Intensive Care Unit, Ospedale Maggiore, Bologna, Italy.
Critical Care Nursing Master course, University of Bologna, Italy.
J Vasc Access. 2021 Jul;22(4):561-567. doi: 10.1177/1129729820953020. Epub 2020 Aug 27.
Radial artery cannulation (RAC) is a common procedure in Intensive Care Units (ICU); radial catheters for ICU patients require increased durability to collect blood samples and to guarantee continuous hemodynamic monitoring. Failure in catheter functionality needs catheter replacement, impacting on staff workload, costs, and patient safety and discomfort.
prospective non-randomised cohort study on adult ICU patients describing intensivists and critical care nurses' approach in radial artery catheterization.
A sample of 103 radial artery cannulations was observed. Catheterization was performed blind in 71 patients (68.9%) and with ultrasound guidance (USG) in 32 (31.1%); majority of blind inserted RAC were at a distance between 0 and 3.9 cm from wrist joint (77.5%) while catheters inserted from 4 to 10 cm were mainly positioned with USG (84.4%). Radial catheters inserted with USG at a distance of 4 to 10 cm from wrist joint had an in-situ time double than those inserted blind (8.2 ± 7.5 vs 4.8 ± 7.3, < 0.038).
As recommended by current evidence and guidelines, USG represents a valuable support during arterial catheterization and is recommended in adult patients with clinical signs of shock, obese, swelling, and in the paediatric population. RAC in the forearm proximally, at a distance of at least 4 cm from wrist, could increase catheter durability and functionality for ICU patients. USG for cannulation in this forearm area is mandatory because of the deeper course of the radial artery.
桡动脉置管（RAC）是重症监护病房（ICU）中的常见操作；ICU 患者的桡动脉导管需要更高的耐用性，以采集血液样本并保证连续的血流动力学监测。如果导管功能失效，就需要更换导管，这会增加医护人员的工作量、成本，并影响患者的安全和舒适度。
对描述重症监护医师和重症监护护士在桡动脉置管过程中方法的成年 ICU 患者进行前瞻性非随机队列研究。
观察到 103 例桡动脉置管。71 例（68.9%）盲法置管，32 例（31.1%）超声引导（USG）置管；大多数距离腕关节 0 至 3.9cm 处插入的盲法 RAC（77.5%），而距离腕关节 4 至 10cm 处插入的导管主要通过 USG 定位（84.4%）。距离腕关节 4 至 10cm 处用 USG 插入的桡动脉导管的在位时间是盲法插入的两倍（8.2±7.5 与 4.8±7.3，<0.038）。
正如现有证据和指南所建议的，USG 在动脉置管过程中提供了有价值的支持，建议在有休克、肥胖、肿胀的临床体征的成年患者中以及儿科人群中使用。在腕关节至少 4cm 处的前臂近端进行 RAC，可以提高 ICU 患者导管的耐用性和功能。由于桡动脉的走行更深，在该前臂区域进行置管时必须使用 USG。
