Use of Ultrasound in arterial line insertion
Date First Published:
March 4, 2009
Last Updated:
July 20, 2010
Report by:
Farhat Rasheed, SpR Emergency Medicine (St. George's Hospital )
Search checked by:
Thiagarajan Jaiganesh ; Olu Fayomi , St. George's Hospital
Three-Part Question:
In patients requiring [arterial line insertion] does[the use of ultrasound ] when compared to the manual palpation method lead to [improved success in catheter placement]?
Clinical Scenario:
A septic hypotensive patient required an arterial line for early goal directed therapy but bilateral radial pulses were weak and multiple attempts were unsuccessful. A radial artery catheter was eventually secured under ultrasound guidance.
Search Strategy:
Healthcare Database Advanced Search(NHS evidence) MEDLINE & EMBASE [(arter* ADJ cathet*).ti,ab OR (arter* ADJ cannula*).ti,ab] AND [exp (*ULTRASONOGRAPHY, INTERVENTIONAL/) OR (sonograph*.ti,ab) OR (doppler*.ti,ab)] [Limit to: Publication Year 1950-Current and Humans and English Language]
For EMBASE [exp (*ULTRASOUND) OR (sonograph*.ti,ab) OR (doppler*.ti,ab)] was used
For EMBASE [exp (*ULTRASOUND) OR (sonograph*.ti,ab) OR (doppler*.ti,ab)] was used
Search Details:
Further searches were done via the Cochrane Database ;Google Scholar. A hand search of papers was also conducted.
Outcome:
19 relevant papers were found. 13 were case series/case reports describing the use of ultrasound in arterial line insertion and 6 papers specifically compared the use of ultrasound with the manual palpation method.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Absence of efficacy of ultrasonic two-way Doppler flow detector in routine percutaneous arterial cannulation Tada T, Amagasa S et al 2003 Japan | 166 patients with a palpable radial artery(RA) pulse undergoing RA cannulation prior to elective surgery randomised to two groups 1.RA cannulated by using a doppler ultrasound detector (audio) to identify site and non touch insertion of catheter 2.RA cannulated by manual palpation method |
prospective; randomised; non blinded | success defined as cannulation at first attempt | no difference found between the two groups | small numbers of elective surgery patients in each group; no mention of blinding of data analysis |
| Use of Ultrasound guidance in the insertion of radial artery catheters Levin P, Sheinin O et al. 2003 Israel | 69 patients elective surgery patients underwent radial artery cannulation by anaesthetists either by manual palpation method or with the use of a 4MHz US transducer | prospective; randomised; non blinded | number of attempts | fewer attempts in US group (p=0.003) | small numbers; endpoint for failure not clear; crossover data between groups not included in analysis; level of experience with ultrasound not controlled for in operators |
| time for succesful attempts | longer in US group (p=0.001) | ||||
| success at first attempt | higher rate in US group (p=0.03) | ||||
| number of cannulae used | fewer cannulae used in US group (p=0.001) | ||||
| A randomized trial assessing the value of ultrasound-guided puncture of the femoral artery for interventional investigations Dudeck O, Teichgraeber U et al 2004 Germany | 112 patients undergoing femoral artery (FA) cannulation for angiography by 2 interventional radiologists divided into 2 groups-FA puncture via palpation method or with the use of 7.5MHz linear US probe on a mechanical swivel arm | prospective;randomised;non blinded | number of attempts for successful placement of catheter | no difference between groups | small numbers; equipment not generalisable to the emergency department |
| patients with leg circumference greater than 60cm at puncture site (n=23) | fewer attempts (p<0.001) and less time (p<0.04) in US group | ||||
| patients with weak arterial pulses (n=42) | fewer attempts(p<0.05) and less time( p<0.04) in US group | ||||
| complications | no difference between groups |
References:
- Tada T, Amagasa S et al. Absence of efficacy of ultrasonic two-way Doppler flow detector in routine percutaneous arterial cannulation
- Levin P, Sheinin O et al. . Use of Ultrasound guidance in the insertion of radial artery catheters
- Dudeck O, Teichgraeber U et al. A randomized trial assessing the value of ultrasound-guided puncture of the femoral artery for interventional investigations