Dynamic needle tip positioning versus the angle-distance technique for ultrasound-guided radial artery cannulation in adults: a randomized controlled trial

Bing Bai, Yuan Tian, Yuelun Zhang, Chunhua Yu, Yuguang Huang, Bing Bai, Yuan Tian, Yuelun Zhang, Chunhua Yu, Yuguang Huang

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.

Keywords: Catheterization; Radial artery; Ultrasonography.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram
Fig. 2
Fig. 2
Diagrams showing how to advance the needle into the radial artery using the DNTP technique. a, Obtain an image of the target artery and adjust the insertion point and orientation of the needle. b, Puncture the target artery, and observe the needle in the artery lumen. c, Advance the ultrasound probe away from the needle until the hyperechoic needle is no longer observed. d, Advance the needle and catheter until the very tip is seen again, and repeat these steps until the tip is observed in the artery lumen
Fig. 3
Fig. 3
Insertion point and orientation of the needle when using the AD technique

References

    1. Ye P, Tan Y, Ye M, Li S, Bai L, Liu L. A novel method for ultrasound-guided radial artery cannulation in neonates by trainee anaesthesiologists: a randomised controlled trial. Eur J Anaesthesiol. 2020;37:91–97. doi: 10.1097/EJA.0000000000001089.
    1. Wang J, Lai Z, Weng X, Lin Y, Wu G, Su J, et al. Modified long-axis in-plane ultrasound technique versus conventional palpation technique for radial arterial cannulation: a prospective randomized controlled trial. Medicine (Baltimore) 2020;99:e18747. doi: 10.1097/MD.0000000000018747.
    1. Nam K, Jeon Y, Yoon S, Kwon SM, Kang P, Cho YJ, et al. Ultrasound-guided radial artery cannulation using dynamic needle tip positioning versus conventional long-axis in-plane techniques in cardiac surgery patients: a randomized, controlled trial. Minerva Anestesiol. 2020;86:30–37. doi: 10.23736/S0375-9393.19.13646-2.
    1. Zhefeng Q, Luo C, Zhang L, Li X, He H, Chi P. Application of optimized ultrasonic localization system for radial artery puncture by intern doctors: a randomized trial. Med Sci Monit. 2019;25:1566–1571. doi: 10.12659/MSM.913044.
    1. Yu Y, Lu X, Fang W, Liu X, Lu Y. Ultrasound-guided artery cannulation technique versus palpation technique in adult patients in pre-anesthesia room: a randomized controlled trial. Med Sci Monit. 2019;25:7306–7311. doi: 10.12659/MSM.916252.
    1. Kiberenge RK, Ueda K, Rosauer B. Ultrasound-guided dynamic needle tip positioning technique versus palpation technique for radial arterial cannulation in adult surgical patients: a randomized controlled trial. Anesth Analg. 2018;126:120–126. doi: 10.1213/ANE.0000000000002261.
    1. White L, Halpin A, Turner M, Wallace L. Ultrasound-guided radial artery cannulation in adult and paediatric populations: a systematic review and meta-analysis. Br J Anaesth. 2016;116:610–617. doi: 10.1093/bja/aew097.
    1. Berk D, Gurkan Y, Kus A, Ulugol H, Solak M, Toker K. Ultrasound-guided radial arterial cannulation: long axis/in-plane versus short axis/out-of-plane approaches? J Clin Monit Comput. 2013;27:319–324. doi: 10.1007/s10877-013-9437-6.
    1. Song IK, Choi JY, Lee JH, Kim EH, Kim HJ, Kim HS, et al. Short-axis/out-of-plane or long-axis/in-plane ultrasound-guided arterial cannulation in children: a randomised controlled trial. Eur J Anaesthesiol. 2016;33:522–527. doi: 10.1097/EJA.0000000000000453.
    1. Shiver S, Blaivas M, Lyon M. A prospective comparison of ultrasound-guided and blindly placed radial arterial catheters. Acad Emerg Med. 2006;13:1275–1279. doi: 10.1197/j.aem.2006.07.015.
    1. Levin PD, Sheinin O, Gozal Y. Use of ultrasound guidance in the insertion of radial artery catheters. Crit Care Med. 2003;31:481–484. doi: 10.1097/01.CCM.0000050452.17304.2F.
    1. Liu L, Tan Y, Li S, Tian J. “Modified dynamic needle tip positioning” short-axis, out-of-plane, ultrasound-guided radial artery cannulation in neonates: a randomized controlled trial. Anesth Analg. 2019;129:178–183. doi: 10.1213/ANE.0000000000003445.
    1. Abdalla UE, Elmaadawey A, Kandeel A. Oblique approach for ultrasound-guided radial artery catheterization vs transverse and longitudinal approaches, a randomized trial. J Clin Anesth. 2017;36:98–101. doi: 10.1016/j.jclinane.2016.10.016.
    1. Goh G, Tan C, Weinberg L. Dynamic ultrasound-guided, short axis, out-of-plane radial artery cannulation: the ‘follow the tip’ technique. Anaesth Intensive Care. 2013;41:431–432.
    1. Ueda K, Bayman EO, Johnson C, Odum NJ, Lee JJ. A randomised controlled trial of radial artery cannulation guided by doppler vs palpation vs ultrasound. Anaesthesia. 2015;70:1039–1044. doi: 10.1111/anae.13062.
    1. Tang L, Wang F, Li Y, Zhao L, Xi H, Guo Z, et al. Ultrasound guidance for radial artery catheterization: an updated meta-analysis of randomized controlled trials. PLoS One. 2014;9:e111527. doi: 10.1371/journal.pone.0111527.
    1. Gao YB, Yan JH, Gao FQ, Pan L, Wang XZ, Lv CJ. Effects of ultrasound-guided radial artery catheterization: an updated meta-analysis. Am J Emerg Med. 2015;33:50–55. doi: 10.1016/j.ajem.2014.10.008.
    1. Pacha HM, Alahdab F, Al-Khadra Y, Idris A, Rabbat F, Darmoch F, et al. Ultrasound-guided versus palpation-guided radial artery catheterization in adult population: a systematic review and meta-analysis of randomized controlled trials. Am Heart J. 2018;204:1–8. doi: 10.1016/j.ahj.2018.06.007.
    1. Bhattacharjee S, Maitra S, Baidya DK. Comparison between ultrasound guided technique and digital palpation technique for radial artery cannulation in adult patients: an updated meta-analysis of randomized controlled trials. J Clin Anesth. 2018;47:54–59. doi: 10.1016/j.jclinane.2018.03.019.
    1. Nakayama Y, Nakajima Y, Sessler DI, Ishii S, Shibasaki M, Ogawa S, et al. A novel method for ultrasound-guided radial arterial catheterization in pediatric patients. Anesth Analg. 2014;118:1019–1026. doi: 10.1213/ANE.0000000000000164.
    1. Goldstein A, Madrazo BL. Slice-thickness artifacts in gray-scale ultrasound. J Clin Ultrasound. 1981;9:365–375. doi: 10.1002/jcu.1870090704.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner