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Ultrasound-guided radial artery catheterization in infants and small children
Sachiyo Ishii1, Nobuaki Shime, Masayuki Shibasaki
1Department of Anesthesiology and Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Insights
Ultrasound guidance significantly improves success rates and reduces complications for radial artery catheterization in pediatric patients. This method is faster and more effective than traditional palpation techniques.
Area of Science:
- Pediatric Anesthesiology
- Vascular Access Procedures
- Medical Imaging Applications
Background:
- Radial artery catheterization is crucial for hemodynamic monitoring in pediatric cardiac surgery.
- Traditional palpation techniques have variable success rates and potential complications.
- Minimally invasive imaging guidance may enhance procedural outcomes.
Purpose of the Study:
- To evaluate the efficacy of ultrasound guidance versus palpation for radial artery catheterization in infants and children.
- To compare success rates, complication rates, and procedural time between the two techniques.
Main Methods:
- A randomized study was conducted at a single university-affiliated hospital.
- Infants and children (3-20 kg) undergoing cardiac surgery were included.
- Radial arteries were randomized to either ultrasound-guided or palpation-guided catheterization.
Main Results:
- Ultrasound guidance achieved significantly higher success rates: 76.3% on first attempt and 94.9% within three attempts, compared to 35.6% and 50.8% with palpation (p < 0.01).
- The median time to artery identification was shorter (18.5s vs 30s), and the number of attempts was fewer (1 vs 2) with ultrasound (p < 0.01).
- Complication rates, specifically hematomas, were significantly lower with ultrasound guidance (5.1% vs 25.4%, p < 0.01).
Conclusions:
- Ultrasound-guided radial artery catheterization is superior to palpation in infants and small children.
- This technique offers improved success rates, reduced complications, and enhanced efficiency.
Objective:
To determine whether ultrasound guidance increases the success rates, decreases the complication rates, and shortens the time to successful radial artery catheterization in infants and small children.
Design:
Randomized study.
Setting:
Single university-affiliated hospital.
Patients:
Infants and children weighing 3-20 kg, undergoing cardiac surgery for congenital heart disease.
Intervention:
We randomly assigned the right and left radial arteries of patients undergoing arterial catheterization to ultrasound-guided technique versus the usual palpation technique.
Measurements:
The primary study endpoints were the rates of successful cannulation at first and within three attempts. The secondary endpoints were time to radial artery identification, number of attempts for successful cannulation, and rate of complications.
Main Results:
Compared with palpation, ultrasound-guided radial artery catheterization was successful in 76.3% versus 35.6% of first attempts and in 94.9% versus 50.8% of arteries after three attempts (both comparisons, p < 0.01). The median time [interquartile range] to identification of the arteries (18.5 seconds [11.25-27.25] vs 30 seconds [17.75-39.5]) was significantly shorter (p < 0.01), the number of attempts [interquartile range] at successful cannulation (1 [1-1] vs 2 [1-2]) was significantly fewer (p < 0.01), and the proportion of hematomas (5.1% vs 25.4%) was significantly lower (p < 0.01) in the ultrasound group than those in the palpation group.
Conclusions:
In infants and small children, ultrasound-guided radial artery catheterization was more successful and expeditious than the usual palpation technique.
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