Ultrasound Versus Traditional Palpation to Guide Radial Artery Cannulation in Critically Ill Children: A Randomized Trial

Anantasit, Nattachai; Cheeptinnakorntaworn, Pimporn; Khositseth, Anant; Lertbunrian, Rojjanee; Chantra, Marut

doi:10.1002/jum.14291

Cited by 32 publications

(21 citation statements)

References 29 publications

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“…Complications related to cannulation (arterial puncture or haematoma) are generally decreased by a factor of 2 to 4 [ 239 , 242 – 244 ], except in one study conducted by Leyvi which did not observe any improvement of the immediate complication rate with ultrasound guidance [ 241 ]. Similar improved results have been reported for arterial cannulation [ 245 – 247 ], with an even greater (four to fivefold) reduction of mechanical complications (haematoma or ischaemia). Several studies have evaluated out-of-plane ultrasound guidance for radial artery cannulation [ 245 , 246 ].…”

Section: Summary Of the Resultssupporting

confidence: 80%

“…Similar improved results have been reported for arterial cannulation [ 245 – 247 ], with an even greater (four to fivefold) reduction of mechanical complications (haematoma or ischaemia). Several studies have evaluated out-of-plane ultrasound guidance for radial artery cannulation [ 245 , 246 ]. Ultrasound guidance tends to be more beneficial in infants and young children ( p = 0.07) [ 246 ].…”

Section: Summary Of the Resultssupporting

confidence: 80%

See 1 more Smart Citation

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Timsit

Baleine

Bernard

et al. 2020

Ann. Intensive Care

138

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The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.

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Section: Summary Of the Resultssupporting

confidence: 80%

Section: Summary Of the Resultssupporting

confidence: 80%

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Timsit

Baleine

Bernard

et al. 2020

Ann. Intensive Care

138

View full text Add to dashboard Cite

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“…ultrasound-guided vascular puncture, especially for operators with insufficient experience. [5][6][7] We adopted a new technique involving the use of double developing lines on the ultrasound probe to ameliorate this shortcoming of ultrasound. We hypothesized that ultrasound-guided vascular puncture with double developing lines could help increase the success rate of radial artery puncture in young children.…”

Section: Radial Artery Cannulation In Young Childrenmentioning

confidence: 99%

Acoustic Shadowing Facilitates Ultrasound-guided Radial Artery Cannulation in Young Children

et al. 2019

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Arterial cannulation in young children can be challenging. Ultrasound guidance using focused acoustic shadowing may be suitable for guiding radial artery puncture in young children. The present research tested the hypothesis that ultrasound guidance using focused acoustic shadowing helps increase the success rate of radial artery cannulation in this population. Methods In a double-blinded, parallel-group trial, 79 young children undergoing surgery under general anesthesia were randomly assigned to two groups (1:1 ratio): the traditional ultrasound group and the novel ultrasound group. Young children in the traditional group underwent conventional ultrasound-guided radial artery puncture, whereas those in the novel ultrasound group underwent radial artery puncture guided by acoustic shadowing ultrasound with double developing lines. All radial artery punctures were performed using the short-axis out-of-plane approach. The primary endpoint was the success rate of cannulation at the first attempt. The secondary endpoints included cannulation failure rate, ultrasound location time, and puncture time. Results The success rate of cannulation at the first attempt in the novel ultrasound group (35 of 39 [90%]) was significantly higher than that in the traditional ultrasound group (24 of 40 [60%]; difference: 30% [95% CI, 12 to 48%], P =0.002). None of the patients in the ultrasound with acoustic shadowing group experienced failure of radial artery puncture and cannulation. The ultrasound location time and puncture time in the ultrasound acoustic shadowing group were significantly lower than that in the traditional ultrasound group (location time: median [interquartile range]: 6 [5, 8] vs. 18 [15, 21] s; puncture time: 24 [15, 41] vs. 40 [23, 56] s). Conclusions Acoustic shadowing via the use of double developing lines significantly improved the success rate of radial artery puncture in young children, compared with that achieved with the use of traditional ultrasound guidance.

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“…Two hundred eighty-six articles were identified from electronic databases (excluding duplicates). After application of the inclusion and exclusion criteria, seven studies [15][16][17][18][19][20][21] were finally included in this meta-analysis. All seven studies were randomized controlled trials of radial artery catheterizations.…”

Section: Literature Searchmentioning

confidence: 99%

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

Zhang

et al. 2020

Crit Care

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Background: The use of an ultrasound-guided technique for radial arterial catheterization has not been well established in pediatric patients. We conducted a systematic review and meta-analysis to evaluate the efficacy of the ultrasound-guided technique for radial artery catheterization in pediatric populations. Method: A systematic review of PubMed, Medline, Embase, and the Cochrane library was performed from their date of inception to December 2019. In this meta-analysis, we conducted online searches using the search terms "ultrasonography," "ultrasonics," "ultrasound-guided," "ultrasound," "radial artery," "radial arterial," "catheter," "cannula," and "catheterization." The rate of the first-attempt and total success, mean attempts to success, mean time to success, and incidence of complications (hematomas) were extracted. Data analysis was performed with RevMan 5.3.5. Results: From 7 relevant studies, 558 radial artery catheterizations were enrolled, including 274 ultrasound-guided and 284 palpation catheterizations. The ultrasound-guided technique could significantly improve the rate of firstattempt and total success (RR 1.78, 95% CI 1.46 to 2.18, P < 0.00001; RR 1.33; 95% CI 1.20 to 1.48; P < 0.00001). However, there was significant heterogeneity for the total success rate among the included studies (I 2 = 67%). The ultrasound-guided radial artery catheterization was also associated with less mean attempts and mean time to success (WMD − 1.13, 95% CI − 1.58 to − 0.69; WMD − 72.97 s, 95% CI − 134.41 to − 11.52) and lower incidence of the hematomas (RR 0.17, 95% CI 0.07 to 0.41). Conclusions: The use of the ultrasound-guided technique could improve the success rate of radial arterial catheterization and reduce the incidence of hematomas in pediatric patients. However, the results should be interpreted cautiously due to the heterogeneity among the studies.

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Ultrasound Versus Traditional Palpation to Guide Radial Artery Cannulation in Critically Ill Children: A Randomized Trial

Cited by 32 publications

References 29 publications

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Acoustic Shadowing Facilitates Ultrasound-guided Radial Artery Cannulation in Young Children

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

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