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

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.

Ultrasound-Guided Dynamic Needle-Tip Positioning Method Is Superior to Conventional Palpation and Ultrasound Method in Arterial Catheterization

“…Based on the publication searching strategy, we obtained a total of 148 results for preliminary screening, and 11 studies from 10 papers were finally included in this meta-analysis ( Figure 1 ) [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Since the paper from Takeshita in 2021 involved two completely independent series of patients and separately reported each serial data, these two studies were separately analyzed in this present study [ 8 ].…”

“…( a ) Risk of bias graph. ( b ) Risk of bias summary [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”

Application of the dynamic needle tip positioning method for ultrasound-guided arterial catheterization in elderly patients: A randomized controlled trial

“…Successful cannulation of an artery requires completing two separate steps: puncturing the arterial wall and subsequent catheter advancement. The DNTP method has the advantage of checking the anterial arterial wall puncture in the short-axis view and visually confirming the catheter advancement whilst confirming that the needle tip is positioned at the centre of the artery cross-section [17][18][19]. In patients who underwent bilateral radial artery catheterization, the first attempt success rates of the DNTP and traditional palpation techniques were 95% and 57.5%, respectively [5].…”

The Improved Catheterization Is Associated With the Deeper Radial Arteries in Ultrasound-Guided Dynamic Needle Tip Positioning Technique

“…Data were obtained from the institutional specialized cohort database of recording ultrasound-guided vascular catheterization (Hospital Clinical Research Database; Beijing Huiren Technology Development Co., Ltd., Beijing, China). The cohort database is currently used for recording the clinical practices, which was first built for our previous randomized controlled study that compared the efficiency of different methods for RAC ( 16 ).…”

“…Notably, the success rates of ultrasound-guided catheterization varied between studies, and the associating factors remained uncertain (13)(14)(15)(16)(17)(18)(19)(20)(21). Though few operators identify the arterial depth before catheterization, it was considered as associated with the performance of ultrasoundguided RAC.…”