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Ultrasound-image Guided Versus Doppler Guided Versus Palpation Technique for Arterial Cannulation in Adults

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Kenichi Ueda, University of Iowa
ClinicalTrials.gov Identifier:
NCT01276171
First received: January 11, 2011
Last updated: April 10, 2017
Last verified: April 2017
  Purpose
Radial arterial cannulation is a common invasive procedure for real-time measurement of arterial blood pressure. Placement of the arterial catheter using conventional palpation is often relatively easy and quick, but this is not always true. A relatively new method for direct visualization of the artery is the use of two-dimensional ultrasound. This technique allows cannulation of the artery to take place under real-time visualization and may increase the success rate of first time pass of the needle. Another technique utilizing Doppler has also proven to be effective in cannulating the radial artery. This technique utilizes changes in acoustic pitch as the probe passes directly over the artery. The primary objective of this study is to compare the first attempt success rate for radial artery cannulation among the palpation, Doppler and U/S guided technique when applied by trainees. Secondary outcomes include: success rate within 5 minutes, successful, number of attempts required, and correlation between success rate and operator experience for successful cannulation of the radial artery.

Condition Intervention
Anesthesia Procedure: Ultrasound Procedure: Doppler Procedure: Palpation

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Ultrasound-image Guided Versus Doppler Guided Versus Palpation Technique for Arterial Cannulation in Adults

Resource links provided by NLM:


Further study details as provided by Kenichi Ueda, University of Iowa:

Primary Outcome Measures:
  • First Attempt Success Rate With 3 Different Technique [ Time Frame: 5 minutes ]
    The primary objective of this study is to compare the first attempt success rate for radial artery cannulation between the palpation, Doppler and U/S guided technique when applied by anesthesia trainees. Secondary outcomes include: success rate within 5 minutes, time to successful cannulation compared with three different techniques.


Secondary Outcome Measures:
  • Time to Successful Cannulation [ Time Frame: 5 minutes ]
  • Total Success Rate [ Time Frame: 5 min ]

Enrollment: 749
Study Start Date: February 2010
Study Completion Date: April 2015
Primary Completion Date: December 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Ultrasound
Participants will place arterial line using ultrasound technique
Procedure: Ultrasound
Participants will place arterial line using ultrasound technique
Active Comparator: Doppler
Participants will place arterial line using doppler technique
Procedure: Doppler
Participants will place arterial line using doppler technique
Active Comparator: Palpation
Participants will place arterial line using palpation technique
Procedure: Palpation
Participants will place arterial line using Palpation technique

Detailed Description:

Radial artery cannulation is a common invasive procedure in the operating room, intensive care unit and emergency department. It allows continuous hemodynamic monitoring and repeated arterial blood sampling. Although severe complications are rare, successful radial artery cannulation can be technically challenging, particularly in hypotensive patients and those with vascular disease. Multiple unsuccessful attempts at arterial cannulation increase patient discomfort, delay timely care and may also contribute to adverse events such as arterial spasm or local hematoma.

The radial artery is traditionally located by palpation. A number of techniques to aid radial artery localization have been described. Doppler-assisted radial arterial cannulation was first described in 1976. Several case reports suggest that Doppler can be helpful in patients with difficult arterial access. More recently, ultrasound-guided radial artery cannulation has been described. In a recent meta-analysis of four randomized controlled trials, ultrasound increased the rate of cannulation on the first attempt by 71% compared with palpation. However, two of the studies were of children and all four were small, with 30-152 participants (311 in total), making the generalizability of these results to adult patients uncertain. Furthermore, variation in the training and experience of the operators was evident within one of the studies.

Accordingly, the aim of this study is to compare three different radial arterial cannulation techniques in adult surgical patients when performed by anesthesia residents: Doppler; palpation; and ultrasound. We think that ultrasound would have a higher rate of cannulation on the first attempt compared with other techniques.

  Eligibility

Ages Eligible for Study:   18 Years to 99 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Main OR patients at UIHC who require arterial catheter placement for surgery

Exclusion Criteria:

  • The patients who will be excluded from the study include those who have had arterial cannulation in the previous month, infections at site of insertion, and AV shunts in upper extremity.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01276171

Locations
United States, Iowa
University of Iowa Hospitals and Clinics
Iowa City, Iowa, United States, 52242
Sponsors and Collaborators
University of Iowa
Investigators
Principal Investigator: Kenichi Ueda, MD University of Iowa
  More Information

Responsible Party: Kenichi Ueda, Clinical Associate Professor, University of Iowa
ClinicalTrials.gov Identifier: NCT01276171     History of Changes
Other Study ID Numbers: 201001776
Study First Received: January 11, 2011
Results First Received: January 12, 2017
Last Updated: April 10, 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: We are not planning on sharing IPD.

ClinicalTrials.gov processed this record on September 21, 2017