Centrale Operativa 118 Emilia Est (Prehospital Emergency Medical Dispatch Centre), Helicopter Emergency Medical Service, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy; Critical Care Nursing Course, University of Bologna, Bologna, Italy.
Critical Care Nursing Course, University of Bologna, Bologna, Italy; Intensive Care Unit, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy.
Anaesth Crit Care Pain Med. 2022 Aug;41(4):101096. doi: 10.1016/j.accpm.2022.101096. Epub 2022 Apr 28.
Radial artery catheterization is a frequently performed procedure for critically ill patients. The correct function of arterial catheters is essential to provide accurate and continuous hemodynamic monitoring, facilitating intermittent blood sampling and helping to optimize the workload for critical care nurses and physicians. However, they are not without their own problems. This narrative practice review discusses several clinical aspects that are not frequently considered but may contribute to enhanced catheter functionality, less device-related failure and more acceptable dwell times. Ultrasound has demonstrated unequivocal efficacies and safety with the procedure, improving first attempt success rates with children, the obese or patients with unstable clinical vital signs and shock. Moreover, anatomic variations of the radial artery are not rare, and ultrasound-guided catheterization reduces the incidence of insertion-related complications such as hematoma, posterior wall puncture, intimal dissection, and radial nerve injury. Ultrasound guidance offers several immediate benefits by enhancing the most appropriate insertion techniques, allows for the correct catheter to vessel ratio measurements to be performed and reduces the angle of insertion, which may affect catheter failure due to inappropriate catheter length. A deeper and more proximal cannulation site at least 4 cm from wrist joint, avoiding the area of wrist flexion, reduces mechanical complications related to patient movements and may improve catheter functionality and dwell along with a better area for stabilization and securement.
桡动脉置管术是危重症患者经常进行的一项操作。动脉导管的正确功能对于提供准确和连续的血流动力学监测至关重要，有助于间歇性采血，并有助于优化重症监护护士和医生的工作量。然而，它们并非没有自身的问题。本叙述性实践综述讨论了几个临床方面，这些方面并不经常被考虑，但可能有助于增强导管功能、减少与器械相关的故障以及延长留置时间。超声在该操作中显示出明确的疗效和安全性，提高了儿童、肥胖患者或临床生命体征不稳定和休克患者的首次尝试成功率。此外，桡动脉的解剖变异并不罕见，超声引导下的置管术可降低与插入相关的并发症发生率，如血肿、后壁穿刺、内膜夹层和桡神经损伤。超声引导可通过增强最合适的插入技术提供多种即时益处，可进行正确的导管与血管比测量，并减小插入角度，这可能会因导管长度不合适而导致导管故障。至少在腕关节 4cm 以上的更深、更靠近近心端的置管部位，避免腕关节弯曲部位，可减少与患者运动相关的机械并发症，并可能改善导管功能和留置时间，同时为稳定和固定提供更好的部位。
