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Randomized Controlled Trial
. 2020 Sep 14;20(1):231.
doi: 10.1186/s12871-020-01152-1.

Dynamic needle tip positioning versus the angle-distance technique for ultrasound-guided radial artery cannulation in adults: a randomized controlled trial

Bing Bai  1 , Yuan Tian  1 , Yuelun Zhang  2 , Chunhua Yu  3 , Yuguang Huang  1
Affiliations
Randomized Controlled Trial

Dynamic needle tip positioning versus the angle-distance technique for ultrasound-guided radial artery cannulation in adults: a randomized controlled trial

Bing Bai et al. BMC Anesthesiol. .

Abstract

Background: Ultrasound guidance can increase the success rate and reduce the incidence of complications of arterial cannulation. There are few studies on the utility of the dynamic needle tip positioning (DNTP) technique versus the angle-distance (AD) technique for ultrasound-guided radial arterial cannulation in adult surgical patients. We assessed and compared the success rates and incidences of complications of these two short-axis out-of-plane techniques.

Methods: A total of 131 adult surgical patients were randomized into DNTP and AD groups to undergo ultrasound-guided radial artery cannulation. The primary outcome was first-pass success without posterior wall puncture. The secondary outcomes included the first-pass success rate, 10-min overall success rate, cannulation time, posterior wall puncture, and the number of skin punctures.

Results: The first-pass success rates without posterior wall puncture were 53.8% in the DNTP group and 44.6% in the AD group (RR = 1.22, 95% CI: 0.86-1.72; P = 0.26). The cannulation time was significantly longer (P = 0.01) in the DNTP group [79.65 (54.3-109.4) seconds] than in the AD group [47.6 (24.9-103.8) seconds]. The posterior wall puncture rate was significantly lower (P = 0.002) in the DNTP group (29.2%) than in the AD group (56.1%; RR = 0.56, 95% CI: 0.42-0.82).

Conclusions: There were no significant differences in the first-pass success rate, with or without arterial posterior wall puncture, or in the 10-min overall success rate between the DNTP and AD groups. However, the cannulation time was longer and the posterior wall puncture rate was lower in the DNTP group.

Trial registration: The trial was registered at www.clinicaltrials.gov (No: NCT03656978 ). Registered 4 September 2018.

Keywords: Catheterization; Radial artery; Ultrasonography.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram
Fig. 2
Fig. 2
Diagrams showing how to advance the needle into the radial artery using the DNTP technique. a, Obtain an image of the target artery and adjust the insertion point and orientation of the needle. b, Puncture the target artery, and observe the needle in the artery lumen. c, Advance the ultrasound probe away from the needle until the hyperechoic needle is no longer observed. d, Advance the needle and catheter until the very tip is seen again, and repeat these steps until the tip is observed in the artery lumen
Fig. 3
Fig. 3
Insertion point and orientation of the needle when using the AD technique
See this image and copyright information in PMC

References

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