Comparaison Between Ultrasound-guided Distal and Proximal Approaches for Radial Artery Catheterization in Intensive Care Unit
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Ultrasonography
- Sponsor
- University Tunis El Manar
- Enrollment
- 94
- Locations
- 1
- Primary Endpoint
- The overall access time
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
Patients were randomly divided into two groups: ultrasound-guided (US-guided) in-plane distal radial access (IP-DRA) and in-plane proximal radial access (IP-PRA) catheterization.
For IP-DRA , a linear transducer is placed in the radial fossa, which is known as the snuff-box. After obtaining a long-axis view of the radial artery ,the needle is inserted in the midpoint of the small footprint transducer. Then,the needle is advanced under real-time US guidance until visualizing the tip of the needle inside the artery .
For IP-PRA , a linear transducer is placed in the standard conventional forearm radial.
After obtaining a long-axis view of the radial artery ,the needle is inserted in the midpoint of the small footprint transducer. Then,the needle is advanced under real-time US guidance until visualizing the tip of the needle inside the artery .
Detailed Description
\*Ultrasound-guided catheterization of the radial artery, by proximal approach: * Patient's hand in hyperextension with slight dorsiflexion of the wrist. * The placement of the ultrasound probe initially linear in order to obtain the "short axis" image of the artery; then a quarter turn until obtaining a longitudinal "long axis" view. * The operator must identify the artery using the pulsed wave Doppler; * Insertion of the needle in the middle of the transducer providing an "in plane" orientation. Thus the needle was advanced slowly and its tip was visualized throughout the procedure. \*Ultrasound-guided catheterization of the radial artery, by distal approach: * If the right hand is along the body / if the left hand is on the trunk. * The ultrasound probe placed at the level of the anatomical snuffbox by placing the transducer in a linear fashion then rotated coronally until a longitudinal image is obtained \*In the 2 groups: - The longitudinal "in plane" approach is used - After visualization of the penetration of the bevel of the needle into the lumen of the artery and the jet of arterial blood into the syringe on aspiration, a flexible metal guide was introduced into the artery through the trocar according to the Seldinger's method. - The correct positioning of the guide in the artery was then confirmed by ultrasound. Any obstacle preventing insertion of the guide system always led to a new puncture.
Investigators
Trabelsi Becem
associate professor
University Tunis El Manar
Eligibility Criteria
Inclusion Criteria
- •Patients admitted in intensive care unit requiring a central venous catheter (CVC)
Exclusion Criteria
- •Patients with radial AV shunt for hemodialysis
- •Patients with Renaud phenomenon or lymphedema
- •Congenital or acquired deformity of arms
- •Cannulation site infection, hematoma and surgery
Outcomes
Primary Outcomes
The overall access time
Time Frame: During the cannulation procedure
Time from the ultrasound scanning to the ultrasound confirmation of the correct position of the guidewire .
Secondary Outcomes
- 5. Rare complications(After 01 weeks of the procedure.)
- 2. Puncture Attempts(During the procedure)
- 3. The guidewire time(during the procedure)
- 4. The access time(during the procedure)