Abstract
Arterial cannulation with ultrasound (US) guidance increases the success rate and reduces complications. US-guided vascular access has two main approaches: long axis in-plane (LA-IP) and short axis out-of-plane (SA-OOP) approaches. The purpose of this study was to compare performance time and possible complications between two techniques. After obtaining ethics committee approval and informed patient consent, a prospective and randomized trial was conducted at ASA I-III, patients between the ages of 20–70 years. 108 patients were scheduled for radial arterial cannulaton in patients undergoing elective surgery under general anesthesia. Patients were divided into two groups as LA-IP and SA-OOP approaches with sealed envelope randomized method. After induction of anesthesia, the distance between skin-to-artery and the diameter of radial artery in US-imaging was recorded. The successful cannulation time, the number of attempts, potential complications such as thrombosis, edema, vasospasm, hematoma and posterior wall puncture were recorded. Demographic and hemodynamic parameters were similar in two groups. The diameter and the depth of artery were also similar in both of groups. Cannulation time was shorter in LA-IP Group compared to SA-OOP (24 ± 17 s vs. 47 ± 34 s respectively, p < 0.05). The arterial cannulation by LA-IP approach increased the rate of cannula-insertion success at the first attempt (76 %) compared to SA-OOP approach (51 %). Posterior wall damage during arterial cannulation were found in 30 patients with SA-OOP Group (56 %) and 11 patients with LA-IP Group (20 %), (p < 0.05). In our study, the use of LA-IP approach during US-guided radial artery cannulation has higher success rate at first insertion. We also found LA-IP approach results in shorter cannulation time and decreased the incidence of complications.
Similar content being viewed by others
References
Scheer BV, Perel A, Pfeiffer UJ. Clinical review: complications and risk factors of peripheral arterial catheters for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care. 2002;6:198–204.
Mangar D, Laborde RS, Vu DN. Delayed ischaemia of the hand necessitating amputation after radial artery cannulation. Can J Anaesth. 1993;40:247–50.
Levin PD, Sheinin O, Gozal Y. Use of ultrasound guidance in the insertion of radial artery catheters. Crit Care Med. 2003;31:481–4.
Miller AH, Roth BA, Mills TJ, et al. Ultrasound guidance versus the landmark technique for the placement of central venous catheters in the emergency department. Acad Emerg Med. 2002;9:800–5.
Shiloh AL, Savel RH, Paulin LM, et al. Ultrasound- guided catheterization of the radial artery: a systematic review and meta-analysis of randomized controlled trials. Chest. 2011;139:524–9.
Shiver S, Blaivas M, Lyon M. A prospective comparison of ultrasound-guided and blindly placed radial arterial catheters. Acad Emerg Med. 2006;13(12):1275–9.
Blaivas M, Brannam L, Fernandez E. Short- axis versus long-axis approaches for teaching ultrasound- guided vascular access on a new inanimate model. Acad Emerg Med. 2003;10:1307–11.
Stone MB, Moon C, Sutijono D, Blaivas M. Needle tip visualization during ultrasound-guided vascular access: short-axis vs long-axis approach. Am J Emerg Med. 2010;28:343–7.
Edanaga M, Mimura M, Azumaguchi T, et al. Comparison of ultrasound-guided and blindly placed radial artery catheterization. Masui. 2012;61:221–4.
Moon CH, Blehar D, Shear MA, et al. Incidence of posterior vessel wall puncture during ultrasound-guided vessel cannulation in a simulated model. Acad Emerg Med. 2010;17:1138–41.
Chittoodan S, Breen D, O’Donnell BD, et al. Long versus short axis ultrasound guided approach for internal jugular vein cannulation: a prospective randomized controlled trial. Med Ultrasound. 2011;13:21–5.
Carmona Monge FJ, Martínez Lareo M, Núñez Reiz A. Ultrasound guided radial artery cannulation: procedure description and literature review. Enferm Intensiva. 2011;22:144–9.
Sandhu NS. Use of ultrasonography as a rescue technique for failed radial artery cannulation. J Clin Anesth. 2004;18:138–41.
Nifong TP, Mc Devitt TJ. The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheter. Chest. 2011;140:48–53.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Berk, D., Gurkan, Y., Kus, A. et al. Ultrasound-guided radial arterial cannulation: long axis/in-plane versus short axis/out-of-plane approaches?. J Clin Monit Comput 27, 319–324 (2013). https://doi.org/10.1007/s10877-013-9437-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10877-013-9437-6