Istanbul Basaksehir Çam and Sakura City Hospital, Basaksehir, Istanbul, Turkey.
Izmir Bozyaka Training and Research Hospital, Bahar mh, Karabaglar, İzmir, Turkey.
J Vasc Access. 2024 Mar;25(2):538-545. doi: 10.1177/11297298221126284. Epub 2022 Oct 6.
Current guidelines recommend the use of ultrasound guidance for arterial cannulation. However, there are no recommendations on the best insertion site for radial artery cannulation in terms of catheter dwell time and incidence of complications.
In this randomized controlled study 94 patients were randomly assigned into three groups, corresponding to three different sites of insertion for radial artery cannulation: hand wrist: (Site/group 1, = 29), distal quarter part of the forearm (Site/group 2, = 30) and the midpoint of the forearm (Site/group 3, = 35). Age, height, weight, and diagnosis of each patient were recorded prior to insertions which were performed by a single investigator experienced in ultrasound-guided vascular access.
Radial artery diameters were similar (2.4 ± 0.4 vs 2.5 ± 0.3 vs 2.6 ± 0.4 mm), however skin to vessel distances were different between groups, and the depth of the radial artery increased progressively from distal to proximal sites. There was a significant difference between groups in terms of success rates at the first attempt. Only two cannulations were successful at first attempt, and overall, only 17 of 35 cannulations were successful at Site 1. Arterial cannula dislodgement rate was highest at Site 1(8/29, 26.7%), while the longest dwell time was at Site 2 with a median of 4 (IQR 3) days.
Considering the high removal rate at the wrist region and the high failure rate at the midpoint of the forearm, the distal quarter of the forearm can be identified as "the optimal insertion site' for ultrasound-guided radial artery cannulation.
目前的指南建议在动脉置管时使用超声引导。然而，在导管留置时间和并发症发生率方面，对于桡动脉置管的最佳插入部位，尚无相关推荐。
在这项随机对照研究中，94 名患者被随机分为三组，对应桡动脉置管的三个不同插入部位：手腕（部位/组 1，=29）、前臂远端四分之一部分（部位/组 2，=30）和前臂中点（部位/组 3，=35）。在插入之前，记录了每位患者的年龄、身高、体重和诊断情况，这些插入操作均由一位经验丰富的超声引导血管通路专家进行。
桡动脉直径相似（2.4±0.4 毫米 vs 2.5±0.3 毫米 vs 2.6±0.4 毫米），但组间皮肤至血管距离不同，桡动脉深度从远端到近端逐渐增加。在首次尝试成功率方面，组间存在显著差异。仅有两次尝试在第一次就成功了，而在总体上，只有 35 次置管中的 17 次在部位 1 成功。部位 1 的动脉插管脱落率最高（8/29，26.7%），而部位 2 的留置时间最长，中位数为 4（IQR 3）天。
考虑到手部区域的高移除率和前臂中点的高失败率，前臂远端四分之一部分可被确定为超声引导桡动脉置管的“最佳插入部位”。
