Ultrasound in emergency medicine
Ultrasound-Guided Radial Artery Catheterization and the Modified Allen's Test

https://doi.org/10.1016/j.jemermed.2008.03.005Get rights and content

Abstract

In this case report, ultrasound-guided radial artery catheterization and a modified Allen's test were performed by Emergency Department (ED) physicians to facilitate the management of an intubated, critically injured patient. Ultrasound was demonstrated to be a valuable tool in determining collateral circulation and guiding radial artery cannulation in a patient unable to cooperate with the traditional Allen's test. Ultrasound guidance may reduce the risk of radial artery catheterization in severely injured patients.

Introduction

The radial artery is frequently catheterized in the Emergency Department (ED) for arterial pressure monitoring, blood gas sampling, and repetitive blood draws for critically ill or injured patients. It is not unusual for patients to transition from stable to critical status during an ED course, and accurate hemodynamic assessment of critical patients is facilitated by radial artery catheterization for arterial pressure monitoring (1, 2). The Allen's test and its modifications have been the standard for assessing collateral blood flow to the hand before radial artery catheterization. The traditional Allen's test is of limited value in critical patients who are unable to cooperate with the examination. This case reports the successful use of B-mode ultrasound to perform radial artery catheterization under direct visualization, and the use of Pulse Wave (PW) Doppler to perform a modified Allen's test to assess radial artery patency in a critically injured, intubated, and sedated patient. Increased use of ultrasonography in the ED may significantly reduce the risk of complications from radial artery catheterization as it has in other vascular access procedures.

Section snippets

Case Report

This case involves a 14-year-old boy brought to the ED after a delivery truck vs. pedestrian accident. The patient was critically injured when he was dragged several yards and run over while attempting to obtain a sports drink from the back of the truck. The driver pulled away, and the patient became entangled in the undercarriage of the vehicle. The patient was brought to the ED with a Glasgow Coma Scale score of 15, spinal precautions, and two large-bore antecubital intravenous catheters. On

Radial Arterial Catheterization

The radial artery is used for a variety of procedures. In the ED, radial artery catheterization is utilized for the management of critical patients for arterial blood gas sampling, continual arterial pressure monitoring as a component of early goal-directed therapy in the treatment of patients with severe sepsis and in hemodynamically unstable patients in general (3). For cardiothoracic surgeons, the radial artery is a popular conduit for coronary artery bypass grafting (4, 5, 6, 7, 8).

Conclusion

This case study reports the successful use of PW Doppler and B-mode ultrasonography by Emergency Physicians to facilitate cannulation of the radial artery and to perform a modified Allen's test and guide management of a severely injured, intubated, and sedated patient. Ultrasonography is a valuable adjunct in the management of critical patients that may reduce the risk of radial artery cannulation.

Acknowledgments

The authors would like to acknowledge SonoSite, Inc. (Bothell, WA) for lending the ultrasound machine used in this case to the Alameda County Medical Center Department of Emergency Medicine.

References (28)

  • D. Hildick-Smith

    Use of the Allen's test and transradial catheterization

    J Am Coll Cardiol

    (2006)
  • B.M. Jones et al.

    Acute ischaemia of the hand resulting from elevation of a radial forearm flap

    Br J Plast Surg

    (1985)
  • H.B. Nguyen et al.

    Critical care in the emergency department: a physiologic assessment and outcome evaluation

    Acad Emerg Med

    (2000)
  • E. Rivers et al.

    Early goal-directed therapy in the treatment of severe sepsis and septic shock

    N Engl J Med

    (2001)

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