Peng Chao, Wu Wen, Zhang Yupei, Han Zhenzhong, Deng Xiaojie, Tan Jinbo, Xi Zuyang, Zhang Rong
Department of Emergency and Critical Care Medicine, Yichang Central People's Hospital, Yichang, 443003, Hubei, China.
Department of Nursing, Yichang Central People's Hospital, Yichang, 443003, Hubei, China.
BMC Anesthesiol. 2025 Jul 17;25(1):348. doi: 10.1186/s12871-025-03228-2.
Arterial catheterization is fundamental for hemodynamic monitoring in critically ill patients, yet instability and loss of arterial pressure waveform remain clinically significant issues. The distal radial artery (dRA) approach has been proposed as a potential alternative to the conventional radial artery (RA) approach. This is the first randomized clinical trial to assess the comparative efficacy and reliability of dRA versus RA catheterization by examining first-attempt success rates and the stability of arterial pressure waveforms in critically ill ICU patients.
This randomized controlled trial enrolled 200 critically ill patients requiring arterial catheterization, assigning them to either dRA (n = 100) or conventional RA (n = 100) groups. All procedures utilized a standard 20-gauge polyurethane peripheral intravenous catheter. Co-primary outcomes included first-attempt success rate and frequency of arterial pressure waveform loss during the initial 72-h period. Secondary outcomes included catheterization time, complications during insertion and management, hemostasis time, and catheter duration. Bonferroni correction was applied for multiple testing (α = 0.025).
First-attempt success rates were comparable between dRA and RA groups (86% vs. 84%, P = 0.688). The dRA group experienced significantly fewer arterial pressure waveform losses across all three days (Day 1: 1.0 [0.0, 2.0] vs. 2.0 [1.0, 2.0]; Day 2: 1.0 [0.0, 1.0] vs. 2.0 [1.0, 2.0]; Day 3: 0.0 [0.0, 1.0] vs. 1.0 [1.0, 2.0]; all P < 0.001). Both groups achieved 100% procedural success with no site crossovers. Arterial catheterization time was longer in the dRA group (P < 0.001). Complication rates during catheterization, management, and after removal were similar between groups. Hemostasis time was significantly shorter in the dRA group (2.6 ± 1.5 min vs. 4.2 ± 0.9 min, P < 0.001). Catheter duration was similar between groups (76.6 ± 16.7 vs. 77.4 ± 16.4 h, P = 0.724).
While first-attempt success rates were similar, the dRA approach offered greater arterial pressure waveform stability and shorter hemostasis time than the conventional RA approach, without increasing complications. Thus, dRA may be a preferable option for arterial catheterization in critically ill patients.
This study is registered in the Chinese Clinical Trials Registry (registration number: ChiCTR2400086284, registration date: 27/06/2024).
动脉导管插入术是危重症患者血流动力学监测的基础，但动脉压波形不稳定和消失在临床上仍然是重要问题。远端桡动脉（dRA）入路已被提议作为传统桡动脉（RA）入路的潜在替代方法。这是第一项通过检查危重症ICU患者首次尝试成功率和动脉压波形稳定性来评估dRA与RA导管插入术比较疗效和可靠性的随机临床试验。
这项随机对照试验纳入了200名需要进行动脉导管插入术的危重症患者，将他们分为dRA组（n = 100）或传统RA组（n = 100）。所有操作均使用标准的20号聚氨酯外周静脉导管。共同主要结局包括首次尝试成功率和最初72小时内动脉压波形消失的频率。次要结局包括导管插入时间、插入和管理过程中的并发症、止血时间和导管留置时间。采用Bonferroni校正进行多重检验（α = 0.025）。
dRA组和RA组的首次尝试成功率相当（86%对84%，P = 0.688）。dRA组在所有三天内动脉压波形消失的情况明显更少（第1天：1.0 [0.0，2.0]对2.0 [1.0，2.0]；第2天：1.0 [0.0，1.0]对2.0 [1.0，2.0]；第3天：0.0 [0.0，1.0]对1.0 [1.0，2.0]；所有P < 0.001）。两组均实现了100%的操作成功，且无部位交叉。dRA组的动脉导管插入时间更长（P < 0.001）。两组在导管插入、管理和拔除后的并发症发生率相似。dRA组的止血时间明显更短（2.6 ± 1.5分钟对4.2 ± 0.9分钟，P < 0.001）。两组的导管留置时间相似（76.6 ± 16.7对77.4 ± 16.4小时，P = 0.724）。
虽然首次尝试成功率相似，但dRA入路比传统RA入路提供了更高的动脉压波形稳定性和更短的止血时间，且不增加并发症。因此，dRA可能是危重症患者动脉导管插入术的更优选择。
本研究在中国临床试验注册中心注册（注册号：ChiCTR2400086284，注册日期：2024年6月27日）。
