Ultrasound-guided vs. palpation-guided techniques for radial artery catherisation in infants

Edition:

Jeong J. Min et al. Eur J Anaesthesiol 2019; 36:200-205

Summary

Randomised controlled trial
74 infants under 12 months of age, undergoing elective cardiac surgery allocated to either ultrasound-guided using short-axis view group (group US) or palpation-guided group (group P) (each n=37) for radial artery catherisation
Procedure performed by one of two anaesthetists (each had more than 2 years of experience in paediatric cardiac anaesthesia and done at least 50 cases US-guided radial arterial catherisation in paediatric patients prior to the study)
In both groups each patient had an US examination of their radial artery at proposed puncture site in short-axis (out-of-plane) view & video-recorded for analysis of arterial characteristics prior to insertion attempt.
In both groups, either an anterior puncture technique or posterior puncture (transfixion) technique were used.
Where catherisation failed within 10 mins of starting the procedure, study protocol was discontinued and total procedural time was recorded as 600 secs

Results

Primary end point was first-pass success: higher in group US (68%) vs group P (38%) P=0.019
Number of attempts until successful catherisation: less attempts in group US (median 1 [IQR 1-2]) than in group P (median 2 [IQR 1-4]) P=0.023
Median procedural time until successful catherisation: no significant difference in between 2 groups – group US 102 secs [IQR 49-394], group P 218 secs [73-600] P=0.054
In group US of the 12 patients that had a failed 1st pass attempt, the patients tended to be younger (median 0 months [IQR 0-1]) and smaller (median 3.5kg [IQR 3.0-4.4])
Posterior puncture technique was used more by the operators (86% vs 14%) but the puncture technique rates were comparable in the 2 groups (group US 89% vs group P 84% P=0.74)

Take Home Message

In an experienced operators hands, use of ultrasound increased the first pass success rate for arterial line insertion and decreased the number of attempts until successful insertion compared to a palpation technique in infants less than 12 months.
These findings are similar to previous studies with older children as subjects.
Smaller and younger infants tend to be more difficult to put arterial lines in.

Reviewed by: Dr Pip Lane