Kucuk Ahmet, Yuce Hasan Husnu, Yalcin Funda, Boyacı Fatıma Nurefsan, Yıldız Sema, Yalcin Saban
Department of Anesthesiology and Reanimation, Medical Faculty, Harran University, Yenişehir Yerleşkesi, 63300, Şanlıurfa, Turkey,
J Clin Monit Comput. 2014 Dec;28(6):567-72. doi: 10.1007/s10877-014-9552-z. Epub 2014 Jan 11.
Arterial cannulation is a common anaesthetic procedure that might be challenging and time-consuming in elderly patients. To establish an appropriate wrist joint position for arterial cannulation is crucial for ultrasound (US)-guided cannulation success. This study aimed to find out the optimal wrist joint angle for long axis in-plane (LA-IP) US-guided approach in radial artery cannulation in elderly patients. One hundred patients over 60 years old, who were assumed to require an arterial catheter for continuous blood pressure monitoring or frequent blood gas analysis in the intensive care unit or in the operating room were included in this prospective randomized study. Patients were randomized to five groups according to the wrist positions (0°, 15°, 30° 45° and 60° groups) for LA-IP approach for radial artery cannulation. Cannulation time (s), number of attempts, total success rate (%), first attempt success rate were recorded in all patients. Mean radial artery height was increased in 45° group compared to other groups (p < 0.05). Distance between skin and radial artery in 45° and 60° groups were statistically significantly decreased compared to 0° group (p < 0.05 for all comparisons). Mean cannulation time of 45° group was statistically decreased compared to other groups (p < 0.05). Number of attempts and total success rate were similar among groups, whereas first attempt success rate was significantly increased in 45° group compared to other groups (p < 0.05). Mean arterial height of the first attempt successful group was statistically increased compared to the first attempt failed group (p < 0.001) and mean cannulation time and mean number of attempts were also negatively correlated with arterial height (p < 0.001; for all comparisons). The 45° wrist angle increment might be advantageous in US-guided LA-IP radial artery cannulation in elderly patients in view of cannulation time and first attempt success rate.
动脉置管是一种常见的麻醉操作，在老年患者中可能具有挑战性且耗时。为动脉置管建立合适的腕关节位置对于超声（US）引导下的置管成功至关重要。本研究旨在找出老年患者桡动脉置管时，长轴平面内（LA-IP）超声引导方法的最佳腕关节角度。本前瞻性随机研究纳入了100例60岁以上的患者，这些患者预计在重症监护病房或手术室需要动脉导管进行连续血压监测或频繁血气分析。根据腕关节位置（0°、15°、30°、45°和60°组）将患者随机分为五组，采用LA-IP方法进行桡动脉置管。记录所有患者的置管时间（秒）、尝试次数、总成功率（%）、首次尝试成功率。与其他组相比，45°组的平均桡动脉高度增加（p<0.05）。与0°组相比，45°和60°组皮肤与桡动脉之间的距离在统计学上显著减小（所有比较p<0.05）。与其他组相比，45°组的平均置管时间在统计学上缩短（p<0.05）。各组间尝试次数和总成功率相似，而45°组的首次尝试成功率与其他组相比显著提高（p<0.05）。首次尝试成功组的平均动脉高度与首次尝试失败组相比在统计学上增加（p<0.001），并且平均置管时间和平均尝试次数也与动脉高度呈负相关（p<0.001；所有比较）。从置管时间和首次尝试成功率来看，45°的腕关节角度增加可能有利于老年患者超声引导下的LA-IP桡动脉置管。
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