Ultrasound-guided arterial catheterization

Abstract

Ultrasonography facilitates arterial catheterization compared to traditional palpation techniques, especially in small arteries. For successful catheterization without complications, practitioners should be familiar with the anatomic characteristics of the artery and ultrasound-guided techniques. There are two approaches for ultrasound-guided arterial catheterization: the short-axis view out-of-plane approach and the long-axis view in-plane approach. There are several modified techniques and tips to facilitate ultrasound-guided arterial catheterization. This review deals with the anatomy relevant to arterial catheterization, several methods to improve success rates, and decrease complications associated with arterial catheterization.

Arterial line insertion

“…It is advisable as a first line option in patients in whom difficulty is predictedhypotensive patients without a palpable radial artery, obesity, multiple previous attempts, or when only a single suitable site is identified. 31,32 Using ultrasound to only mark the skin is less useful than real time guidance. 31 The best results may be achieved by combining a short or long axis approach with dynamic needle tip positioning to prevent complications and improve first pass success.…”

“…31 The best results may be achieved by combining a short or long axis approach with dynamic needle tip positioning to prevent complications and improve first pass success. 32 If using the long axis technique, positioning the needle bevel down may reduce posterior wall perforation. 32 Buetti et al conducted a large randomised controlled trial comparing the rate of infection when ultrasound was used in arterial line placement, using sterile precautions, probe cover and gel, and identified no increase in infections.…”

Comparison between ultrasound guided and palpatory method for radial artery Catheterization.

“…Yet one can deduct from the published data that the difference was reported as non-significant, 72% versus 64% in another study (p=0.39). 4,5,6 The mean time required for catheterization was 64.5 ± 10.3 sec using ultrasound guidance while 150.8 ± 20.6 sec in palpatory method group ( p=0.005), yet contradictory findings were noted in a local study, with 35.6 ± 17.4 sec in ultrasound versus 34.9 ± 19.4 sec in palpatory method group (p=0.882). 4,7 There was also difference in published literature, with regards to mean number of attempts, e.g.…”

“…4,5,6 The mean time required for catheterization was 64.5 ± 10.3 sec using ultrasound guidance while 150.8 ± 20.6 sec in palpatory method group ( p=0.005), yet contradictory findings were noted in a local study, with 35.6 ± 17.4 sec in ultrasound versus 34.9 ± 19.4 sec in palpatory method group (p=0.882). 4,7 There was also difference in published literature, with regards to mean number of attempts, e.g. 1.2 ± 0.7 in ultrasound versus 2.2 ± 0.8 attempts in palpatory method group (p = 0.001) in total of 60 patients, as compared to 1.47 ± 1.1 versus 1.53 https://doi.org/10.29309/TPMJ/2022.29.11.7004…”

“…It is acclaimed to decrease total time and number of attempts needed for catheterization, and also increases the likelihood of successful catheterization in first attempt. 3,4 In two studies ultrasound increased the chances of successful first attempt, with one study comparing groups of 40 patients the difference was 88% against 70% for palpatory method (p= 0,027). Yet one can deduct from the published data that the difference was reported as non-significant, 72% versus 64% in another study (p=0.39).…”