Use Ultrasound When Placing a Radial Artery Line

Published in Am J Emerg Med 2015 Jan 33:50

Authors: Gao Y-B et al.

In a meta-analysis, ultrasound guidance led to more successfully placed radial artery lines than palpation alone.

Radial artery catheters are frequently placed in the emergency department (ED) and intensive care unit (ICU) for hemodynamic monitoring and arterial blood gas analysis. A number of small studies have compared ultrasound-guided placement of radial artery catheters to traditional placement via palpation. These authors conducted a meta-analysis of randomized, controlled trials comparing the two techniques to determine the relative success rates of first-attempt arterial cannulation.

Eleven trials involving 803 patients (502 adults in seven studies and 301 children in four) met the inclusion criteria. Ultrasound guidance was associated with a significantly higher rate of first-attempt success than palpation (relative risk, 1.47). This result held true in subgroup analyses of both adults and children. Notably, there was significant heterogeneity among studies in terms of care locations (ED vs. ICU), experience of operators, and ultrasound devices used.

Comment

Limitations of the meta-analysis aside, the finding that ultrasound guidance was more effective than palpation for placement of radial artery lines make intuitive sense. Given that the use of ultrasound is now standard for placement of central venous lines, so too should it be for radial artery catheters.