cardiothoracic Anesthesiologist. J Cardiothorac Vasc Anesth 2021; 36:1132-1147. [PMID: 33563532 DOI: 10.1053/j.jvca.2021.01.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/06/2021] [Accepted: 01/09/2021] [Indexed: 12/21/2022]
Abstract
Point-of-Care Ultrasound (POCUS) is a valuable bedside diagnostic tool for a variety of expeditious clinical assessments or as guidance for a multitude of acute care procedures. Varying aspects of nearly all organ systems can be evaluated using POCUS and, with the increasing availability of affordable ultrasound systems over the past decade, many now refer to POCUS as the 21st-century stethoscope. With the current available and growing evidence for the clinical value of POCUS, its utility across the perioperative arena adds enormous benefit to clinical decision-making. Cardiothoracic anesthesiologists routinely have used portable ultrasound systems for nearly as long as the technology has been available, making POCUS applications a natural extension of existing cardiothoracic anesthesia practice. This narrative review presents a broad discussion of the utility of POCUS for the cardiothoracic anesthesiologist in varying perioperative contexts, including the preoperative clinic, the operating room (OR), intensive care unit (ICU), and others. Furthermore, POCUS-related education, competence, and certification are addressed.
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Affiliation(s)
- Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Bradley Coker
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Promil Kukreja
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Lev Deriy
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Albert Pierce
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL.
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Dhar M. Non-traumatic “saline flush stylet” technique as an alternative rescue approach in difficult peripheral arterial catheter insertion. BALI JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.4103/bjoa.bjoa_58_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Huang HP, Zhao WJ, Wen F, Li XY. Application of ultrasound-guided radial artery cannulation in paediatric patients: A systematic review and meta-analysis. Aust Crit Care 2020; 34:388-394. [PMID: 33097369 DOI: 10.1016/j.aucc.2020.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Numerous studies have demonstrated the benefits and safety of ultrasound guidance in comparison with conventional palpation for radial artery cannulation in adult patients. However, the current evidence for paediatric patients is not fully understood. OBJECTIVE The objective of this study was to compare the efficiency and safety of ultrasound guidance with those of traditional palpation for radial artery cannulation in paediatric patients and provide convincing evidence for clinical practice. METHODS PubMed, Cochrane Library, ClinicalTrials.gov (Min et al-2019, NCT02795468, Anantasit et al-2017, NCT02668471), China National Knowledge Infrastructure, and Wanfang Data were systematically searched from their inception until December 31, 2019, to identify relevant randomised controlled trials. Data were extracted from the included studies independently by two investigators. The primary outcome of interest was the first-attempt success rate. Review Manager Version 5.3 and trial sequential analysis (beta = 0.9) were applied to analyse the collected data. RESULTS A total of eight randomised controlled trials involving 680 paediatric patients were included in this study. The pooled findings showed that ultrasound-guided radial artery cannulation, in comparison with traditional palpation, can significantly improve the first-attempt success rate (relative risk [RR] = 1.65, 95% confidence interval [CI] = 1.36-2.01, P < 0.00001). Trial sequential analysis indicated that this available evidence was conclusive. Moreover, ultrasound guidance was associated with an increased total success rate (RR = 1.38, 95% CI = 1.15-1.66, P = 0.0004), a decreased mean procedural time (standardised mean difference = -0.89, 95% CI = -1.52 to -0.25, P = 0.006), and incidence of haematoma (RR = 0.19, 95% CI = 0.10-0.35, P < 0.00001). CONCLUSION Ultrasound-guided radial arterial cannulation in paediatric patients is associated with improved first-attempt success rates, total success rates, and mean procedural time and decreased incidence of haematoma. The current evidence suggests that ultrasound guidance should be the standard of care for radial artery cannulation in clinical practice.
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Affiliation(s)
- Hua-Ping Huang
- Operation Room of Mianyang Central Hospital, Sichuan, China.
| | - Wen-Jun Zhao
- Operation Room of Mianyang Central Hospital, Sichuan, China
| | - Fang Wen
- Operation Room of Mianyang Central Hospital, Sichuan, China
| | - Xiao-Yu Li
- Pediatric Department of Mianyang Central Hospital, Sichuan, China
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40
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Bardin-Spencer AJ, Spencer TR. Arterial insertion method: A new method for systematic evaluation of ultrasound-guided radial arterial catheterization. J Vasc Access 2020; 22:733-738. [DOI: 10.1177/1129729820944104] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Peripheral arterial catheter insertion is a common procedure for critically ill patients requiring frequent blood gas sampling and continuous blood pressure monitoring. There are clear advantages of ultrasound-guided arterial cannulation, which have shown to be more effective in reducing complications, time to successful cannulation, number of attempts, and overall first-time success rates. Evidence suggests that using palpation alone has a first-time success rate of less than 70% yet is still a widely performed technique. A systematic evaluation may be required to reduce variations in arterial catheterization practices. Design: The arterial insertion method is a systematic evaluation to aid in arterial catheter insertion with ultrasound guidance, intended to improve the procedural approach. The process of arterial insertion method ensures appropriate choice of zone selection to optimize catheter longevity and performance in patients requiring arterial access. Moving the insertion site proximally 4 cm from the red zone into the green zone may reduce mechanical complications and preserve catheter performance and dwell time. Conclusion: The standardization of ultrasound guidance in arterial catheterization promotes vessel health and patient safety through device and site optimization. The arterial insertion method systematic evaluation may be utilized to reduce variation in practice and promote the use of ultrasound as a standard for the insertion of radial arterial catheters.
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41
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Bai B, Tian Y, Zhang Y, Yu C, Huang Y. Dynamic needle tip positioning versus the angle-distance technique for ultrasound-guided radial artery cannulation in adults: a randomized controlled trial. BMC Anesthesiol 2020; 20:231. [PMID: 32928119 PMCID: PMC7491138 DOI: 10.1186/s12871-020-01152-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
Background Ultrasound guidance can increase the success rate and reduce the incidence of complications of arterial cannulation. There are few studies on the utility of the dynamic needle tip positioning (DNTP) technique versus the angle-distance (AD) technique for ultrasound-guided radial arterial cannulation in adult surgical patients. We assessed and compared the success rates and incidences of complications of these two short-axis out-of-plane techniques. Methods A total of 131 adult surgical patients were randomized into DNTP and AD groups to undergo ultrasound-guided radial artery cannulation. The primary outcome was first-pass success without posterior wall puncture. The secondary outcomes included the first-pass success rate, 10-min overall success rate, cannulation time, posterior wall puncture, and the number of skin punctures. Results The first-pass success rates without posterior wall puncture were 53.8% in the DNTP group and 44.6% in the AD group (RR = 1.22, 95% CI: 0.86–1.72; P = 0.26). The cannulation time was significantly longer (P = 0.01) in the DNTP group [79.65 (54.3–109.4) seconds] than in the AD group [47.6 (24.9–103.8) seconds]. The posterior wall puncture rate was significantly lower (P = 0.002) in the DNTP group (29.2%) than in the AD group (56.1%; RR = 0.56, 95% CI: 0.42–0.82). Conclusions There were no significant differences in the first-pass success rate, with or without arterial posterior wall puncture, or in the 10-min overall success rate between the DNTP and AD groups. However, the cannulation time was longer and the posterior wall puncture rate was lower in the DNTP group. Trial registration The trial was registered at www.clinicaltrials.gov (No: NCT03656978). Registered 4 September 2018.
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Affiliation(s)
- Bing Bai
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yuan Tian
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Chunhua Yu
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Yuguang Huang
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
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Gibbons RC, Zanaboni A, Saravitz SM, Costantino TG. Ultrasound Guidance Versus Landmark-Guided Palpation for Radial Arterial Line Placement by Novice Emergency Medicine Interns: A Randomized Controlled Trial. J Emerg Med 2020; 59:911-917. [PMID: 32917440 DOI: 10.1016/j.jemermed.2020.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/29/2020] [Accepted: 07/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND More than 10 million arterial lines are placed annually worldwide, many of which happen in the emergency department. Before the introduction of point-of-care ultrasound, landmark-guided palpation (LMGP) was considered standard of care. OBJECTIVE The objective of this study is to compare ultrasound-guided (USG) and LMGP of radial arterial line cannulation by novice emergency medicine interns. METHODS This was a single-center, prospective, randomized controlled trial (NCT03326739) of a convenience sample of adult patients who presented to an urban, university hospital with 100,000 visits annually. There was no funding for this study. Patients who required an arterial line were blindly randomized into LMGP or USG groups. Only novice emergency medicine interns, defined as interns with <15 previous placements, who were not blinded, performed the cannulation. Statistical analyses included t and Fisher exact tests. RESULTS Forty patients were enrolled with 20 patients randomized to each group. USG had a first-pass success of 75% vs. 0% for LMGP (p < 0.00001) and an overall success of 100% vs. 15% for LMGP (p < 0.00001), a mean of 1.30 attempts vs. 2.95 attempts for LMGP (a difference of 1.65; p < 0.0001), and a mean time for placement of 264 s vs. 524 s for LMGP (a difference of 260; p = 0.0025). Of the failed LMGP, USG crossover was 100% successful with a mean of 1.37 attempts (95% confidence interval 0.58-2.16) and 180 s for placement (95% confidence interval 97.92-262.08). Five percent of LMGP had a complication vs. 0% for USG (p = 1.0). CONCLUSIONS USG improved first-pass and overall success of radial arterial line cannulation while reducing time to access and attempts when used by novice emergency medicine interns.
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Affiliation(s)
- Ryan C Gibbons
- Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Allison Zanaboni
- Department of Emergency Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Schae M Saravitz
- Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Thomas G Costantino
- Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Timsit JF, Baleine J, Bernard L, Calvino-Gunther S, Darmon M, Dellamonica J, Desruennes E, Leone M, Lepape A, Leroy O, Lucet JC, Merchaoui Z, Mimoz O, Misset B, Parienti JJ, Quenot JP, Roch A, Schmidt M, Slama M, Souweine B, Zahar JR, Zingg W, Bodet-Contentin L, Maxime V. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit. Ann Intensive Care 2020; 10:118. [PMID: 32894389 PMCID: PMC7477021 DOI: 10.1186/s13613-020-00713-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.
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Affiliation(s)
- Jean-François Timsit
- APHP/Hopital Bichat-Medical and Infectious Diseases ICU (MI2), 46 rue Henri Huchard, 75018, Paris, France.,UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases, Control and Care Inserm/Université de Paris, Sorbonne Paris Cité, 75018, Paris, France
| | - Julien Baleine
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve University Hospital, 371 Avenue Doyen G Giraud, 34295, Montpellier Cedex 5, France
| | - Louis Bernard
- Infectious Diseases Unit, University Hospital Tours, Nîmes 2 Boulevard, 37000, Tours, France
| | - Silvia Calvino-Gunther
- CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine Aiguë, 38000, Grenoble, France
| | - Michael Darmon
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Jean Dellamonica
- Centre Hospitalier Universitaire de Nice, Médecine Intensive Réanimation, Archet 1, UR2CA Unité de Recherche Clinique Côte d'Azur, Université Cote d'Azur, Nice, France
| | - Eric Desruennes
- Clinique d'anesthésie pédiatrique, Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, CHU Lille, 59000, Lille, France.,Unité accès vasculaire, Centre Oscar Lambret, 3 rue Frédéric Combemale, 59000, Lille, France
| | - Marc Leone
- Anesthésie Réanimation, Hôpital Nord, 13015, Marseille, France
| | - Alain Lepape
- Service d'Anesthésie et de Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, Lyon, France.,UMR CNRS 5308, Inserm U1111, Laboratoire des Pathogènes Émergents, Centre International de Recherche en Infectiologie, Lyon, France
| | - Olivier Leroy
- Medical ICU, Chatilliez Hospital, Tourcoing, France.,U934/UMR3215, Institut Curie, PSL Research University, 75005, Paris, France
| | - Jean-Christophe Lucet
- AP-HP, Infection Control Unit, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France.,INSERM IAME, U1137, Team DesCID, University of Paris, Paris, France
| | - Zied Merchaoui
- Pediatric Intensive Care, Paris South University Hospitals AP-HP, Le Kremlin Bicêtre, France
| | - Olivier Mimoz
- Services des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, 86021, Poitiers, France.,Université de Poitiers, Poitiers, France.,Inserm U1070, Poitiers, France
| | - Benoit Misset
- Department of Intensive Care, Sart-Tilman University Hospital, and University of Liège, Liège, Belgium
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research and Department of Infectious Diseases, Caen University Hospital, 14000, Caen, France.,EA2656 Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0) UNICAEN, CHU Caen Medical School Université Caen Normandie, Caen, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Antoine Roch
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Service des Urgences, 13015, Marseille, France.,Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Matthieu Schmidt
- Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris, France.,INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Sorbonne Universités, 75651, Paris Cedex 13, France
| | - Michel Slama
- Medical Intensive Care Unit, CHU Sud Amiens, Amiens, France
| | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-Ralph Zahar
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, Paris, France.,Service de Microbiologie Clinique et Unité de Contrôle et de Prévention Du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Walter Zingg
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laetitia Bodet-Contentin
- Medical Intensive Care Unit, INSERM CIC 1415, CRICS-TriGGERSep Network, CHRU de Tours and Université de Tours, Tours, France
| | - Virginie Maxime
- Surgical and Medical Intensive Care Unit Hôpital, Raymond Poincaré, 9230, Garches, France.
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Imbriaco G, Monesi A, Giugni A, Cilloni N. Radial artery cannulation in intensive care unit patients: Does distance from wrist joint increase catheter durability and functionality? J Vasc Access 2020; 22:561-567. [PMID: 32854566 DOI: 10.1177/1129729820953020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Radial artery cannulation (RAC) is a common procedure in Intensive Care Units (ICU); radial catheters for ICU patients require increased durability to collect blood samples and to guarantee continuous hemodynamic monitoring. Failure in catheter functionality needs catheter replacement, impacting on staff workload, costs, and patient safety and discomfort. METHODS prospective non-randomised cohort study on adult ICU patients describing intensivists and critical care nurses' approach in radial artery catheterization. RESULTS A sample of 103 radial artery cannulations was observed. Catheterization was performed blind in 71 patients (68.9%) and with ultrasound guidance (USG) in 32 (31.1%); majority of blind inserted RAC were at a distance between 0 and 3.9 cm from wrist joint (77.5%) while catheters inserted from 4 to 10 cm were mainly positioned with USG (84.4%). Radial catheters inserted with USG at a distance of 4 to 10 cm from wrist joint had an in-situ time double than those inserted blind (8.2 ± 7.5 vs 4.8 ± 7.3, p < 0.038). CONCLUSIONS As recommended by current evidence and guidelines, USG represents a valuable support during arterial catheterization and is recommended in adult patients with clinical signs of shock, obese, swelling, and in the paediatric population. RAC in the forearm proximally, at a distance of at least 4 cm from wrist, could increase catheter durability and functionality for ICU patients. USG for cannulation in this forearm area is mandatory because of the deeper course of the radial artery.
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Affiliation(s)
- Guglielmo Imbriaco
- Intensive Care Unit, Ospedale Maggiore, Bologna, Italy.,Critical Care Nursing Master course, University of Bologna, Italy
| | - Alessandro Monesi
- Intensive Care Unit, Ospedale Maggiore, Bologna, Italy.,Critical Care Nursing Master course, University of Bologna, Italy
| | - Aimone Giugni
- Division of Anesthesia, Intensive Care, and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Nicola Cilloni
- Division of Anesthesia, Intensive Care, and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
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Ultrasound guidance and risk for intravascular catheter-related infections among peripheral arterial catheters: a post-hoc analysis of two large randomized-controlled trials. Ann Intensive Care 2020; 10:89. [PMID: 32643100 PMCID: PMC7343671 DOI: 10.1186/s13613-020-00705-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact on infectious risk of ultrasound guidance at insertion remains controversial in short-term arterial catheters (ACs). The present study investigated the association between ultrasound guidance (US) during AC insertion and major catheter-related infections (MCRI), catheter-related bloodstream infections (CR-BSI) or colonization, using univariate and multivariate marginal Cox model for clustered data. The skin colonization at catheter removal was evaluated to explain our results. RESULTS We used individual data from two multicenter randomized-controlled trials (RCTs) that included a total of 3029 patients, 10 ICUs and 3950 ACs. US guidance was used for 386 (9.8%) catheter placements. In the univariate Cox model analysis, AC insertion with US versus without US exhibited similar risks for MCRI (HR 0.86, CI 95% 0.27-2.72, p = 0.79), CR-BSI (HR 0.87, CI 95% 0.20-3.72, p = 0.85) and catheter colonization (HR 1.31, CI 95% 0.92-1.86, p = 0.13). After adjustment on confounders, risks associated with US guidance remained similar versus non-US for MCRI (HR 0.71, CI 95% 0.23-2.24, p = 0.56), CR-BSI (HR 0.71, CI 95% 0.17-3.00, p = 0.63) and catheter colonization (HR 0.92, CI 95% 0.63-1.34, p = 0.67). No differences between US and non-US for MCRI, CR-BSI and colonization were observed according to the insertion site, radial or femoral. At catheter removal, the skin colonization was similar between US and non-US groups (p = 0.69). CONCLUSIONS Using the largest dataset ever collected from large multi-centric RCTs conducted with relatively consistent insertion and maintenance catheter protocols, we showed that the risk of infectious complications for ACs inserted under US guidance is not superior compared to those inserted without US guidance. Trial registration These studies were registered within ClinicalTrials.gov (numbers NCT01629550 and NCT01189682).
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Oh EJ, Lee JH, Kwon EJ, Min JJ. Simulation-based training using a vessel phantom effectively improved first attempt success and dynamic needle-tip positioning ability for ultrasound-guided radial artery cannulation in real patients: An assessor-blinded randomized controlled study. PLoS One 2020; 15:e0234567. [PMID: 32525955 PMCID: PMC7289374 DOI: 10.1371/journal.pone.0234567] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background We evaluated whether a simulation-based training with a vessel phantom improves the basic skills of a novice required for ultrasound-guided radial artery cannulation in real patients. In addition, we analysed whether repeated simulation training sets with an inter-training interval would accelerate the learning curve. Methods From March 2019 to July 2019, twenty-one anesthesiology residents were randomized into either a simulation group (n = 11) or control group (n = 10). Residents performed a total of 84 ultrasound-guided radial artery cannulations in real patients. The simulation group participated in two sets of simulation training on a vessel phantom (10 sessions per set) with a one-month inter-training interval. Trainee’s performance proficiency was scored using a developed checklist, and a learning curve for each training set was constructed. To evaluate the effectiveness of our training curriculum in skill transfer, each resident performed four ultrasound-guided radial artery cannulations in real patients. The primary outcome was first attempt success rate and the secondary outcome was dynamic needle-tip positioning ability in real patients. Results The first attempt success rate and dynamic needle-tip positioning ability by ultrasound transducer were significantly higher in the simulation group than the control group (81.8% vs. 50%, P = 0.002 and 68.2% vs. 7.5%, P < 0.001, respectively). A reduced number of sessions was required to reach a plateau score on the learning curve in the repeated training set compared in the first-set (7 (5–8) vs. 3 (2–4), P = 0.003, respectively). Conclusions Simulation-based training using a vessel phantom effectively improved the first attempt success rate for ultrasound-guided radial artery cannulation in real patients and the dynamic needle-tip positioning ability by ultrasound transducer in novice anesthesiology residents. In addition, repeated training curriculum accelerated the learning curve for recall skill proficiency and reduced inter-individual variability for skill acquisition. Clinical trial registration Clinical Research Information Service (KCT0003471, Principle investigator: Jeong Jin Min, Date of registration: 06/March/2019).
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Affiliation(s)
- Eun Jung Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Eun Jin Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jeong Jin Min
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
- * E-mail:
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Zhang W, Li K, Xu H, Luo D, Ji C, Yang K, Zhao Q. Efficacy of ultrasound-guided technique for radial artery catheterization in pediatric populations: a systematic review and meta-analysis of randomized controlled trials. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:197. [PMID: 32375841 PMCID: PMC7201726 DOI: 10.1186/s13054-020-02920-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
Abstract
Background The use of an ultrasound-guided technique for radial arterial catheterization has not been well established in pediatric patients. We conducted a systematic review and meta-analysis to evaluate the efficacy of the ultrasound-guided technique for radial artery catheterization in pediatric populations. Method A systematic review of PubMed, Medline, Embase, and the Cochrane library was performed from their date of inception to December 2019. In this meta-analysis, we conducted online searches using the search terms “ultrasonography,” “ultrasonics,” “ultrasound-guided,” “ultrasound,” “radial artery,” “radial arterial,” “catheter,” “cannula,” and “catheterization.” The rate of the first-attempt and total success, mean attempts to success, mean time to success, and incidence of complications (hematomas) were extracted. Data analysis was performed with RevMan 5.3.5. Results From 7 relevant studies, 558 radial artery catheterizations were enrolled, including 274 ultrasound-guided and 284 palpation catheterizations. The ultrasound-guided technique could significantly improve the rate of first-attempt and total success (RR 1.78, 95% CI 1.46 to 2.18, P < 0.00001; RR 1.33; 95% CI 1.20 to 1.48; P < 0.00001). However, there was significant heterogeneity for the total success rate among the included studies (I2 = 67%). The ultrasound-guided radial artery catheterization was also associated with less mean attempts and mean time to success (WMD − 1.13, 95% CI − 1.58 to − 0.69; WMD − 72.97 s, 95% CI − 134.41 to − 11.52) and lower incidence of the hematomas (RR 0.17, 95% CI 0.07 to 0.41). Conclusions The use of the ultrasound-guided technique could improve the success rate of radial arterial catheterization and reduce the incidence of hematomas in pediatric patients. However, the results should be interpreted cautiously due to the heterogeneity among the studies.
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Affiliation(s)
- Wen Zhang
- Department of Ultrasound, Liaocheng People's Hospital, Liaocheng City, Shandong Province, China
| | - Kunpeng Li
- Department of Orthopaedics, Liaocheng People's Hospital, No 67 Dongchang West Road, Liaocheng City, 252000, Shandong Province, China
| | - Hui Xu
- Department of Orthopaedics, Liaocheng People's Hospital, No 67 Dongchang West Road, Liaocheng City, 252000, Shandong Province, China.
| | - Dawei Luo
- Department of Orthopaedics, Liaocheng People's Hospital, No 67 Dongchang West Road, Liaocheng City, 252000, Shandong Province, China
| | - Changbin Ji
- Department of Orthopaedics, Liaocheng People's Hospital, No 67 Dongchang West Road, Liaocheng City, 252000, Shandong Province, China
| | - Keshi Yang
- Department of Orthopaedics, Liaocheng People's Hospital, No 67 Dongchang West Road, Liaocheng City, 252000, Shandong Province, China
| | - Qinghua Zhao
- Department of Ultrasound, Liaocheng People's Hospital, Liaocheng City, Shandong Province, China
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Abstract
Background
Pediatric radial artery cannulation is challenging because of the small vessel size. Nitroglycerin is a potent vasodilator and facilitates radial artery cannulation by increasing the internal diameter and preventing the vasospasm in adult patients. The authors hypothesize that subcutaneous nitroglycerin injection will improve the success rate of pediatric radial artery cannulation.
Methods
This double-blind, randomized, controlled, single-center study enrolled pediatric patients (n = 113, age less than 2 yr) requiring radial artery cannulation during general anesthesia. The participants were randomized into the nitroglycerin group (n = 57) or control group (n = 56). After inducing general anesthesia, nitroglycerin solution (5 μg/kg in 0.5 ml), or normal saline (0.5 ml) was subcutaneously injected above the chosen radial artery over 10 s with ultrasound guidance. Three minutes later, the ultrasound-guided radial artery cannulation was performed. Radial artery diameter was measured before and after the subcutaneous injection and after cannulation. The primary outcome was the first-attempt successful cannulation rate. The secondary outcomes included the diameter of the radial artery and the overall complication rate including hematoma and vasospasm.
Results
A total of 113 children were included in the analysis. The nitroglycerin group had a higher first-attempt success rate than the control group (91.2% [52 of 57] vs. 66.1% [37 of 56]; P = 0.002; odds ratio, 5.3; 95% CI, 1.83 to 15.6; absolute risk reduction, –25.2%; 95% CI, –39.6 to –10.7%). Subcutaneous nitroglycerin injection increased the diameter of the radial artery greater than normal saline (25.0 ± 19.5% vs. 1.9 ± 13.1%; 95% CI of mean difference, 16.9 to 29.3%; P < 0.001). Overall complication rate was lower in the nitroglycerin group than in the control group (3.5% [2 of 57] vs. 31.2% [18 of 56]; P = 0.001; odds ratio, 0.077; 95% CI, 0.017 to 0.350; absolute risk reduction, 28.6%; 95% CI, 15.5 to 41.8%).
Conclusions
Subcutaneous nitroglycerin injection before radial artery cannulation improved the first-attempt success rate and reduced the overall complication rates in pediatric patients.
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
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Rashid MM, Lahaye LA, Riley CL, Liebman S, Murphy WP, Shah PR. Longitudinal Competency-Based Point-of-Care Ultrasound Curriculum in Anesthesiology. A A Pract 2020; 14:155-165. [DOI: 10.1213/xaa.0000000000001147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Osuda M, Edanaga M, Matsumoto T, Yamamoto A, Ihara S, Tanaka S, Yamakage M. Comparison of Mill Suss™-guided radial artery catheterization with the long-axis in-plane ultrasound-guided method under general anesthesia: a randomized controlled trial. J Anesth 2020; 34:464-467. [PMID: 32095884 DOI: 10.1007/s00540-020-02749-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/10/2020] [Indexed: 11/25/2022]
Abstract
Continuous arterial blood pressure measurement is an effective perioperative monitoring method in patients with high-risk comorbidities. Recently, ultrasound guidance has been reported to facilitate radial artery catheterization. A new device, Mill Suss™, has also been developed for visualization of the radial artery and superficial veins using near-infrared laser light. In this study, we hypothesized that the Mill Suss-guided method might reduce the time and the number of attempts required for radial artery catheterization under general anesthesia, as compared to the long-axis in-plane ultrasound-guided method. Seventy-two adult patients aged 20-80 years, ASA physical status I or II, were randomly assigned to the Mill Suss-guided group (Group M: n = 36) or ultrasound-guided group (Group U: n = 36). Primary outcomes were the time required for successful radial artery catheterization and the number of cannulation attempts. There were no significant differences in the characteristics of patients between the two groups. The time required for successful radial artery catheterization was significantly shorter in Group M than in Group U. The number of attempts for successful cannulation was not statistically significantly different between the two groups. However, the results might be different among anesthesiologists well experienced in the ultrasound-guided method.
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Affiliation(s)
- Michiko Osuda
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Mitsutaka Edanaga
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tomomi Matsumoto
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Asuka Yamamoto
- Department of Anesthesia, Oji General Hospital, Tomakomai, Japan
| | - Saki Ihara
- Department of Anesthesia, Oji General Hospital, Tomakomai, Japan
| | - Satoru Tanaka
- Department of Anesthesia, Oji General Hospital, Tomakomai, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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