DRA vs PRA for US-guided Radial Artery Catheterization in ICU
Study Details
Study Description
Brief Summary
Patients were randomly divided into two groups: ultrasound-guided (US-guided) in-plane distal radial access (IP-DRA) and in-plane proximal radial access (IP-PRA) catheterization.
For IP-DRA , a linear transducer is placed in the radial fossa, which is known as the snuff-box. After obtaining a long-axis view of the radial artery ,the needle is inserted in the midpoint of the small footprint transducer. Then,the needle is advanced under real-time US guidance until visualizing the tip of the needle inside the artery .
For IP-PRA , a linear transducer is placed in the standard conventional forearm radial.
After obtaining a long-axis view of the radial artery ,the needle is inserted in the midpoint of the small footprint transducer. Then,the needle is advanced under real-time US guidance until visualizing the tip of the needle inside the artery .
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
*Ultrasound-guided catheterization of the radial artery, by proximal approach:
-
Patient's hand in hyperextension with slight dorsiflexion of the wrist.
-
The placement of the ultrasound probe initially linear in order to obtain the "short axis" image of the artery; then a quarter turn until obtaining a longitudinal "long axis" view.
-
The operator must identify the artery using the pulsed wave Doppler;
-
Insertion of the needle in the middle of the transducer providing an "in plane" orientation. Thus the needle was advanced slowly and its tip was visualized throughout the procedure. *Ultrasound-guided catheterization of the radial artery, by distal approach:
-
If the right hand is along the body / if the left hand is on the trunk.
-
The ultrasound probe placed at the level of the anatomical snuffbox by placing the transducer in a linear fashion then rotated coronally until a longitudinal image is obtained *In the 2 groups: - The longitudinal "in plane" approach is used - After visualization of the penetration of the bevel of the needle into the lumen of the artery and the jet of arterial blood into the syringe on aspiration, a flexible metal guide was introduced into the artery through the trocar according to the Seldinger's method. - The correct positioning of the guide in the artery was then confirmed by ultrasound. Any obstacle preventing insertion of the guide system always led to a new puncture.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Other: IP-DRA In plane distal radial artery catherterization |
Procedure: IP-DRA vs IP- PRA
Catetherization approach in plane : distal radial artery VS proximal radial artery
|
| Other: IP-PRA In plane proximal radial artery catherterization |
Procedure: IP-DRA vs IP- PRA
Catetherization approach in plane : distal radial artery VS proximal radial artery
|
Outcome Measures
Primary Outcome Measures
- The overall access time [During the cannulation procedure]
Time from the ultrasound scanning to the ultrasound confirmation of the correct position of the guidewire .
Secondary Outcome Measures
- 2. Puncture Attempts [During the procedure]
Which is the number of puncture attempts from first one until the successful one
- 3. The guidewire time [during the procedure]
Time from the first skin puncture to the ultrasound confirmation of the correct placement of the guidewire
- 4. The access time [during the procedure]
time between the first skin puncture and the jet of arterial blood
- 5. Rare complications [After 01 weeks of the procedure.]
Pseudo-aneurysm, AV fistula formation, radial artery dissection, which are assessed by Doppler US. In addition to radial artery eversion or perforation.
Eligibility Criteria
Criteria
Inclusion Criteria:
- Patients admitted in intensive care unit requiring a central venous catheter (CVC)
Exclusion Criteria:
-
Patients with radial AV shunt for hemodialysis
-
Patients with Renaud phenomenon or lymphedema
-
Congenital or acquired deformity of arms
-
Cannulation site infection, hematoma and surgery
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Mrezga Nabeul Tunisie | Nabeul | Tunisia | 8000 |
Sponsors and Collaborators
- University Tunis El Manar
Investigators
- Study Chair: Mechaal Ben Ali, Professor, University Tunis El Manar
Study Documents (Full-Text)
None provided.More Information
Publications
- Deepika K, Palaniappan D, Fuhrman T, Saltzmanm B. Anatomic snuffbox radial artery cannulation. Anesth Analg. 2010 Oct;111(4):1078-9. doi: 10.1213/ANE.0b013e3181ef343a.
- Hansen MA, Juhl-Olsen P, Thorn S, Frederiksen CA, Sloth E. Ultrasonography-guided radial artery catheterization is superior compared with the traditional palpation technique: a prospective, randomized, blinded, crossover study. Acta Anaesthesiol Scand. 2014 Apr;58(4):446-52. doi: 10.1111/aas.12299. Epub 2014 Mar 3.
- Kiemeneij F. Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI). EuroIntervention. 2017 Sep 20;13(7):851-857. doi: 10.4244/EIJ-D-17-00079.
- Kucuk A, Yuce HH, Yalcin F, Boyacı FN, Yıldız S, Yalcin S. Forty-five degree wrist angulation is optimal for ultrasound guided long axis radial artery cannulation in patients over 60 years old: a randomized study. J Clin Monit Comput. 2014 Dec;28(6):567-72. doi: 10.1007/s10877-014-9552-z. Epub 2014 Jan 11.
- Sethi S, Maitra S, Saini V, Samra T, Malhotra SK. Comparison of short-axis out-of-plane versus long-axis in-plane ultrasound-guided radial arterial cannulation in adult patients: a randomized controlled trial. J Anesth. 2017 Feb;31(1):89-94. doi: 10.1007/s00540-016-2270-6. Epub 2016 Oct 19.
- DRA UTRAC