Margin of safety for needle puncture of a radial artery

Saima, Shunsuke; Okuda, Yasuhisa

doi:10.1007/s00540-021-02932-w

Cited by 10 publications

(7 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Reported risk factors for puncture-related complications after cardiac interventions mainly include age, sex, sheath size, use of heparin and antiplatelet drugs, and coagulation dysfunction. Additionally, the hemostasis method used to remove the arterial cannula is a crucial factor for complications of radial artery catheterization in cardiac surgeries and cardiac catheterization [10][11][12][13] . Therefore, we examined whether the aforementioned risk factors can predict complications of TRA for monitoring purposes.…”

Section: Discussionmentioning

confidence: 99%

“…The rm and at base of the radial bone as well as the thick-walled structure of the radial artery increase the suitability for compression; accordingly, hemostasis can be achieved by applying modest pressure. However, given the variations in the anatomical position of radial artery at the wrist [29,30] and the margin of safe distance from the wrist for needle puncture of a radial artery (5.4 cm in women and 6.8 cm in men) [11] , it is di cult to accurately compress the proximal end of the puncture site during manual compression.…”

Section: Discussionmentioning

confidence: 99%

“…These complications mainly occur in TRA performed for cardiac catheterization, coronary angiography, and percutaneous intervention, which usually involve larger sheath and cannula sizes [8,9] . Additionally, the use of heparin and antiplatelet drugs, coagulation dysfunction, and hemostasis methods for removing the arterial catheter are crucial factors related to complications of TRA cannulation in cardiac surgery and catheterization [10][11][12][13] . However, the incidence of complications of TRA for intraoperative hemodynamic monitoring and their related risk factors remain unclear.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Complications and Related Risk Factors of Transradial Access Cannulation for Hemodynamic Monitoring in General Surgery： A Prospective Observational Study

Hou

Zhou

et al. 2023

Preprint

View full text Add to dashboard Cite

Purpose To examine the short-term complications of arterial cannulation for intraoperative monitoring and their related risk factors.Methods We included adult inpatients (≥ 18 years old) who underwent an initial transradial access (TRA) cannulation and were scheduled for general surgery between April 8 and November 30, 2020. We used 20G arterial puncture needles for puncturing and manual compression for hemostasis. Demographic, clinical, surgical, anesthetic, and laboratory data were extracted from electronic medical records. Vascular, neurologic, and infectious complications of TRA cannulation were recorded and analyzed. Univarable and multivariable logistic regression analyses were used to identify risk factors related to TRA cannulation for intraoperative monitoring.Results Among 509 included patients, 174 developed TRA cannulation-related complications. Puncture site bleeding/hematoma and median nerve injury were observed in 158 (31.0%) and 16 (3.1%) patients, respectively. No patient developed cannula-related infections. Multivariable regression analysis revealed increased odds of puncture site bleeding/hematoma in women (odds ratio 4.49, 95% CI 2.73–7.36; P < 0.001) and patients who received intraoperative red blood cell (RBC) suspension transfusion ≥ 4U (odds ratio 5.26, 95% CI 1.41–19.57; P = 0.01). No risk factors for nerve injury were identified.Conclusion Bleeding/hematoma was a common complication of TRA cannulation for intraoperative hemodynamic monitoring during general surgery. Median nerve injury may be an underrecognized complication. Female sex and extensive intraoperative RBC transfusion are associated with an increased risk of bleeding/hematoma; however, the risk factors for nerve injury remain unclear.Trial registration The study protocol was registered at https://www.chictr.org.cn (ChiCTR1900025140).

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Complications and Related Risk Factors of Transradial Access Cannulation for Hemodynamic Monitoring in General Surgery： A Prospective Observational Study

Hou

Zhou

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…37 The Arterial Insertion Method (AIM) provides a systematic approach in RAC insertion with US guidance, strengthening various procedural aspects, impacting catheter performance, reducing mechanical failures, and enhances dressing adherence and securement which may improve dwell time, device functionality and reduce variations in practice. 6,38…”

Section: Distance From Wrist Creasementioning

confidence: 99%

10 best practice tips with radial arterial catheterization

Imbrìaco

Spencer²,

Bardin-Spencer

2022

J Vasc Access

View full text Add to dashboard Cite

Radial arterial catheters (RAC) are used extensively across critical care settings (Anesthesia, Intensive Care, Emergency Medicine) for continuous hemodynamic monitoring, allowing for immediate adjustments in vasopressor therapies and blood collection. Radial catheter failures are an ongoing significant issue for critical care clinicians with reported incidences at almost 25%. Common complications include loss of function, lack of blood return, poor quality waveforms and dislodgement, posing potential patient risks, and sudden loss of intra-arterial monitoring frequently requires prompt replacement. Contemporary research and technological improvements have highlighted several concepts to enhance the approach of RAC insertion and management while reducing immediate and late complications. The authors have prioritized the following 10 “best practice” aspects that may improve overall device function and reliability.

show abstract

“…13,14 An arterial line inserted at more than 4–10 cm away from the wrist is found to be more durable and may be safer in terms of nerve injury risk. 15 Other complications, such as ischemia, hematoma, and infection, in relation to insertion site for radial artery are not investigated. Moreover, it is unclear if even more proximal sites (more than 10 cm) may increase success, safety and catheter’s functionality.…”

Section: Introductionmentioning

confidence: 99%

The distal quarter of the forearm is the optimal insertion site for ultrasound-guided radial artery cannulation: A randomized controlled trial

Yücel¹,

Tekgül

Okur

2022

J Vasc Access

View full text Add to dashboard Cite

Background: Current guidelines recommend the use of ultrasound guidance for arterial cannulation. However, there are no recommendations on the best insertion site for radial artery cannulation in terms of catheter dwell time and incidence of complications. Methods: In this randomized controlled study 94 patients were randomly assigned into three groups, corresponding to three different sites of insertion for radial artery cannulation: hand wrist: (Site/group 1, n = 29), distal quarter part of the forearm (Site/group 2, n = 30) and the midpoint of the forearm (Site/group 3, n = 35). Age, height, weight, and diagnosis of each patient were recorded prior to insertions which were performed by a single investigator experienced in ultrasound-guided vascular access. Results: Radial artery diameters were similar (2.4 ± 0.4 vs 2.5 ± 0.3 vs 2.6 ± 0.4 mm), however skin to vessel distances were different between groups, and the depth of the radial artery increased progressively from distal to proximal sites. There was a significant difference between groups in terms of success rates at the first attempt. Only two cannulations were successful at first attempt, and overall, only 17 of 35 cannulations were successful at Site 1. Arterial cannula dislodgement rate was highest at Site 1(8/29, 26.7%), while the longest dwell time was at Site 2 with a median of 4 (IQR 3) days. Conclusions: Considering the high removal rate at the wrist region and the high failure rate at the midpoint of the forearm, the distal quarter of the forearm can be identified as “the optimal insertion site’ for ultrasound-guided radial artery cannulation.

show abstract

Margin of safety for needle puncture of a radial artery

Cited by 10 publications

References 5 publications

Complications and Related Risk Factors of Transradial Access Cannulation for Hemodynamic Monitoring in General Surgery： A Prospective Observational Study

Complications and Related Risk Factors of Transradial Access Cannulation for Hemodynamic Monitoring in General Surgery： A Prospective Observational Study

10 best practice tips with radial arterial catheterization

The distal quarter of the forearm is the optimal insertion site for ultrasound-guided radial artery cannulation: A randomized controlled trial

Contact Info

Product

Resources

About