Ultrasound Guidance for Radial Artery Catheterization: An Updated Meta-Analysis of Randomized Controlled Trials

Abstract

BackgroundSince a previous meta-analysis reported that ultrasound guidance was associated with a higher first-attempt success rate in catheterization of the radial artery, a number of randomized controlled trials (RCTs) have reported inconsistent results. The aim of the present study is to conduct an updated meta-analysis to clarify the role of ultrasound guidance for radial artery catheterization.MethodsA systematic literature search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted using specific search terms. Eligible studies were RCTs that compared ultrasound guidance with traditional palpation for radial artery catheterization. The Mantel-Haenszel method using the random effects model was adopted in this meta-analysis.ResultsSeven RCTs with 482 patients were included. Compared with traditional palpation, ultrasound guidance significantly increased the first-attempt success rate of radial artery catheterization (RR 1.51, 95% CI 1.07–2.14, P = 0.02). Subgroup analyses suggested that the superiority of ultrasound guidance for radial artery catheterization was significant when the technique was operated by experienced users, performed in small children and infants, and on elective procedures in the operating room. In addition, ultrasound guidance significantly reduced mean-attempts to success (WMD −1.13, 95% CI −1.58 to −0.69, P<0.00001), mean-time to success (WMD −74.77s, 95% CI −137.89s to −11.64s, P = 0.02), and the occurrence of hematoma (RR 0.17, 95% CI 0.07–0.41, P = 0.0001).ConclusionsThe present meta-analysis suggests a clear benefit from ultrasound guidance for radial artery catheterization compared with the traditional palpation. Preliminary training and familiarization with the ultrasound-guided technique is needed before applying it for radial artery catheterization, especially for inexperienced operators.

Ultrasound guidance versus direct palpation for radial artery catheterization by expert operators: a randomized trial among Canadian cardiac anesthesiologists

“…17 In 2014, two systematic reviews/meta-analyses of randomized controlled trials dedicated to US-guided radial artery catheterization were published. 18,19 While both concluded that US use is associated with improved first-attempt success, a small underlying evidence base continued, and a majority of the included trials were dedicated to pediatric patients. Until 2014, there were only three included trials on adult patients; two were conducted in an emergency department setting, 14,20 and one was performed in the operating room setting.…”

US-guided peripheral vascular interventions, comments on the EFSUMB guidelines

“…Five meta-analyses of US guidance for radial artery catheterization in children and in adults reported a significant reduction of first-attempt failure, procedural time, and local hematoma rate compared to the standard landmark and palpation-based approach [45][46][47][48][49]. Regarding transradial access for cardiac catheterisation, a significant improvement of first-pass access rates, number of attempts and time to access in comparison to the traditional palpation-guided approach was shown in a prospective multicentre randomized control trial (RCT) [50].…”

Review of Ultrasound-Guided Radial Artery Catheter Placement

“…For all subjects, ultrasound was associated with a risk ratio of 1.47 for first-attempt success; for adult subjects, the risk ratio was 1.38, and for pediatric subjects, the risk ratio was 1.73. 13 In another recent meta-analysis, Tang et al 14 also assessed first-attempt success rate and found a risk ratio of 1.98 versus 1.38 for experienced versus inexperienced operators. They concluded that ultrasound guidance reduced the mean number of attempts required for successful catheter placement, reduced time to successful catheter placement, and reduced the number of hematomas.…”

“…16 Ultrasound guidance may reduce catheter-related infections due to a reduction in attempts and increased firstattempt success rate. 13,14 Ultrasound guidance reduces the likelihood of hitting the nerve bundle and other structures near the artery due to real-time visualization of the needle as it approaches the artery and underlying structures. This should reduce the morbidity associated with radial artery catheter placement because the procedure can be associated with significant pain, especially when catheter placement requires multiple attempts.…”

“…This should reduce the morbidity associated with radial artery catheter placement because the procedure can be associated with significant pain, especially when catheter placement requires multiple attempts. To our knowledge, the morbidity associated with insertion has not been specifically evaluated in any studies; however, the meta-analysis from Tang et al 14 suggests that there is less morbidity (fewer attempts, hematomas, and less time for successful catheter placement) with insertion when ultrasound guidance is used. Although it has not been studied specifically, ultrasound guidance is likely to be helpful in training less experienced providers to place radial artery catheters.…”