Ultrasound Guidance and Other Determinants of Successful Peripheral Artery Catheterization in Critically Ill Children. (Dodd)

Kantor DB, et al. Ultrasound Guidance and Other Determinants of Successful Peripheral Artery Catheterization in Critically Ill Children. Pediatr Crit Care Med. 2016 Dec;17(12):1124-1130.

OBJECTIVE: Peripheral arterial catheterization is a common invasive procedure performed in critically ill children. However, the benefits of using ultrasound guidance for this procedure in critically ill children, especially when used by inexperienced trainees, are unclear. Our aims were to evaluate whether the use of ultrasound guidance for the placement of radial arterial catheters reduced time and improved success when compared with the palpation method and also to determine patient and trainee variables that influence procedure outcomes. Finally, we evaluated whether adoption of ultrasound guidance among trainees comes at the expense of learning landmark-based methods.

DESIGN: Prospective observational cohort.

SETTING: University affiliated PICU.

PATIENTS: A total of 208 procedures performed by 45 trainees in 192 unique patients (1 mo to 20 yr old) were observed.

INTERVENTION: Implementation of ultrasound curriculum.

MEASUREMENTS AND MAIN RESULTS: The main outcome measures were time and number of attempts required for the procedure. Compared with palpation method, ultrasound guidance was associated with reduced procedure time (8.1 ± 5.2 min compared with 16.5 ± 8.8 min; p < 0.001), reduced number of attempts (3.1 ± 2.6 attempts compared with 6.9 ± 4.2 attempts; p < 0.001), and improved first attempt success rate (28% compared with 11%; p = 0.001) even after adjusting for key confounders in multivariate random effects models. The factors most likely to interfere with peripheral arterial catheterization are patient age, patient systolic blood pressure, patient body mass index, degree of fluid overload, and trainee months in fellowship. The use of ultrasound guidance mitigates the influence of each of these factors. We found no evidence that the adoption of ultrasound guidance by trainees is associated with reduced proficiency in landmark-based methods.

CONCLUSIONS: The use of ultrasound guidance by trainees for radial artery catheterization in critically ill children is associated with improved outcomes compared with the palpation method.

Ultrasound-guided radial artery catheterization in infants and small children. (Ruth)

Pediatr Crit Care Med. 2013 Apr 26. [Epub ahead of print] PMID: 23628835

OBJECTIVE: To determine whether ultrasound guidance increases the success rates, decreases the complication rates, and shortens the time to successful radial artery catheterization in infants and small children.

DESIGN: Randomized study.

SETTING: Single university-affiliated hospital.

PATIENTS: Infants and childrenweighing 3-20 kg, undergoing cardiac surgery for congenital heart disease.

INTERVENTION: We randomly assigned the right and left radial arteries of patients undergoing arterial catheterization to ultrasound-guidedtechnique versus the usual palpation technique.

MEASUREMENTS: The primary study endpoints were the rates of successful cannulation at first and within three attempts. The secondary endpoints were time to radial arteryidentification, number of attempts for successful cannulation, and rate of complications. MAIN

RESULTS: Compared with palpation, ultrasound-guided radial artery catheterization was successful in 76.3% versus 35.6% of first attempts and in 94.9% versus 50.8% of arteries after three attempts (both comparisons, p < 0.01). The median time [interquartile range] to identification of the arteries (18.5 seconds [11.25-27.25] vs 30 seconds [17.75-39.5]) was significantly shorter (p < 0.01), the number of attempts [interquartile range] at successful cannulation (1 [1-1] vs 2 [1-2]) was significantly fewer (p < 0.01), and the proportion of hematomas (5.1% vs 25.4%) was significantly lower (p < 0.01) in the ultrasound group than those in the palpation group.

CONCLUSIONS: In infants and small children, ultrasound-guided radial artery catheterization was more successful and expeditious than the usual palpation technique.

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