Optimal wrist position for long and short axis ultrasound guided radial artery cannulation

The radial artery is the most common site for arterial cannulation. Procedures for improving radial artery cannulation have involved direct visualization of the vessel with ultrasonography (US). The aim of this study evaluate the short axis and long axis radial artery measurements at 0º, 45º, 60º wrist joint angle and find out the optimal wrist joint angle for long and short axis US guided radial artery cannulation.

This study was approved by the Institutional Ethical Committee and the study was performed in accordance with the ethical principles for human investigations, as outlined by the Second Declaration of Helsinki. One hundred fifty-two (90 men and 62 women, 18-48 years of age, mean age: 32.9 ± 6.1) healthy volunteers were recruited. The radial artery distance between skin and height, width, area in short axis and radial artery distance between skin and height was measured in long axis at 0º, 45º, 60º wrist joint angle were measured. Results. Short axis radial artery distance between skin, width, height, area and long axis radial artery distance between skin, height were statistically significantly different among 0º, 45º, 60º (p< 0.05; for all comparisons). Short axis width was statistically significantly increased at 45º compared to at 0º (p< 0.001;). Short axis radial artery distance between skin and height at 45º were statistically significantly decreased than at 0º (p< 0.001; for all comparisons) and long axis skin distance and height at 45º were also statistically significantly decreased than at 0º (p< 0.001; for both comparisons). Short axis radial artery skin distance and area at 60º is statistically significantly decreased than at 45º (p< 0.001; for both comparisons) and also long axis height of radial artery at 60º is statistically significantly decreased than at 45º (p< 0.001;).

Angle increment up to 45º might help clinicians for radial artery cannulation in short axis plane whereas this angle increment maneuver decreased the arterial height in long axis which might be a potential disadvantage for cannulation.