Melhuish Thomas M, White Leigh D
Faculty of Medicine, University of New South, Wales; Wagga Wagga Rural Referral Hospital, NSW, Australia.
Wagga Wagga Rural Referral Hospital, NSW, Australia; School of Medicine, University of Wollongong, NSW, Australia.
Am J Emerg Med. 2016 Dec;34(12):2372-2378. doi: 10.1016/j.ajem.2016.08.059. Epub 2016 Aug 30.
Wrist extension is commonly taught as part of the radial artery cannulation technique. Currently the degree of wrist extension required to optimize cannulation success remains inconclusive. This is the first meta-analysis to investigate optimal wrist positioning for radial artery cannulation.
Five major databases (CINAHL, SCOPUS, PubMed, Medline and Web of Science) were systematically searched until June 2016. All studies were assessed for level of evidence and risk of bias. The data for each outcome was then assessed via a meta-analysis.
Five studies including 500 patients were found. There is moderate evidence to support 45° wrist angulation for improved radial artery cannulation. Radial arterial height is likely to be increased at 45°, cannulation time is significantly faster and success rates are likely higher than at other degrees of angulation. However, this evidence is confounded by the significant heterogeneity (I >75%) which is at least in part related to a high proportion of healthy young volunteers who were amongst the studied populations.
This review found moderate evidence in support of a 45° wrist angulation to facilitate arterial cannulation, however the results are largely limited by the external validity of the data collected given the restrictive populations studied. Any further studies investigating the effect of altering wrist angulation on radial artery cannulation should focus on populations who are either likely to require arterial cannulation or predisposed to difficult access.
腕关节伸展通常作为桡动脉穿刺技术的一部分进行教授。目前，为优化穿刺成功率所需的腕关节伸展程度尚无定论。这是第一项调查桡动脉穿刺最佳腕关节位置的荟萃分析。
系统检索了五个主要数据库（CINAHL、SCOPUS、PubMed、Medline和Web of Science），直至2016年6月。对所有研究进行证据水平和偏倚风险评估。然后通过荟萃分析评估每个结果的数据。
共纳入五项研究，涉及500名患者。有中等证据支持腕关节成角45°可改善桡动脉穿刺。45°时桡动脉高度可能增加，穿刺时间明显更快，成功率可能高于其他成角度数。然而，这一证据受到显著异质性（I>75%）的影响，这至少部分与研究人群中健康年轻志愿者的高比例有关。
本综述发现有中等证据支持腕关节成角45°有助于动脉穿刺，然而，鉴于所研究人群的局限性，结果在很大程度上受到所收集数据的外部有效性的限制。任何进一步研究改变腕关节成角对桡动脉穿刺影响的研究都应关注可能需要动脉穿刺或易于出现穿刺困难的人群。
