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Ultrasound-guided vs. palpation-guided techniques for radial arterial catheterisation in infants

A randomised controlled trial

Min, Jeong J.*; Tay, Chee K.*; Gil, Nam-Su*; Lee, Jong-Hwan; Kim, Sojin; Kim, Chung S.; Yang, Ji-Hyuk; Jun, Tae-Gook

European Journal of Anaesthesiology (EJA): March 2019 - Volume 36 - Issue 3 - p 200–205
doi: 10.1097/EJA.0000000000000926
Paediatric anaesthesia

BACKGROUND The usefulness of ultrasound-guided techniques for radial arterial catheterisation has been well identified; however, its usefulness has not been completely evaluated in infants under 12 months of age, who are generally considered the most difficult group for arterial catheterisation.

OBJECTIVE We evaluated whether ultrasound guidance would improve success rates and reduce the number of attempts at radial arterial catheterisation in infants.

DESIGN A randomised, controlled and patient-blinded study.

SETTING Single-centre trial, study period from June 2016 to February 2017.

PATIENTS Seventy-four infants undergoing elective cardiac surgery.

INTERVENTION Patients were allocated randomly into either ultrasound-guided group (group US) or palpation-guided group (group P) (each n=37) according to the technique applied for radial arterial catheterisation. All arterial catheterisations were performed by one of two experienced anaesthesiologists based on group assignment and were recorded on video.

MAIN OUTCOME MEASURES The primary endpoint was the first-pass success. The number of attempts and total duration of the procedure until successful catheterisation were also analysed.

RESULTS The first-pass success rate was significantly higher in the group US than in the group P (68 vs. 38%, P = 0.019). In addition, fewer attempts were needed for successful catheterisation in the group US than in the group P (median 1 [IQR 1 to 2] vs. 2 [1 to 4], P = 0.023). However, the median [IQR] procedural time (s) until successful catheterisation in the two groups was not significantly different (102 [49 to 394] vs. 218 [73 to 600], P = 0.054).

CONCLUSION The current study demonstrated that the ultrasound-guided technique for radial arterial catheterisation in infants effectively improved first-pass success rate and also reduced the number of attempts required.

TRIAL REGISTRATION ClinicalTrials.gov NCT02795468.

From the Department of Anaesthesiology and Pain Medicine (JJM, N-SG, J-HL, SK, CSK), Department of Thoracic and Cardiovascular Surgery (J-HY, T-GJ), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea and Department of Respiratory and Critical Care, Singapore General Hospital, Singapore (CKT)

Correspondence to Jong-Hwan Lee, MD, PhD, Associate Professor, Department of Anaesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea Tel: +82 2 3410 1928; fax: +82 2 3410 0361; e-mail: jonghwanlee75@gmail.com

Published online 13 November 2018

© 2019 European Society of Anaesthesiology