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A novel method for ultrasound-guided radial artery cannulation in neonates by trainee anaesthesiologists

A randomised controlled trial

Ye, Ping; Tan, Yanzhe; Ye, Mao; Li, Shangyingying; Bai, Lin; Liu, Lifei

doi: 10.1097/EJA.0000000000001089
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BACKGROUND The modified dynamic needle tip positioning (MDNTP) technique for ultrasound-guided radial artery cannulation (MDNTP-US technique) in neonates can be technically challenging for trainee anaesthesiologists. We hypothesised that by associating the MDNTP-US technique with hypodermic 0.9% sodium chloride (Saline MDNTP-US technique), which increases the subcutaneous radial artery depth, the procedure would become easier for trainee anaesthesiologists.

OBJECTIVE To compare the Saline MDNTP-US technique, with the MDNTP-US technique for radial artery catheterisation in neonates by trainee anaesthesiologists with limited experience.

DESIGN Randomised controlled trial.

PATIENTS Ninety-six neonates scheduled to undergo major abdominal surgery requiring continuous arterial pressure monitoring between May 2018 and December 2018 at the Children's Hospital of Chongqing Medical University were enrolled. Neonates with signs of skin erosions or haematomas at or near the insertion site, as well as those with low noninvasive blood pressure values, were excluded.

INTERVENTION Neonates were randomised to the Saline MDNTP-US and MDNTP-US groups in a 1 : 1 ratio. Twelve trainees performed the cannulation procedures.

MAIN OUTCOME MEASURES Duration of procedure, first attempt success rate, rate of success within 10 min, and the incidence of haematoma and thrombosis.

RESULTS The median [IQR] time to perform cannulation was less for the Saline MDNTP-US technique than for the MDNTP-US technique: 203 [160 to 600] vs. 600 s [220 to 600]; P = 0.005. The rate of success within 10 min, 72.9 vs. 47.9%; P = 0.012, was higher in the Saline MDNTP-US group than in the MDNTP-US group. The incidence of haematoma on postoperative day 1 was lower in the Saline MDNTP-US group than in the MDNTP-US group: 8.3 vs. 22.9%; P = 0.049.

CONCLUSION Trainee anaesthesiologists can achieve higher success rates by using the Saline MDNTP-US technique instead of the MDNTP-US technique for radial artery catheterisation in neonates, taking less time with a lower incidence of complications.

TRIAL REGISTRATION ChiCTR-IOR-17014119 (Chinese Clinical Trial Registry).

From the Department of Anesthesiology, Children's Hospital of Chongqing Medical University (PY, YT, MY, SL, LB, LL), Ministry of Education Key Laboratory of Child Development and Disorders (PY, YT), Chongqing Key Laboratory of Paediatrics (PY, SL) and Chongqing International Science and Technology Cooperation Centre for Child Development and Disorders, Chongqing, PR China (PY, LB)

Correspondence to Dr Lifei Liu, Department of Anesthesiology, Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yu Zhong District, Chongqing 400014, PR China Tel: +86 18996218065; fax: +86 2363632143; e-mail: lifeiliu@hospital.cqmu.edu.cn

© 2019 European Society of Anaesthesiology