Liang Yupeng, Liu Peizhong, Wei Chao, Li Wenjin, Li Chuangpeng, Lai Tianwei, Peng Se, Xu Jiamin, Zhang Hezhen, Li Pusheng, Li Shaohui
The Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine Zhuhai, Zhuhai, Guangdong, China.
J Vasc Access. 2025 Jul;26(4):1272-1279. doi: 10.1177/11297298241270537. Epub 2024 Aug 16.
The distal radial artery presents a particular challenge for puncture and catheterization due to its diminutive size, tortuous path, and tendency to spasm, increasing the risk of procedural failure and injury. Ultrasound guidance improves success rates and reduces risk in radial artery catheterization. This study evaluates the efficacy and safety of a refined dynamic needle tip positioning technique for distal radial artery access.
One hundred twelve patients were randomized to either the modified dynamic needle tip positioning technique (MDNTP) or palpation guidance groups (palpation group), each with 56 participants. The primary outcomes were the success rate of the initial puncture and overall puncture success rate, while secondary outcomes included procedural time and complications such as puncture site hematoma and radial artery occlusion within 24 h.
The MDNTP group exhibited superior initial puncture success (71.43% vs 46.43%, < 0.05) and fewer puncture attempts (median 1 (1, 2) vs 2 (1, 4), < 0.05), resulting in a higher overall puncture success rate (98.21% vs 87.50%, = 0.028). Notably, sheath insertion times were significantly shorter (17 (12, 21) s vs 57 (32, 100) s, = 0.001) and the Sheath insertion success rate was higher (96.43% vs 82.14%, = 0.015) in the MDNTP group. Furthermore, the incidence of puncture site hematomas was reduced (5.36% vs 19.64%, = 0.022), although puncture time was longer (60 (28, 116) s vs 40 (15, 79) s, = 0.033). Despite these differences, total procedural time and the incidence of radial artery occlusion at 24 h postoperatively were comparable between the two groups.
The MDNTP technique boosts the success of distal radial artery puncture and catheterization, reducing the risk of complications associated with the procedure.
由于桡动脉远端管径细小、走行迂曲且易于痉挛，对其进行穿刺和置管具有特殊挑战，这增加了操作失败和损伤的风险。超声引导可提高桡动脉置管的成功率并降低风险。本研究评估一种改良的动态针尖定位技术用于桡动脉远端穿刺的有效性和安全性。
112例患者被随机分为改良动态针尖定位技术（MDNTP）组或触诊引导组（触诊组），每组56例。主要结局为首次穿刺成功率和总体穿刺成功率，次要结局包括操作时间以及24小时内穿刺部位血肿和桡动脉闭塞等并发症。
MDNTP组首次穿刺成功率更高（71.43%对46.43%，P<0.05）且穿刺尝试次数更少（中位数1（1，2）对2（1，4），P<0.05），从而总体穿刺成功率更高（98.21%对87.50%，P=0.028）。值得注意的是，MDNTP组鞘管置入时间显著更短（17（12，21）秒对57（32，100）秒，P=0.001）且鞘管置入成功率更高（96.43%对82.14%，P=0.015）。此外，穿刺部位血肿的发生率降低（5.36%对19.64%，P=0.022），尽管穿刺时间更长（60（28，116）秒对40（15，79）秒，P=0.033）。尽管存在这些差异，但两组的总操作时间和术后24小时桡动脉闭塞的发生率相当。
MDNTP技术提高了桡动脉远端穿刺和置管的成功率，降低了与该操作相关的并发症风险。
