Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
Paediatr Anaesth. 2021 Dec;31(12):1357-1363. doi: 10.1111/pan.14311. Epub 2021 Oct 20.
Historically, the ulnar artery has rarely been considered for arterial cannulation as it is less easily palpated than the radial artery. With the current routine use of ultrasound in pediatric patients, the ulnar is as accessible as the radial and could be viewed as an equivalent site for cannulation.
The purpose of this study was to compare ulnar and radial artery suitability for arterial cannulation in pediatric patients using 2-dimensional ultrasound.
We examined the ulnar and radial arteries of pediatric patients aged birth to 6 years who were scheduled to undergo general anesthesia. Following anesthesia induction, the investigators positioned the patient's wrist to 30-45 degrees of extension and obtained images of the ulnar and radial arteries in the transverse and longitudinal planes. Assessments of the arteries' anterior-posterior diameter, cross-sectional area and depth were made by visual inspection at the time of image acquisition and by electronic caliper measurement of recorded images.
In 108 patients, mean anterior-posterior diameter of the ulnar artery was larger than the radial artery in the transverse view, longitudinal view, and cross-sectional area in 63.6%, 59.4%, and 60.4% of patients (p = .002, .004, and .006, respectively). Mean ulnar artery size was, on average, larger than the radial artery by 7.7%, 8.1%, and 12.9% in the transverse AP diameter, longitudinal AP diameter, and cross-sectional area (95% CI 3.1-12.4%; 3.2-13.0%; 4.4-21.5%). The investigator's visual evaluation of vessel size at the bedside showed substantial agreement with the measured cross-sectional area (linear-weighted kappa of 0.73). In a subset of 13 patients age <24 months, the mean depth of the ulnar artery was 2.13 mm compared to 1.65 mm for the radial artery (difference -0.48 mm 95% CI 1.08-0.12).
The ulnar artery was larger than the radial artery in 60% of pediatric patients thus may offer an arterial cannulation site advantage due to its larger size. The use of 2-dimensional ultrasound examination allows accurate assessment of upper extremity distal arteries in order to optimize site selection for arterial cannulation in pediatric patients.
历史上，由于尺动脉不如桡动脉容易触及，因此很少将其用于动脉插管。随着目前儿科患者常规使用超声，尺动脉与桡动脉一样容易触及，可视为插管的等效部位。
本研究旨在使用二维超声比较小儿患者尺动脉和桡动脉的动脉插管适用性。
我们检查了计划接受全身麻醉的出生至 6 岁的儿科患者的尺动脉和桡动脉。麻醉诱导后，研究人员将患者的手腕置于 30-45 度伸展位，并在横切和纵切面上获取尺动脉和桡动脉的图像。在获取图像时通过视觉检查以及通过电子卡尺测量记录的图像来评估动脉的前后直径、横截面积和深度。
在 108 例患者中，在横切面、纵切面和横截面积中，尺动脉的前后直径均大于桡动脉，分别为 63.6%、59.4%和 60.4%（p=.002，.004 和.006）。平均而言，尺动脉的大小比桡动脉大 7.7%、8.1%和 12.9%，分别为横切 AP 直径、纵切 AP 直径和横截面积（95%CI 3.1-12.4%；3.2-13.0%；4.4-21.5%）。研究者在床边对血管大小的视觉评估与测量的横截面积具有高度一致性（线性加权 Kappa 值为 0.73）。在 13 名年龄<24 个月的患者亚组中，尺动脉的平均深度为 2.13mm，而桡动脉的平均深度为 1.65mm（差值-0.48mm，95%CI 1.08-0.12）。
在 60%的儿科患者中，尺动脉大于桡动脉，因此其较大的尺寸可能提供动脉插管部位的优势。二维超声检查的使用可以准确评估上肢远端动脉，从而优化儿科患者动脉插管的部位选择。
