Ultrasound Guided Versus Landmark Guided Arterial Line Placement by Emergency Medicine Interns

Not Applicable

Completed

• Conditions: Vascular Access Complication
• Interventions: Procedure: Arterial Line Placement

• Registration Number: NCT03326739
• Lead Sponsor: Temple University

Brief Summary

Critically ill patients in the emergency department commonly require arterial line placement for continuous direct blood pressure monitoring, frequent arterial blood gas sampling, and frequent blood sampling. Trans-radial catheterization has been shown to reduce access site complications and increase patient comfort compared to trans-femoral access. Radial artery access on the first attempt is optimal; attempts at reentry delay care and increase the risk of vascular spasm, hematoma, infection, neurovascular injury, and pain. The traditional pulse palpation method of radial artery cannulation can be challenging, especially in patients with weak pulses (i.e. morbidly obese or hypotensive individuals).

A review of literature suggests that ultrasound guided trans-radial catheterization compared to standard pulse palpation reduces access time and increases rate of first-entry success when performed by physicians trained in ultrasound. Thus, complications ascribed to reentry are prevented and timely care is provided.

To the investigator's knowledge, only one other prospective study has been conducted to assess the utility of ultrasound guided radial artery cannulation in the emergency department. Due to the paucity of literature to support the use of ultrasound guided trans-radial catheterization in critically ill patients, the study will aim to provide further data on the topic. Both techniques are considered standard of care.

Detailed Description

Patients presenting to the Emergency Department 18 years old or greater, who do not belong to a vulnerable group, requiring arterial line placement will be included in this trial. The investigators will randomize each patient into LM vs US. Data collected will include number of attempts, success rate, and time for procedure to be completed. PGY-1 residents will perform the arterial line placement.

Study Timeline

• Study Start: 2017-01-01
• Study First Submitted: 2017-10-17
• Study First Submitted QC: 2017-10-27
• Study First Posted: 2017-10-31
• Primary Completion: 2019-12-31
• Study Completion: 2019-12-31
• Status Verified: 2020-01
• Last Update Submitted: 2020-01-20
• Last Update Posted: 2020-01-22

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 40

Inclusion Criteria

• Patients requiring arterial line placement.

Exclusion Criteria

• Adults Unable to Consent
• Members of Vulnerable Populations

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Ultrasound Guided A-Line Placement	Arterial Line Placement	Patients in this group will have ultrasound guided arterial line placement.
Landmark Guided A-line Placement	Arterial Line Placement	Patients in this group will have landmark guided arterial line placement.

Primary Outcome Measures

Name	Time	Method
Superiority of Method of arterial line placement	1 day	Number of attempts until successful cannulation.

Secondary Outcome Measures

Name	Time	Method
Success of method	1 day	Completion of arterial line placement after three attempts

Trial Locations

Locations (1)

Lewis Katz School of Medicine at Temple University; 🇺🇸 Philadelphia, Pennsylvania, United States