Single and double developing lines improve ultrasound-guided radial artery catheterization in obese patients: A randomized controlled trial

Qi, Zhang; Jiang, Jindi; Shi, Conglong; Wu, Bianliang; Gui, Bo; Zhou, Xuelong

doi:10.1016/j.accpm.2022.101166

Cited by 6 publications

(3 citation statements)

References 13 publications

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“…One of the included studies has compared first-attempt success rates between single and double-developing lines and did not find any significant difference. 16 In addition, pooling RRs from studies that have reported first-attempt success rates using single or double acoustic lines were no different. However, this needs to be tested in a setting where inexperienced physicians are undertaking this procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Inexperienced physicians performed the procedure in 2 of the studies while experienced physicians inserted the cannulas in the other 4 studies. 13 , 14 , 16 – 18 Four out of the 6 trials used metal-containing strands from the X-ray detectable gauge to create acoustic shadow, while the other two trials used sutures. 13 – 18 Table 1 presents the characteristics of all the included studies.…”

Section: R Esultsmentioning

confidence: 99%

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Acoustic Shadowing to Facilitate Ultrasound Guided Arterial Cannulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Mishra,

Rath,

Wibrow

et al. 2024

Indian Journal of Critical Care Medicine

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A bstract Aim and background Ultrasound-guided arterial catheterization is a frequently performed procedure. Additional techniques such as acoustic shadowing-assisted ultrasound may be useful in improving success rate. This systematic review aimed to assess the efficacy of acoustic shadowing assisted ultrasound for arterial catheterization. Materials and methods PubMed, Medline, EMBASE, Cochrane Library, EMCARE, and MedNar were searched in January 2024. Randomized controlled trials comparing the first attempt success rate of arterial catheterization using acoustic shadowing ultrasound vs unassisted ultrasound were included. Data were pooled for risk ratios (RRs) using the random-effects model. Subgroup analysis was conducted based on a single or double acoustic line. Sensitivity analysis was undertaken after excluding pediatric data. The certainty of evidence (COE) was assessed using the GRADE framework. Results Six randomized controlled trials ( n = 777) were included. A meta-analysis found the first attempt success rate is significantly higher in the acoustic ultrasound group ( n = 6, RR: 0.47, 95% CI: 0.34–0.66, p ≤ 0.00001). Hematoma formation was significantly less in the acoustic ultrasound group ( n = 6, RR: 0.52, 95% CI: 0.34–0.80, p = 0.003). First attempt success was significantly higher in the single acoustic line ultrasound (USG) group compared to the unassisted ultrasound group ( n = 3, RR: 0.41, 95% CI: 0.28–0.59, p ≤ 0.00001). Sensitivity analysis after excluding pediatric data was similar to the primary analysis ( n = 5, RR: 0.50, 95% CI: 0.33–0.70, p ≤ 0.00001). Certainty of evidence was “Moderate” for the first attempt cannulation. Conclusions Acoustic shadowing-assisted ultrasound improved first-attempt arterial catheterization success rate and was associated with reduced hematoma formation. How to cite this article Mishra L, Rath C, Wibrow B, Anstey M, Ho K. Acoustic Shadowing to Facilitate Ultrasound Guided Arterial Cannulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2024;28(7):677–685.

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Section: Discussionmentioning

confidence: 99%

Section: R Esultsmentioning

confidence: 99%

Acoustic Shadowing to Facilitate Ultrasound Guided Arterial Cannulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Mishra,

Rath,

Wibrow

et al. 2024

Indian Journal of Critical Care Medicine

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“…Consequently, difficulties encountered during radial cannulation leading to conversion into femoral access were similarly shown to be associated with reduced patient height and body surface area [ 18 , 19 ]. This is somewhat surprising since radial catheterization is usually thought to be particularly challenging in obese patients [ 20 ]. However, it was demonstrated that radial artery diameter is increased in obese patients compared with lean subjects, which possibly explains our finding that difficult cannulation was associated with reduced body mass index [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Lower Patient Height and Weight Are Predisposing Factors for Complex Radial Arterial Catheterization

Huber

Menzenbach

Velten

et al. 2023

JCM

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Background: Radial artery (RA) catheterization for invasive blood pressure monitoring is often performed via palpation, and an ultrasound is used secondarily only in case of multiple unsuccessful attempts. Although more elaborate, it has been shown that primary ultrasound-guided catheterization may be advantageous compared with palpation. The aim of this study was to identify factors associated with difficult RA catheterization. Methods: Left RA ultrasound assessments were performed in patients with indicated invasive blood pressure monitoring the day before surgery. RA catheterization was performed by personnel blinded to the ultrasound results. Based on the number of attempts needed for successful catheter placement, the cohort was divided into uncomplicated (group 1) and difficult (more than one attempt, group 2) catheterization cases. Cases subjected to primary ultrasound were excluded from the analysis. Results: Body weight, height and surface area (BSA) of patients in group 2 (n = 16) were significantly lower than those of patients in group 1 (n = 25), and internal RA diameters were significantly smaller in group 2 patients. In the whole cohort, BSA was significantly associated with distal and proximal internal RA diameters. In contrast, no differences were observed in the skin-to-artery distance, the longitudinal axis deviation (kinking) or blood flow velocity. Median time to successful catheterization was 77 (47–179) s. Prolonged time needed for cannulation was significantly associated with lower body weight, BMI and BSA, and with reduced distal and proximal internal RA diameter. Conclusions: RA catheterization performed through pulse palpation may be difficult, especially in adult patients with lower body weight and height, due to reduced arterial diameters. Initial use of ultrasound in these patients may reduce first-attempt failure, preventing procedural delays and patient discomfort.

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Comparison of ultrasound-guided dynamic needle tip positioning and acoustic shadowing technique with palpation technique for radial arterial cannulation by experienced clinicians: A randomized controlled trial

2023

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Background: Radial artery cannulation is usually done for monitoring invasive blood pressure during intraoperative period. The dynamic needle tip positioning approach allows continuous visualization of the needle tip during ultrasound-guided cannulation. The acoustic shadowing technique, using two lines on the ultrasound probe, might be used to facilitate radial artery puncture. We aimed to compare these two ultrasound-guided techniques of radial artery cannulation with the traditional palpation method in adult patients. Methods: In this trial, 180 adult patients requiring arterial cannulation were randomized into three groups (Traditional palpation (TP), Dynamic needle tip positioning (DNTP), and acoustic shadow technique (AST)). All cannulations were carried out by experienced anesthetists. Data was analyzed for the success rate of arterial cannulation in the first attempt, total number of attempts in 5 min, time taken to cannulate, number of cannulas used, and complications related to the procedure. Results: The first attempt success rates among TP, DNTP, and AST were 66.7%, 66.7%, and 71.7%, respectively ( p = 0.794). The median time taken for cannulation was 60.5 (37.0, 129.5) s, 71.0 (50.0, 170.0) s, and 108.0 (58.0, 181.0) s, respectively ( p = 0.066) and the median number of cannulation attempts was 1, in all the three groups ( p = 0.684). There was also no difference in the total number of cannulas used, the overall success rate of cannulation, and complications related to the procedure in the three groups. Conclusion: The TP, DNTP, and AST technique for radial artery cannulation had comparable first attempt success rate, the time taken for cannulation, the number of cannulas used, and overall complications. We conclude that radial arterial cannulation by palpation, as well as ultrasound-guided DNTP and AST techniques performed by experienced clinicians in hemodynamically stable adult patients are equally advantageous.

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Single and double developing lines improve ultrasound-guided radial artery catheterization in obese patients: A randomized controlled trial

Cited by 6 publications

References 13 publications

Acoustic Shadowing to Facilitate Ultrasound Guided Arterial Cannulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Acoustic Shadowing to Facilitate Ultrasound Guided Arterial Cannulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Lower Patient Height and Weight Are Predisposing Factors for Complex Radial Arterial Catheterization

Comparison of ultrasound-guided dynamic needle tip positioning and acoustic shadowing technique with palpation technique for radial arterial cannulation by experienced clinicians: A randomized controlled trial

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