A randomized comparison of ultrasound guided versus direct palpation method of radial artery cannulation techniques in adult patients under-going open heart surgery. | [Anaesthesia, Pain and Intensive Care • 2016]

Author(s):

1. Amina Nasreen: National Institute of Cardiovascular Diseases, Rafiqui Shaheed Road, Karachi, Pakistan

2. Amin M. Khuwajal: National Institute of Cardiovascular Diseases, Rafiqui Shaheed Road, Karachi, Pakistan

3. Parveen Akhtar: National Institute of Cardiovascular Diseases, Rafiqui Shaheed Road, Karachi, Pakistan

4. Najma Amjad: National Institute of Cardiovascular Diseases, Rafiqui Shaheed Road, Karachi, Pakistan

5. Zahid Akhtar Rao: Bahria University Medical & Dental College, Karachi, Pakistan

Abstract:

Background & Objective: The use of two dimensional ultrasound techniques allows radial artery cannulation to take place under real time visualization and may increase the success rate of first time pass of the needle and reduce the complications of the invasive procedure compared to traditional palpation and trial method. We aimed to compare the success rate of radial arterial catheter insertion at first attempt and average time for successful first attempt by traditional palpation method with ultrasound guided technique in adult patients undergoing open heart surgery. Methodology: A randomized study was conducted at our hospital during a 12 months period from 1st January 2014 to 31st December 2014. After taking permission from hospital ethical committee, one hundred adult patients were enrolled in whom radial artery cannulation was required prior to open heart surgical procedures including CABG, valvular heart disease, atrial septal and ventricular septal defect repairs and total correction. Patients were divided in two equal groups. In Group I radial artery cannulation was performed by ultrasound guidance and in Group II it was done by palpation method; in both groups Seldinger technique was used. Demographic and medical data were recorded in both groups. Heart rate, and invasive blood pressure monitoring was done in the arm in which the catheter was going to be inserted. Allen test with the help of pulse oximeter was also per-formed in all patients for detecting adequacy of ulnar artery flow. Time to first successful cannulation and the number of attempts were noted. Computer software SPSS 19.0 was used for data statistical analysis, the Chi-square/Fisher`s exact test used for the comparison of qualitative/categorical variable in between groups. Student`s t-test used for comparison of quantitative / continuous variables in between groups. Results: Average time to first successful attempt was 72.4 ± 23.0 sec vs. 94.6 ± 13.7 sec in Group I and II respectively (p=0.001). Average number of attempts at same radial artery was significantly less in ultrasound group (1.4 ± 1.0) as compared to palpation group (2.0 ± 0.7) (p=0.001). Ultrasound group (Group 1) had successful insertion at the first attempt in 36 (72%) patients, as compared to 32 (64%) patients in (Group II), but the difference was statistically not significant (p = 0.391). Conclusion: Average time for successful first attempt was significantly less for radial artery cannulation performed by two dimensional ultrasound guidance as compared to palpation method; however, it did not significantly increase the success rate of first time cannulation of radial artery.

Page(s): 38-42

DOI: DOI not available

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 20, Issue: 1, Year: 2016

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