Ultrasound-Guided Long-Axis Versus Short-Axis Femoral Artery Catheterization in Neonates and Infants Undergoing Cardiac Surgery: A Randomized Controlled Study

Abstract

Objective: The objective of the present study was to compare ultrasound-guided long-axis (LAX) and short-axis (SAX) femoral artery catheterization in neonates and infants undergoing cardiac surgery.

Design: A single-center, prospective, randomized, single-blinded, controlled study.

Setting: This study was conducted in the operating room and intensive care unit of the division of cardiac surgery, Mansoura University Children's Hospital, Egypt.

Participants: Ninety neonates and infants undergoing elective cardiac surgery were enrolled in this study and randomly allocated to ultrasound-guided LAX and SAX groups.

Interventions: Ultrasound-guided femoral artery catheterization was done using either LAX (in-plane) or SAX (out-of-plane) technique.

Measurements and main results: The primary outcome measure was the rate of a successful first puncture. The secondary outcome measures were the rates of mechanical complications, failure rate, time to a successful first, second, and third puncture, total time of catheterization, and imaging time. The first puncture success rate was significantly higher (p = 0.048) in the LAX group (34 of 41, 82.9%) than in the SAX group (25 of 41, 60.9%). The mean time to a successful first puncture was significantly shorter (p < 0.001) in the LAX group (153.1 ± 30.1 seconds) than in the SAX group (227.2 ± 48.8 seconds). The total catheterization time was significantly shorter in the LAX group than in the SAX group. There was no significant difference in the rate of complication.

Conclusion: With a single experienced operator performing the ultrasound-guided femoral artery cannulation, the LAX technique resulted in a higher first puncture success rate and shorter time to cannulation than the SAX technique.

Keywords: catheterization; femoral artery; infants; long axis; neonate; ultrasound.