Prospective Comparison of Ultrasound-Guided Versus Palpation Techniques for Arterial Line Placement by Residents in a Teaching Institution

Abstract

Background Arterial line insertion is traditionally done by blind palpation. Residents may need multiple attempts for successful insertion, leading to longer procedure times and many failed attempts. Objective We hypothesized that ultrasound guidance (USG) would be faster and more successful than traditional blind palpation (TBP) for radial artery line placement by residents. Methods Patients undergoing elective surgery requiring a radial arterial line were randomized to either the USG or TBP groups. Exclusion criteria included a need for arterial line placement in an awake patient, emergent surgery, or American Society of Anesthesiologists (ASA) physical status class VI. After the induction of anesthesia, a postgraduate year 3 (PGY-3) or PGY-4 anesthesia resident placed an arterial line by either USG or TBP. Results A total of 412 patients and 85 of 106 residents (80%) in the training program were included. The 2 groups were similar with respect to sex, weight, height, ASA class, baseline systolic blood pressure, and baseline heart rate. USG was faster than TBP (mean times 171.1 6 16.7 seconds versus 243.6 6 23.5 seconds, P ¼ .012), required fewer attempts (mean 1.78 6 0.11 versus 2.48 6 0.15, P ¼ .035), and had an improved success rate (96% versus 90%, P ¼ .012). Conclusions We found that residents using USG in an academic institution resulted in significantly faster placement of the arterial lines, fewer attempts, and fewer catheters used.

Spatiotemporal Measurement of Arterial Pulse Waves Enabled by Wearable Active-Matrix Pressure Sensor Arrays

“…The created 2D pulse wave map provided the most optimal pulse waveform for reliable pulse wave analysis. Moreover, the spatial pulse map allows for the estimation of the arterial line position; thus, the device can be used as a low-cost sensor for arterial catheter injection, replacing the use of traditional blind palpation or high-cost equipment . The exact quantification of pulse signals at different points can also be used in estimating blood pressure or diagnosing diseases. , Such spatiotemporal measurement of vital signals with pixelated wearable sensor arrays will serve as critical enablers to propel paradigm shift in future medical devices.…”

Efficacy of ultrasound-guided technique for radial artery catheterization in pediatric populations: a systematic review and meta-analysis of randomized controlled trials

“…Since the use of ultrasound guidance was first reported in arterial catheterization by Nagabhushan et al [22] in 1976, ultrasound guidance has been increasingly used for arterial catheterization. Several reports were published to demonstrate the advantage of the ultrasoundguided technique for the insertion of an arterial catheter in adult populations [23,24]. A recent meta-analysis conducted by Aouad-Maroun and his colleagues [14] aimed to compare the ultrasound-guided technique with other techniques (including the traditional palpation technique and Doppler) for arterial catheterization in pediatric patients.…”

Aplicaciones actuales de la ultrasonografía en anestesia

“…Los centros médicos académicos deberían considerar la ecografía para cualquier cateterización arterial radial desafiante (p. ej., pacientes con obesidad mórbida, edema tisular, hipoxia y terapia vasoconstrictora) 17 . Esta información no solo es relevante para la formación en programas de anestesiología sino también, otras especialidades que incluyen medicina interna, cuidados intensivos y cirugía.…”