Cannulation of the radial artery with three dimensional biplanar versus conventional two dimensional ultrasound guidance

Rationale: Arterial cannulation for continuous invasive blood pressure monitoring and blood sampling is a standard procedure for patients undergoing major abdominal or cardiothoracic surgery. Traditionally performed by digital palpation, ultrasound (US) is increasingly used for this procedure. However, US guidance marginally increases success rates for this procedure. As US techniques can be performed in short or long axis, both approaches have their shortcomings. Using three dimensional biplanar US, both short and long axis views can be displayed simultaneously. We hypothesize the additional information of the anatomical site will improve radial artery cannulation success rate.

Objective: Compare performance of radial artery catheterization using three dimensional biplanar ultrasound guidance versus conventional two dimensional US

Study design: Prospective randomized controlled trial

Study population: Adult patients >18 years, requiring scheduled cardiothoracic surgery for which radial artery catheterization is required

Intervention: Radial artery cannulation using three dimensional biplanar US guidance

Main study parameters/endpoints: First pass success rate, scan time, needling time, procedure time, number of skin punctures, number of needle redirections, complications including posterior wall puncture, and hematoma, needle visibility, operator satisfaction

3D guided arterial cannulation increases first pass success rate and decreases punctures

February 2022: analysis of primary and secondary endpoints,The primary endpoint, first pass success, will be compared between the group where 3D US is used, compared to the 2D US group, using a chi square test. Regarding secondary study parameters, for continuous variables, distribution of data will be assessed for normality. If a normal distribution is found, a parametric t-test will be used. If the data is not normally distributed, a mann whitney u test will be used. Categorical data will be analysed using a chi squared test. Fisher’s exact test will be used for data with small sample sizes.