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Schults JA, Young ER, Marsh N, Larsen E, Corley A, Ware RS, Murgo M, Alexandrou E, McGrail M, Gowardman J, Charles KR, Regli A, Yasuda H, Rickard CM. Risk factors for arterial catheter failure and complications during critical care hospitalisation: a secondary analysis of a multisite, randomised trial. J Intensive Care 2024; 12:12. [PMID: 38459599 PMCID: PMC10924392 DOI: 10.1186/s40560-024-00719-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/04/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES Arterial catheters (ACs) are critical for haemodynamic monitoring and blood sampling but are prone to complications. We investigated the incidence and risk factors of AC failure. METHODS Secondary analysis of a multi-centre randomised controlled trial (ACTRN 12610000505000). Analysis included a subset of adult intensive care unit patients with an AC. The primary outcome was all-cause device failure. Secondary outcomes were catheter associated bloodstream infection (CABSI), suspected CABSI, occlusion, thrombosis, accidental removal, pain, and line fracture. Risk factors associated with AC failure were investigated using Cox proportional hazards and competing-risk models. RESULTS Of 664 patients, 173 (26%) experienced AC failure (incidence rate [IR] 37/1000 catheter days). Suspected CABSI was the most common failure type (11%; IR 15.3/1000 catheter days), followed by occlusion (8%; IR 11.9/1,000 catheter days), and accidental removal (4%; IR 5.5/1000 catheter days). CABSI occurred in 16 (2%) patients. All-cause failure and occlusion were reduced with ultrasound-assisted insertion (failure: adjusted hazard ratio [HR] 0.43, 95% CI 0.25, 0.76; occlusion: sub-HR 0.11, 95% CI 0.03, 0.43). Increased age was associated with less AC failure (60-74 years HR 0.63, 95% CI 0.44 to 0.89; 75 + years HR 0.36, 95% CI 0.20, 0.64; referent 15-59 years). Females experienced more occlusion (adjusted sub-HR 2.53, 95% CI 1.49, 4.29), while patients with diabetes had less (SHR 0.15, 95% CI 0.04, 0.63). Suspected CABSI was associated with an abnormal insertion site appearance (SHR 2.71, 95% CI 1.48, 4.99). CONCLUSIONS AC failure is common with ultrasound-guided insertion associated with lower failure rates. Trial registration Australian New Zealand Clinical Trial Registry (ACTRN 12610000505000); date registered: 18 June 2010.
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Affiliation(s)
- Jessica A Schults
- Metro North Health, Herston Infectious Disease Institute, Herston, Queensland, Australia.
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia.
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia.
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.
| | - Emily R Young
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Amanda Corley
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Marghie Murgo
- Metro North Health, Herston Infectious Disease Institute, Herston, Queensland, Australia
| | - Evan Alexandrou
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
- Department of Intensive Care, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Matthew McGrail
- Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
| | - John Gowardman
- Intensive Care Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Karina R Charles
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Adrian Regli
- Department of Intensive Care, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Medical School, The Notre Dame University, Fremantle, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical Center, Saitama, Japan
- Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
| | - Claire M Rickard
- Metro North Health, Herston Infectious Disease Institute, Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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Singla D, Mangla M, Agarwal A, Kumari R. Comparative Evaluation of Three Different Techniques of Radial Artery Cannulation: A Prospective Randomised Study. Cureus 2024; 16:e52326. [PMID: 38357073 PMCID: PMC10866683 DOI: 10.7759/cureus.52326] [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: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE We planned this study to compare three approaches to arterial cannulation, i.e., catheter over the needle, catheter over the guidewire, and ultrasound-guided cannulation, in terms of overall success rate, first pass success rate, time for cannulation and incidence of complications. METHODS After obtaining informed written consent from the patient, they were randomized into three groups, based on chits in the box technique, to undergo radial artery cannulation as follows: group N (using catheter over needle technique), group W (using catheter over guidewire technique), group U (radial artery cannulations under ultrasound guidance). We calculated a sample size of 50 patients in each group based on the primary endpoint of the overall success rate. The data was analyzed using one-way ANOVA and post hoc Tukey's test. RESULTS There was a non-statistically significant trend towards a higher overall success rate in groups W and U compared to group N (47 and 46, respectively, compared to 43, p-value 0.35). Similarly, no significant differences were observed concerning any of the characteristics of radial artery cannulation, except the first pass success rate, where the success rate was highest in group W (33, 70.21%), followed by group U (34, 68%) with a p-value of 0.04. CONCLUSION Though catheter over guidewire and ultrasound-based techniques offer advantages in terms of higher first-pass success rate, they do not significantly increase the overall success rate or reduce the total incidence of complications.
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Affiliation(s)
- Deepak Singla
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Mishu Mangla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Hyderabad, IND
| | - Ankit Agarwal
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Ranjeeta Kumari
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, IND
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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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Yao J, Hao S, Zhou C, Quan Z. Effect of side guide marks of ultrasound transducer on the success rate of ultrasound transducer-guided radial artery puncture: A randomized trial. J Vasc Access 2023; 24:1421-1427. [PMID: 35441559 DOI: 10.1177/11297298221091415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Compared with blind technique, ultrasound (US) transducer-guided technique for radial artery puncture can improve the success rate. However, difficulty in handling US transducer-guided technology is a key limitation to its wider use. The aim of the study was to explore the effect of guide marks on the side of US transducer on the success rate of US transducer-guided radial artery puncture. METHODS In this parallel-group trial, 127 patients undergoing elective liver cancer resection and splenectomy under general anesthesia were randomly allocated to the traditional group or the Intervention group. The traditional group used the conventional US transducer-guided radial artery puncture technology, while the Intervention group used the US transducer-guided radial artery puncture technology with the guide marks on the side of the US transducer probe. The primary observation index was success rate of radial artery cannulation at the first attempt; the secondary observation indices were failure rate of cannulation, location time, and total time for successful cannulation. RESULTS The successful rate of cannulation in the Intervention group (59 out of 63, 93.6%) was greater than that in the traditional group (50 out of 64, 78.1%, p = 0.01). The posterior wall puncture rate in the Intervention group was lower than that in the traditional group (11.1% vs 32.8%, p = 0.005). The location time in the Intervention group was longer than that in the traditional group (20.1 ± 3.8 vs 16.6 ± 4.0 s, p < .001), while the total cannulation time was significantly shorter (20.7 ± 4.3 vs 32.4 ± 7.4 s, p < 0.001). CONCLUSION Using guide marks on the side of US transducer can help improve success rate of US transducer-guided radial artery puncture at the first attempt and reduce the risk of puncture-related complications.
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Affiliation(s)
- Jie Yao
- Department of Anesthesiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Shuai Hao
- Department of Anesthesiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Chen Zhou
- Department of Zoology and Physiology, University of Wyoming, Laramie, Wyoming, USA
| | - ZheFeng Quan
- Department of Anesthesiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
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Jayasankar JP, Vijayaraghavan S, Reddy PB, Kottayil BP, Gopalkrishnan RM, Neema PK. Acute superficial and deep necrosis of lower limb following femoral arterial cannulation in a neonate undergoing arterial switch operation for transposition of great arteries. Ann Card Anaesth 2023; 26:438-441. [PMID: 37861581 PMCID: PMC10691566 DOI: 10.4103/aca.aca_177_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/31/2022] [Accepted: 01/28/2023] [Indexed: 10/21/2023] Open
Abstract
Arterial lines are routinely used for hemodynamic monitoring and blood sampling in the operating room and in cardiac surgery intensive care unit. The complications related to arterial line insertion are very low; the knowledge of the relevant artery anatomy, skills and the experience of the operator and selection of a right size cannula plays a vital role in reducing morbidity related to arterial line insertion. We describe extensive superficial and deep necrosis of lower limb following arterial cannula insertion in a preterm neonate undergoing arterial switch procedure and discuss measures to prevent such a complication.
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Affiliation(s)
- Jessin P. Jayasankar
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sundeep Vijayaraghavan
- Department of Plastic Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Praveen B. Reddy
- Department of Paediatric Cardiac Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Brijesh P. Kottayil
- Department of Paediatric Cardiac Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Rajesh M. Gopalkrishnan
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Praveen Kumar Neema
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Munaf M, Gadhinglajkar S, Nayanar VKN, Dash PK, Puthuvasserry S, Sagar S. Radial artery pseudoaneurysm following pediatric arterial cannulation. Ann Card Anaesth 2023; 26:359-360. [PMID: 37470545 PMCID: PMC10451147 DOI: 10.4103/aca.aca_171_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/28/2022] [Accepted: 12/25/2022] [Indexed: 07/21/2023] Open
Affiliation(s)
- Mamatha Munaf
- Department of Cardiothoracic and Vascular Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Shrinivas Gadhinglajkar
- Department of Cardiothoracic and Vascular Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - V Krishna N. Nayanar
- Department of Cardiothoracic and Vascular Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Prasanta K. Dash
- Department of Cardiothoracic and Vascular Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Suneel Puthuvasserry
- Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sunil Sagar
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Wang Z, Guo H, Shi S, Xu Y, Ye M, Bai L, Tan Y, Li Y, Liu L. Long-axis in-plane combined with short-axis out-of-plane technique in ultrasound-guided arterial catheterization in infants: A randomized controlled trial. J Clin Anesth 2023; 85:111038. [PMID: 36603327 DOI: 10.1016/j.jclinane.2022.111038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 01/05/2023]
Abstract
STUDY OBJECTIVE To determine whether the long-axis in-plane (LAX-IP) combined with short-axis out-of-plane (SAX-OOP) technique is more suitable than modified dynamic needle tip positioning (MDNTP) technique for ultrasound-guided radial artery catheterization in infants. DESIGN A randomized controlled trial. SETTING Department of Anesthesiology, Children's Hospital of Chongqing Medical University. PATIENTS Overall, 72 patients, aged 1-12 months old, who were primarily undergoing thoracic or cardiac surgery in the Children's Hospital of Chongqing Medical University between July 1, 2021, and March 31, 2022, were selected. These patients were randomly divided into two groups: i) the MDNTP group and ii) the LAX-IP combined with SAX-OOP group. INTERVENTIONS Radial artery cannulation in the two groups was performed using ultrasound-guided MDNTP or LAX-IP combined with SAX-OOP technique. MEASUREMENTS The primary outcome was first-time success rate, and the secondary outcomes included total success rate, cannulation time, and incidence of complications. MAIN RESULTS In the LAX-IP combined with SAX-OOP group, the first-time success rate was 75.0% (n = 27), total success rate was 97.2% (n = 35), cannulation time was 91.39 ± 102.60 s, puncture attempts was 1.5 ± 1.3 times, and local hematoma was formed on the first day in one (2.8%) infant. In the MDNTP group, the first-time success rate was 36.1% (n = 13) (P = 0.001; RR, 2.08; 95% confidence interval, 1.29-3.34), total success rate was 91.7% (n = 33) (P = 0.303; RR, 1.06; 95% confidence interval, 0.95-1.19), cannulation time was 181.00 ± 146.72 s(P = 0.047; Median difference,-89.61; 95% confidence interval, -149.12 to -30.10), puncture attempts was 2.3 ± 1.6 times (P = 0.133; Median difference,-0.81), and local hematoma was formed on the first day in nine (25%) infants (P = 0.006; RR, 0.11; 95% confidence interval, 0.01-0.83). No thrombosis occurred in any group. CONCLUSIONS The ultrasound-guided LAX-IP combined with SAX-OOP technique for radial arterial catheterization in infants, which was performed by anesthesia residents, exhibited an increased first-time success rate, reduced cannulation time, and lower incidence of complications than the MDNTP technique.
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Affiliation(s)
- Ziyi Wang
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, PR China
| | - Hongjie Guo
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, PR China
| | - Shujun Shi
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, PR China
| | - Ying Xu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, PR China; National Clinical Research Center for Child Health and Disorders, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, PR China; Chongqing Key Laboratory of Pediatrics, PR China
| | - Mao Ye
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, PR China; National Clinical Research Center for Child Health and Disorders, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, PR China; Chongqing Key Laboratory of Pediatrics, PR China
| | - Lin Bai
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, PR China; National Clinical Research Center for Child Health and Disorders, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, PR China; Chongqing Key Laboratory of Pediatrics, PR China
| | - Yanzhe Tan
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, PR China; National Clinical Research Center for Child Health and Disorders, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, PR China; Chongqing Key Laboratory of Pediatrics, PR China
| | - Yihui Li
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, PR China; National Clinical Research Center for Child Health and Disorders, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, PR China; Chongqing Key Laboratory of Pediatrics, PR China
| | - Lifei Liu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, PR China; National Clinical Research Center for Child Health and Disorders, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, PR China; Chongqing Key Laboratory of Pediatrics, PR 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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Struck MF, Rost F, Schwarz T, Zimmermann P, Siekmeyer M, Gräfe D, Ebel S, Kirsten H, Kleber C, Lacher M, Donaubauer B. Epidemiological Analysis of the Emergency Vascular Access in Pediatric Trauma Patients: Single-Center Experience of Intravenous, Intraosseous, Central Venous, and Arterial Line Placements. CHILDREN 2023; 10:children10030515. [PMID: 36980073 PMCID: PMC10047298 DOI: 10.3390/children10030515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/24/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023]
Abstract
Vascular access in severely injured pediatric trauma patients is associated with time-critical circumstances and low incidences, whereas only scarce literature on procedure performance is available. The purpose of this study was to analyze the performance of different vascular access procedures from the first contact at the scene until three hours after admission. Intubated pediatric trauma patients admitted from the scene to a single Level I trauma center between 2008 and 2019 were analyzed regarding intravenous (IV) and intraosseous (IO) accesses, central venous catheterization (CVC) and arterial line placement. Sixty-five children with a median age of 14 years and median injury severity score of 29 points were included, of which 62 (96.6%) underwent successful prehospital IV or IO access by emergency medical service (EMS) physicians, while it failed in two children (3.1%). On emergency department (ED) admission, IV cannulas of prehospital EMS had malfunctions or were dislodged in seven of 55 children (12.7%). IO access was performed in 17 children without complications, and was associated with younger age, higher injury severity and higher mortality. Fifty-two CVC placements (58 attempts) and 55 arterial line placements (59 attempts) were performed in 45 and 52 children, respectively. All CVC and arterial line placements were performed in the ED, operating room (OR) and intensive care unit (ICU). Ten mechanical complications related to CVC placement (17.8%) and seven related to arterial line placement (10.2%) were observed, none of which had outcome-relevant consequences. This case series suggests that mechanical issues of vascular access may frequently occur, underlining the need for special preparedness in prehospital, ED, ICU and OR environments.
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Affiliation(s)
- Manuel Florian Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, 04103 Leipzig, Germany
- Correspondence: ; Tel.: +49-341-97-17700
| | - Franziska Rost
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Thomas Schwarz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, 04103 Leipzig, Germany
- Department of Anesthesiology, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Peter Zimmermann
- Department of Pediatric Surgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Manuela Siekmeyer
- Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Daniel Gräfe
- Institute of Pediatric Radiology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Holger Kirsten
- Institute for Medical Statistics, Informatics, and Epidemiology, Medical Faculty, University of Leipzig, 04107 Leipzig, Germany
| | - Christian Kleber
- Department of Orthopedics, Traumatology, and Plastic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Martin Lacher
- Department of Pediatric Surgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Bernd Donaubauer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, 04103 Leipzig, Germany
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10
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Armstrong C, Butson B, Kwa P. Arterial line insertion. Emerg Med Australas 2023; 35:142-147. [PMID: 36509515 DOI: 10.1111/1742-6723.14148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 12/15/2022]
Abstract
Arterial line insertion is a common ED procedure with considerable clinician variation in preferred technique and equipment. This article aims to review some of the controversies and evidence surrounding this common ED procedure.
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Affiliation(s)
- Clare Armstrong
- Emergency Department, Townsville University Hospital, Townsville, Queensland, Australia
| | - Ben Butson
- Emergency Department, Townsville University Hospital, Townsville, Queensland, Australia.,LifeFlight Retrieval Medicine, Townsville, Queensland, Australia.,School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Paul Kwa
- Emergency Department, Townsville University Hospital, Townsville, Queensland, Australia.,School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
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11
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Outcomes of Femoral Arterial Catheterisation in Neonates: A Retrospective Cohort Study. CHILDREN 2022; 9:children9081259. [PMID: 36010148 PMCID: PMC9406862 DOI: 10.3390/children9081259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
Background: To review the outcome of all femoral arterial catheter (FAC) insertions in a single, large neonatal unit over a 12 year period, we will describe the incidence of harms arising from FAC insertion and to identify risk factors associated with ischaemic injury. Methods: Retrospective survey of data relating to all episodes of FAC insertion in a single neonatal intensive care unit over a 12 year period up to 2020. Results: 146 FACs were inserted into 139 babies with a median (interquartile range) gestation and birth weight of 27 (24 to 37) weeks and 1092 (682 to 2870) g. Impaired limb perfusion occurred in 32 (22%). This was transient and recovered with no injury in 26 of the 32. There was an increased risk of impaired limb perfusion in babies with lower weight at the time of insertion; from 5.7% in babies over 3000 g to 34.7% in babies under 1000 g (relative risk 6.1 (1.5 to 24.6)). Six babies (4%) had ischaemic injury. Risk factors for ischaemic injury included weight below 1000 g (four cases), pre-existing partial arterial obstruction (two cases), concerns about limb perfusion prior to FAC insertion (two cases) and a delay in removing the FAC after recognition of the poor perfusion (five cases). Two clinicians inserted 71 (50%) FACs and had no associated injuries. Conclusions: FAC can be used in neonates, although there is a risk of ischaemic injury, particularly in very small babies. Our data can be used to inform decisions about patient selection for this procedure.
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12
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Kemmochi M, Nawa Y, Ohno S, Sawashita Y, Terada H, Oba K. Analysis of the radial and ulnar arteries using ultrasound and a vascular visualization device in children. Paediatr Anaesth 2022; 32:747-753. [PMID: 35267230 DOI: 10.1111/pan.14434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Radial artery is the preferred site for cannulation. Recently, the ulnar artery was chosen as an alternative in adults. AIMS We aimed to measure the diameter and depth of the ulnar and radial arteries using ultrasound, and our secondary purpose was to evaluate their anatomical position using a near-infrared transcutaneous illumination device. METHODS Forty-eight children (age range: 0-144 months) were assigned to the following groups: group Infant (aged <12 months), group Preschool (aged ≤12 to <72 months), and group School (aged ≥72 months). The diameter, depth, and position of the ulnar and radial arteries were compared between groups. RESULTS There was no significant difference between the diameters of the ulnar and radial arteries. In group Infant, group Preschool, and group School, mean diameters of the ulnar artery were 1.27 ± 0.15 mm, 1.62 ± 0.27 mm, and 2.03 ± 0.28 mm, respectively, and the radial artery were 1.29 ± 0.15 mm, 1.69 ± 0.27 mm, and 2.06 ± 0.29 mm, respectively. The corresponding differences between the diameters of ulnar and radial arteries were -0.02 mm, -0.07 mm, and -0.02 mm [95% CI -0.16 mm to 0.12 mm, -0.25 mm to 0.11 mm, and -0.25 mm to 0.21 mm; p = .776, p = .411, and p = .852]. In groups Preschool and School, the ulnar artery was at the recommended depth of 2-4 mm for arterial cannulation compared with the radial artery. In the Infant, Preschool, and School age groups, the ulnar and radial arteries were at the recommended depth of 2-4 mm for arterial cannulation in 70.0%, 100.0%, 93.8%, and 80.0%, 65.0%, and 50.0% of the cases, respectively. (difference: -10.0%, 35.0%, and 43.8%, 95%; CI -43.4% to 23.4%, 14.1% to 55.9%, and 19.4% to 68.1%, respectively). CONCLUSIONS The ulnar artery can be considered a promising alternative to the radial artery for facilitating arterial cannulation in children.
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Affiliation(s)
- Makoto Kemmochi
- Department of Anesthesiology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Yuko Nawa
- Department of Anesthesiology, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Sho Ohno
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yasuaki Sawashita
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hirofumi Terada
- Department of Anesthesiology, Kushiro City General Hospital, Kushiro, Japan
| | - Koji Oba
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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13
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Abbasi RK, Packiasabapathy S, Hamilton M, Walker SG, Mazurek M, Dierdorf S. Ipsilateral double arterial puncture in children. Paediatr Anaesth 2022; 32:581-582. [PMID: 35150182 DOI: 10.1111/pan.14413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Rania K Abbasi
- Department of Anesthesia, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Senthil Packiasabapathy
- Department of Anesthesia, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Matthew Hamilton
- Department of Anesthesia, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Scott G Walker
- Department of Anesthesia, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael Mazurek
- Department of Anesthesia, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stephen Dierdorf
- Department of Anesthesia, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
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14
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Xiong J, Hui K, Xu M, Zhou J, Zhang J, Duan M. Distal radial artery as an alternative approach to forearm radial artery for perioperative blood pressure monitoring: a randomized, controlled, noninferiority trial. BMC Anesthesiol 2022; 22:67. [PMID: 35264106 PMCID: PMC8905752 DOI: 10.1186/s12871-022-01609-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The novel distal radial artery (dRA) approach is a popular arterial access route for interventional cardiology and neurointerventions. We explored the dRA as an alternative site to the classic forearm radial artery (RA) for perioperative blood pressure monitoring. We hypothesized that dRA catheterization is noninferior to RA for the first attempt success rate. METHODS This was a single-center, prospective, randomized controlled, noninferiority study. Adult patients who underwent elective surgery at the Jinling Hospital from May 2021 to August 2021 were enrolled. The primary endpoint was to test the noninferiority of the first attempt success rate between the groups. Secondary endpoints included anatomical characteristics, catheterization time, arterial posterior wall puncture rate, postoperative compression time, dampened arterial pressure waveforms, and complications. RESULTS Totally, 161 patients who received either dRA (n = 81) or RA (n = 80) catheterization were analyzed. The first attempt success rates were 87.7 and 91.3% in the dRA and RA groups, respectively, with a mean difference of - 3.6% (95% CI, - 13.1 to 5.9%). The dRA diameter and cross-sectional area were significantly smaller than those of the RA (P < 0.001). The subcutaneous depth of dRA was significantly greater than that of the RA (P < 0.001). The dRA had a longer catheterization time (P = 0.008) but a shorter postoperative compression time (P < 0.001). The arterial posterior wall puncture rate of dRA was significantly higher than that of the RA (P = 0.006). The dRA had fewer dampened arterial waveforms than RA (P = 0.030) perioperatively. CONCLUSIONS The dRA is a rational alternative approach to RA for perioperative arterial pressure monitoring and provides a noninferior first attempt success rate. TRIAL REGISTRATION This study is registered in the Chinese Clinical Trials Registry (registration number: ChiCTR2100043714 , registration date: 27/02/2021).
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Affiliation(s)
- Jingwei Xiong
- Department of Anesthesiology, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210002, People's Republic of China
| | - Kangli Hui
- Department of Anesthesiology, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210002, People's Republic of China
| | - Miaomiao Xu
- Department of Anesthesiology, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210002, People's Republic of China
| | - Jiejie Zhou
- Department of Anesthesiology, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210002, People's Republic of China
| | - Jie Zhang
- Department of Anesthesiology, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210002, People's Republic of China
| | - Manlin Duan
- Department of Anesthesiology, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210002, People's Republic of China. .,Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, People's Republic of China.
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15
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Wang J, Weng X, Huang Q, Lai Z, Zhao Z, Lan J, Wu G, Lin L, Su J, Liu J, Zhang L. Modified Long-Axis In-Plane Ultrasound-guided Radial Artery Cannulation In Adult Patients: A Randomized Controlled Trial. Anaesth Crit Care Pain Med 2021; 41:100989. [PMID: 34864274 DOI: 10.1016/j.accpm.2021.100989] [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: 08/16/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION For adults with small radial arteries, ultrasound-guided radial artery cannulation remains challenging and the relevant data is currently lacking. The study aimed to test the hypothesis that modified long-axis in-plane ultrasound guidance (M-LAIP) would improve success rates of radial artery cannulation in this population. PATIENTS AND METHODS This was a prospective, randomised, and controlled clinical study that enrolled 201 adult patients with diameters of the radial artery less than 2.2 mm. Patients were randomised to M-LAIP, short-axis out-of-plane (SAOP), or conventional palpation (C-P) group according to different approaches of radial artery cannulation (M-LAIP, SAOP, and C-P). Outcome measurements included the success rate, cannulation time, and cannulation-related adverse events. RESULTS The cannulation success rate was significantly higher in the M-LAIP group than in the SAOP or C-P groups (first success rate: 80.3% vs. 53.8% or 33.8%; P < 0.001; total success rate: 93.9% vs. 78.5% or 50.8%; P < 0.001). Total cannulation time in the M-LAIP group was shorter than that in the SAOP group (P = 0.002) or the C-P group (P < 0.001). The rates of posterior wall puncture and haematoma in the M-LAIP group were lower than that in the SAOP group or C-P group (P < 0.008). CONCLUSION The use of the M-LAIP approach significantly improved the success rate of radial artery cannulation, shortened procedure time, and lowered the rates of posterior wall puncture and haematoma in adults with radial artery diameters less than 2.2 mm, compared with that achieved by the SAOP or C-P approach.
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Affiliation(s)
- Jiebo Wang
- Department of Anesthesiology, Fujian Medical University Union Hospital, No.29 Xin-Quan Road, Fuzhou, 350001, China
| | - Xianfeng Weng
- Department of Anesthesiology, Fujian Medical University Union Hospital, No.29 Xin-Quan Road, Fuzhou, 350001, China
| | - Qijian Huang
- Department of Anesthesiology, Fujian Medical University Union Hospital, No.29 Xin-Quan Road, Fuzhou, 350001, China
| | - Zhongmeng Lai
- Department of Anesthesiology, Fujian Medical University Union Hospital, No.29 Xin-Quan Road, Fuzhou, 350001, China
| | - Zisong Zhao
- Department of Anesthesiology, Fujian Medical University Union Hospital, No.29 Xin-Quan Road, Fuzhou, 350001, China
| | - Jianning Lan
- Department of Anesthesiology, Fujian Medical University Union Hospital, No.29 Xin-Quan Road, Fuzhou, 350001, China
| | - Guohua Wu
- Department of Anesthesiology, Fujian Medical University Union Hospital, No.29 Xin-Quan Road, Fuzhou, 350001, China
| | - Lei Lin
- Department of Anesthesiology, Fujian Medical University Union Hospital, No.29 Xin-Quan Road, Fuzhou, 350001, China
| | - Jiansheng Su
- Department of Anesthesiology, Fujian Medical University Union Hospital, No.29 Xin-Quan Road, Fuzhou, 350001, China
| | - Junle Liu
- Department of Anesthesiology, Fujian Medical University Union Hospital, No.29 Xin-Quan Road, Fuzhou, 350001, China
| | - Liangcheng Zhang
- Department of Anesthesiology, Fujian Medical University Union Hospital, No.29 Xin-Quan Road, Fuzhou, 350001, China.
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Georgeades C, Rothstein AE, Plunk MR, Arendonk KV. Iatrogenic vascular trauma and complications of vascular access in children. Semin Pediatr Surg 2021; 30:151122. [PMID: 34930587 DOI: 10.1016/j.sempedsurg.2021.151122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Vascular access is frequently a critical component of the diagnostic and therapeutic procedures required to manage childhood illnesses, including many emergent conditions and critical illnesses. Vascular access in the pediatric population presents unique challenges, and many clinical and technical factors must be considered to avoid complications that can occur with vascular access procedures. This article reviews various aspects of vascular access and associated iatrogenic trauma in children, including risk factors, management of complications, and preventive measures to avoid complications. It is only with a comprehensive understanding of the topic that vascular access in children can be performed safely, effectively, and efficiently.
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Affiliation(s)
- Christina Georgeades
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999N 92nd Street, Suite 320, Milwaukee, WI 53226, United States.
| | - Abby E Rothstein
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, 8701W. Watertown Plank Road, Milwaukee, WI 53226, United States
| | - Matthew R Plunk
- Department of Radiology, Children's Wisconsin and Medical College of Wisconsin, 9000W. Wisconsin Avenue, MS-721, Milwaukee, WI 53226, United States
| | - Kyle Van Arendonk
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999N 92nd Street, Suite 320, Milwaukee, WI 53226, United States
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17
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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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18
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Abdel-Ghaffar HS, Bakr MAM, Osman MAK, Hanna SGL, Ali WN. End-tidal carbon dioxide measurements as a surrogate to arterial carbon dioxide during pediatric laparoscopic surgeries: a prospective observational cohort study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2021:S0104-0014(21)00326-2. [PMID: 34411630 DOI: 10.1016/j.bjane.2021.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Maintaining normocapnia during mechanical ventilation in anesthetized children during laparoscopic surgeries is highly recommended. There is a debate regarding the use of capnography (ETCO2) as a trend monitor for evaluation of arterial carbon dioxide levels (PaCO2). We analyzed the relationship between ETCO2 and PaCO2 with time in elective pediatric laparoscopic surgeries. METHODS This study was a prospective observational cohort analysis of 116 paired comparisons between PaCO2 and ETCO2 computed from 29 children (ASA I, 12-72 months). Arterial blood samples were withdrawn before, at 15 minutes and 30 minutes during pneumoperitoneum and 1 minute after deflation. ETCO2 value was recorded simultaneously, while arterial blood was withdrawn. PaCO2-ETCO2 relationship was evaluated by Pearson's correlation coefficients and Bland Altman Method of agreement. RESULTS Out of the 116 comparisons analyzed, a PaCO2-ETCO2 difference beyond 0 to ≤ 5 mmHg was recorded in 71 comparisons (61.2%) with negative difference in 34 comparisons (29.3%). A positive significant correlation between PaCO2 and ETCO2 was recorded before (r = 0.617, p = 0.000) and at 15 minutes (r = 0.582, p = 0.001), with no significant correlation at 30 minutes (r = 0.142, p = 0.461), either after deflation (r = 0.108, p = 0.577). Bland-Altman plots showed agreement between ETCO2 and PaCO2 before inflation with mean PaCO2-ETCO2 difference 0.14 ± 5.6 mmHg (limits of 95% agreement -10.84-11.2, simple linear regression testing p-value 0.971), with no agreement at 15 minutes (0.51 ± 7.15, -13.5-14.5, p = 0.000), 30 minutes. (2.62 ± 7.83, -12.73-17.97, p = 0.000), or after deflation (1.81 ± 6.56, -10.93-14.55, p = 0.015). CONCLUSION Usage of capnography as a trend monitor in pediatric laparoscopic surgeries may not be a reliable surrogate for PaCO2 levels. TRIAL REGISTRATION Clinical Trials. gov (Identifier: NCT03361657).
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Affiliation(s)
- Hala Saad Abdel-Ghaffar
- Assiut University, Faculty of Medicine, Anesthesia and Intensive Care Department, Assiut, Egypt.
| | | | | | | | - Wesam Nashat Ali
- Assiut University, Faculty of Medicine, Anesthesia and Intensive Care Department, Assiut, Egypt
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Quan X, Liu J, Roxlo T, Siddharth S, Leong W, Muir A, Cheong SM, Rao A. Advances in Non-Invasive Blood Pressure Monitoring. SENSORS (BASEL, SWITZERLAND) 2021; 21:s21134273. [PMID: 34206457 PMCID: PMC8271585 DOI: 10.3390/s21134273] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 01/30/2023]
Abstract
This paper reviews recent advances in non-invasive blood pressure monitoring and highlights the added value of a novel algorithm-based blood pressure sensor which uses machine-learning techniques to extract blood pressure values from the shape of the pulse waveform. We report results from preliminary studies on a range of patient populations and discuss the accuracy and limitations of this capacitive-based technology and its potential application in hospitals and communities.
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Affiliation(s)
- Xina Quan
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
- Correspondence: ; Tel.: +1-408-216-0099
| | - Junjun Liu
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
| | - Thomas Roxlo
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
| | - Siddharth Siddharth
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
| | - Weyland Leong
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
| | - Arthur Muir
- PyrAmes Inc., Cupertino, CA 95014, USA; (J.L.); (T.R.); (S.S.); (W.L.); (A.M.)
| | - So-Min Cheong
- Department of Geography & Atmospheric Science, University of Kansas, Lawrence, KS 66045, USA;
| | - Anoop Rao
- Department of Pediatrics, Neonatology, Stanford University, Palo Alto, CA 94304, USA;
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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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