Mesa Bharath Kumar, Sinha Mamta, Kumar Mayank, Ramchandani Sarita, Dey Chandan, Agrawal Nandkishore, Khetarpal Monica
Anesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND.
Emergency Medicine and Trauma, All India Institute of Medical Sciences, Raipur, Raipur, IND.
Cureus. 2024 Feb 14;16(2):e54183. doi: 10.7759/cureus.54183. eCollection 2024 Feb.
Introduction Radial artery cannulation is a commonly performed invasive procedure for assessing a patient's hemodynamic status and collecting blood samples. Ultrasound guidance has shown benefits in improving the success rate of first-attempt cannulation. Two main approaches, short-axis out-of-plane (SAOOP) and long-axis in-plane (LAIP), are commonly used. A modified technique called dynamic needle-tip positioning (DNTP) using the short-axis out-of-plane approach has been reported to enhance arterial catheterization. This study aims to compare the first-attempt success rates of radial artery cannulation using the two techniques, DNTP versus LAIP, along with overall success rates, cannulation time, and number of attempts. Methods This prospective, randomized, controlled, clinical study was conducted after obtaining clearance from the Institute Ethics Committee of AIIMS, Raipur. Ninety-six patients between the ages of 18 and 50 years, undergoing elective surgery under general anesthesia, and required radial arterial cannulation were randomized and equally allocated into two groups as the LAIP and DNTP approaches. The first-pass success rate, time to achieve successful cannulation, number of attempts needed, overall success rate within five minutes, and potential complications, such as thrombosis, vasospasm, and hematoma, were recorded. Results A total of 96 patients were included, with 48 in the LAIP group and 48 in the DNTP group. The DNTP group showed statistically significant advantages over the LAIP group, with a higher first-pass success rate (97.9% vs. 83.3%; p = 0.014) and shorter time to achieve successful cannulation (9.29±3.79 vs. 26.16±20.22 seconds; p = 0.001). Conclusion The ultrasound-guided short-axis DNTP technique for radial artery cannulation demonstrated a significant advantage as compared to the LAIP technique. The DNTP technique resulted in higher first-attempt cannulation success and shorter cannulation time.
引言
桡动脉置管是一种常用于评估患者血流动力学状态和采集血样的侵入性操作。超声引导已显示出有助于提高首次置管成功率。常用的两种主要方法是短轴平面外（SAOOP）和长轴平面内（LAIP）。据报道，一种使用短轴平面外方法的改良技术——动态针尖定位（DNTP）可提高动脉插管成功率。本研究旨在比较使用DNTP与LAIP这两种技术进行桡动脉置管的首次成功率、总体成功率、置管时间和尝试次数。
方法
本前瞻性、随机、对照临床研究在获得赖布尔全印医学科学研究所伦理委员会批准后进行。96例年龄在18至50岁之间、接受全身麻醉下择期手术且需要进行桡动脉置管的患者被随机且平均分为LAIP组和DNTP组。记录首次通过成功率、成功置管时间、所需尝试次数、五分钟内的总体成功率以及潜在并发症，如血栓形成、血管痉挛和血肿。
结果
共纳入96例患者，LAIP组和DNTP组各48例。DNTP组相对于LAIP组显示出统计学上的显著优势，首次通过成功率更高（97.9%对83.3%；p = 0.014），成功置管时间更短（9.29±3.79对26.16±20.22秒；p = 0.001）。
结论
与LAIP技术相比，超声引导下的桡动脉置管短轴DNTP技术显示出显著优势。DNTP技术首次置管成功率更高，置管时间更短。
