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Randomized Controlled Trial
. 2016 Jul 11;16(1):34.
doi: 10.1186/s12871-016-0202-5.

Effect of bevel direction on the success rate of ultrasound-guided radial arterial catheterization

Sung-Won Min  1 , Hyong-Rae Cho  2 , Young-Tae Jeon  3 , Ah-Young Oh  3 , Hee-Pyoung Park  4 , Chun Woo Yang  5 , Woo Hee Choi  5 , Byung-Gun Kim  6
Affiliations
Randomized Controlled Trial

Effect of bevel direction on the success rate of ultrasound-guided radial arterial catheterization

Sung-Won Min et al. BMC Anesthesiol. .

Abstract

Background: This study assessed the effect of bevel direction on the success rate of ultrasound guided radial artery catheterization.

Methods: A total of 204 patients requiring radial artery catheterization were randomly divided into bevel-up (n = 102) and bevel-down (n = 102) groups. Success rate, cannulation time, and number of attempts were compared groups.

Results: In the bevel-down group, an arterial line was placed on the first attempt in 86 of 102 (84.3 %; 95 % confidence interval [CI] = 76 % to 90 %) patients versus 73 of 102 (71.6 %; 95 % CI = 62.1 % to 79.4 %) in the bevel-up group (p = 0.028). In the bevel-down group, the mean time to a successful radial arterial cannulation was 33.3 ± 6.3 seconds (95 % CI = 32.1-34.6) versus 35.9 ± 7.6 seconds (95 % CI = 34.4-37.2) in the bevel-up group (p = 0.011). The median score was 33.2 and interquartile range [IQR] was 10.9 (30.3-41.2) for the mean cannulation time in the bevel-up group. In the bevel-down group, the mean score was 32.3 (IQR 3.90, 30-33.9) for mean cannulation time. In the bevel-down group, 11 of 102 (7 %; 95 % CI = 0 to 16 %) patients developed a posterior wall puncture versus 22 of 102 ((21.6 %; 95 % CI = 14.7 to 17.2 %) in the bevel-up group.

Conclusion: The bevel-down approach during ultrasound-guided radial artery catheterization exhibited a higher success with fewer complications compared to the bevel-up approach.

Trial registration: Clinical Research Information Service is Korean Clinical Trials Registry ( KCT0001836 ). It was registered retrospectively 30th Nov 2015.

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Figures

Fig. 1
Fig. 1
The puncture needle is inserted perpendicular to the transducer (left image) and appears on theultrasound screen (right image) as a dot within the lumen of the radial artery
Fig. 2
Fig. 2
Measurement of the depth from skin of radial artery on the frozen image in ultrasound
Fig. 3
Fig. 3
Measurement of the diameter of the radial artery on the frozen image in ultrasound
Fig. 4
Fig. 4
Image of a posterior wall hematoma. Left, pre-catheterization right, post-catheterization
Fig. 5
Fig. 5
Patient randomization and follow-up according to the CONSORT (Consolidated Standards of Reporting Trials) guidelines
See this image and copyright information in PMC

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