Ultrasound-guided Versus Direct Palpation Radial Artery Catheter Insertion Among Cardiac Anesthesiologists

Not Applicable

Completed

Interventions: Device: Direct Palpation-guided Radial Artery Catheter insertion
Device: Ultrasound-guided Radial Artery Catheter Insertion

Brief Summary: When a patient undergoes heart surgery, their Anesthesiologist will insert a tiny plastic tube, called a catheter, in the artery of the patient's wrist. This is called a radial artery catheter. A radial artery catheter allows accurate measurement of the patient's blood pressure during surgery. There are two common techniques for placing the radial artery catheter. The first is a "blind" technique whereby the Anesthesiologist feels for the pulse in the patient's wrist and places the catheter using the location of the pulse as a guide. The second technique, less commonly used, is one whereby the Anesthesiologist uses an ultrasound machine (painless to the patient) to "see" the artery, and thereby uses the ultrasound to guide the catheter placement. Our study will test the hypothesis that ultrasound-guided radial artery catheterization will have faster insertion times, with fewer complications compared with palpation-guided insertion.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Suspected inability to comply with study procedures, including language difficulties or medical history and/or concomitant disease, as judged by the investigator
Previous surgery at the site of proposed radial artery catheterization
Any vascular condition that may preclude eligibility for radial artery line insertion as judged by the investigator
Patients with ventricular assist devices
Previous inclusion in this study

Arm && Interventions

Group	Intervention	Description
direct palpation	Direct Palpation-guided Radial Artery Catheter insertion	Radial artery catheter insertion will be conducted by direct palpation and use of anatomic knowledge by the Anesthesiologist.
Ultrasound	Ultrasound-guided Radial Artery Catheter Insertion	Radial artery catheter insertion will be conducted by ultrasound guidance. A Sono-site ilook 25 Ultrasound (Sono-site, Inc., Bothell, WA, USA) with a 10-5 MHz linear array ultrasound transducer will be used. At the discretion on the Anesthesiologist, an out-of-plane (i.e. needle plane at right angles to ultrasound plane) will be used. Colour flow doppler may also be used to identify the artery if necessary.

Primary Outcome Measures

Name	Time	Method
Time to Successful Radial Arterial Catheterization	up to 5 minutes	The time to successful radial arterial catheterization was defined as time zero to time of placement. Time zero for the DP group began when the anesthesiologist's fingers were placed on the patient with the purpose of palpating the artery. Time zero for the US group began when the US transducer was first placed on the patient's skin for the purpose of identifying the radial artery. Time to placement was defined as the interval from time zero until the time at which an arterial tracing was viewed on the monitor.

Secondary Outcome Measures

Name	Time	Method
Number of Attempts	up to 5 minutes	An attempt was defined as a new purposeful penetration of the skin with the needle (i.e., following complete withdrawal of the needle from the skin).
Complication Rate (Hematoma)	up to 5 minutes	A hematoma was defined a collection of blood or formation of a bruise surrounding the site of radial artery catheterization
Number of Re-directions	up to 5 minutes	A re-direct was defined as the needle being purposefully withdrawn at least 5 mm and re-directed (but not removed from the skin entirely).

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