A Prospective Comparison of Ultrasound Guided and Blindly Placed Radial Arterial Catheters

• Published in: Academic emergency medicine 2007-01, Vol.14 (1), p.15
• Main Authors: Shiver, Stephen A, Blaivas, Michael, Lyon, Matthew
• Format: Article
• Language: English
• Subjects: Blood pressure; Catheters; Comparative analysis; Ultrasonic imaging; Veins & arteries
• ISSN: 1069-6563; 1553-2712

Arterial line placement for continuous blood pressure measurement and frequent arterial blood sampling are commonly required in critically ill patients. To compare ultrasound (US) guided versus traditional palpation placement of arterial lines for time to placement, number of attempts, sites used, cost, and complications. This was a prospective, randomized interventional study at a Level I academic urban ED with an annual census of 78,000. Power calculation revealed 30 patients in each group would be adequate to determine a 50% difference in time to placement. A random number generator placed patients into either the palpation or US guided groups. Entry criteria included any adult patient requiring an arterial line according to the treating attending. Patients who had previous attempts at an arterial line during the visit or could not be randomized due to time constraints were excluded. Enrollment was on a convenience basis, during hours worked by researchers over a six month period. Patients in either group who had three failed attempts were rescued with the other technique for patient comfort. The four study physicians each met ACEP criteria for US credentisding and were experienced in US guided peripheral and central venous line placement. None used US to place arterial lines prior to the study. Statistical analysis included Fischer's Exact, Mann-Whitney, and Student's t-test. Sixty patients were enrolled and 30 randomized to each group. Mean time for line placement in the US group was 72 sec vs. 314 sec for palpation (difference 242; p = 0.0001). Mean number of placement attempts in the US group was 1.2 vs. 2.2 in palpation (difference 1; p ... 0.001). Mean number of sites used for US was 1.1 vs. 1.6 palpation (difference 0.5; p = 0.001). Mean number of kits used for US was 1.1 vs. 1.8 palpation (difference 0.7; p = 0.001). Eleven (37%) in the palpation group required rescue with US but none in the US group required rescue. Half of all palpation group patients developed a hematoma versus two US patients. The material cost for a successful US guided arterial line to the hospital was $9.35 vs. $15.30 for the palpation group. In this study ultrasound guidance for arterial line placement was successful more frequently, took less time, lead to fewer hematomas. and cost less per patient in supplies than for the traditional palpation method. (ProQuest Information and Learning: ... denotes formulae/symbols omitted.)