Ultrasound Improves First-Attempt Success with Radial Arterial Line Placement

Published in Anaesthesia 2015 Apr 8

Authors: Ueda K et al.

In this randomized, controlled trial of surgery patients, first-attempt radial arterial line placement by anesthesiologists was more successful when guided by ultrasound than palpation or Doppler.

The radial artery is traditionally located by palpation, but this can be challenging in patients with hypotension, small-caliber vessels, or peripheral arterial disease. Multiple or prolonged attempts at cannulation can increase patient discomfort and contribute to vasospasm. Previous studies evaluating the efficacy of ultrasound-guided arterial line placement had small samples sizes or involved only children.

In this single-center study, 749 adult patients undergoing elective surgery were randomized to arterial line placement guided by palpation, Doppler, or bedside ultrasound. Participating anesthetist trainees had 1 to 4 years of experience and completed ultrasound and Doppler training on a radial artery simulator. The first-attempt success rate was significantly higher in the ultrasound arm than either the palpation or Doppler arms (53% vs. 39% and 39%). However, the overall success rate at 5 minutes was similar among groups.

Comment
Use of point-of-care ultrasound has been demonstrated to improve success rates and decrease complications in virtually all types of vascular access, and arterial line placement is no different (NEJM Journal Watch Emerg Med Feb 2015 and Am J Emerg Med 2015; 33:50). When available, point-of-care ultrasound should be used without exception.