Related Experiment Video
Updated: Oct 1, 2026
Brachial Artery Catheterization in Swine
Published on: March 30, 2019
IBP-DISTAL protocol: distal vs radial access for invasive BP in critical care
Hongmei Liu1, Yuanyuan Zhao2, Meiqun Yu3
1Department of Nursing, The General Hospital of the Eighth Division, Shihezi People's Hospital, The Third Affiliated Hospital of Shihezi University Medical College, No. 411, West 1st Road, Shihezi City, Xinjiang Uyghur Autonomous Region, China. 1545907523@qq.com.
Aims:
To determine whether distal radial artery (dTRA) cannulation is non-inferior to conventional radial artery (TRA) cannulation for first-pass success and subsequent safety and accuracy of invasive blood pressure monitoring in awake, critically ill adults.
Design:
Prospective, multicenter, randomized, open-label, parallel-group, non-inferiority trial.
Methods:
The study will be conducted in three tertiary hospitals in northwestern China. Eligible patients (≥ 18 years old) requiring invasive arterial pressure monitoring, with palpable distal and proximal radial pulses and a negative modified Allen test, will be centrally randomized (1:1; stratified by previous ipsilateral intervention) to dTRA or TRA. Both groups will undergo blind puncture with a uniform 20 G catheter-over-needle system; ultrasound is reserved for rescue. Pre-procedure ultrasound maps vessel diameter, intima-media thickness and flow velocity.
Primary Endpoint:
one-time success rate of catheterization. Secondary endpoints: total cannulation time, crossover rate, 24 h and 30-day radial artery occlusion (RAO) by Doppler, local complications (EASY hematoma grade), BARC major bleeding (types 2, 3, 5), accidental dislodgment, pain (VAS 0-10), functional score (Barthel Index), and major adverse cardiovascular/cerebrovascular events during ICU stay. Target enrollment 204 (102 per arm) gives 85% power to demonstrate non-inferiority at one-sided α = 0.025, allowing 20% failure rate. All ultrasound assessments are performed by technicians blinded to allocation.
Discussion:
This nurse-led protocol reflects real-world Chinese practice (blind puncture, no ultrasound routine) while standardizing compression (≥ 5 min) and post-procedural care across centers. Results will clarify whether dTRA offers shorter hemostasis time, lower RAO and better comfort without compromising hemodynamic monitoring fidelity.
Impact:
If non-inferiority is confirmed, dTRA could become the preferred default access for invasive blood pressure monitoring in critical care, preserving future radial conduit and improving patient experience.
Trial Registration:
This study has been registered on Chinese Clinical Trial Registry (ChiCTR.org.cn) under the identifier ChiCTR2500101331 (Apr 23, 2025).
Related Concept Videos
01:11Assessment of radial pulse
The radial pulse, located at the wrist, is often the preferred site for assessing peripheral pulse because of its accessibility and dependability. The process of determining the radial pulse involves several steps:
01:21Sites for measuring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:25Assessment of apical radial pulse
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
Pre-Procedural Preparation
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...