Prospective Comparison of Ultrasound-Guided Versus Palpation Techniques for Arterial Line Placement by Residents in a Teaching Institution

Arterial line insertion is traditionally done by blind palpation. Residents may need multiple attempts for successful insertion, leading to longer procedure times and many failed attempts. We hypothesized that ultrasound guidance (USG) would be faster and more successful than traditional blind palpa...

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Bibliographic Details
Published in:Journal of graduate medical education 2019-04, Vol.11 (2), p.177-181
Main Authors: Yeap, Yar Luan, Wolfe, John W, Stewart, Jennifer, Backfish, Kevin M
Format: Article
Language:English
Subjects:
Adult
Anesthesiology - education
Anesthesiology - methods
Catheterization, Peripheral - methods
Female
Hospitals, Teaching
Humans
Internship and Residency - methods
Male
Original Research
Palpation - methods
Prospective Studies
Radial Artery
Ultrasonography, Interventional - methods
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Summary:Arterial line insertion is traditionally done by blind palpation. Residents may need multiple attempts for successful insertion, leading to longer procedure times and many failed attempts. We hypothesized that ultrasound guidance (USG) would be faster and more successful than traditional blind palpation (TBP) for radial artery line placement by residents. Patients undergoing elective surgery requiring a radial arterial line were randomized to either the USG or TBP groups. Exclusion criteria included a need for arterial line placement in an awake patient, emergent surgery, or American Society of Anesthesiologists (ASA) physical status class VI. After the induction of anesthesia, a postgraduate year 3 (PGY-3) or PGY-4 anesthesia resident placed an arterial line by either USG or TBP. A total of 412 patients and 85 of 106 residents (80%) in the training program were included. The 2 groups were similar with respect to sex, weight, height, ASA class, baseline systolic blood pressure, and baseline heart rate. USG was faster than TBP (mean times 171.1 ± 16.7 seconds versus 243.6 ± 23.5 seconds,  = .012), required fewer attempts (mean 1.78 ± 0.11 versus 2.48 ± 0.15,  = .035), and had an improved success rate (96% versus 90%,  = .012). We found that residents using USG in an academic institution resulted in significantly faster placement of the arterial lines, fewer attempts, and fewer catheters used.
ISSN:1949-8349
1949-8357
DOI:10.4300/JGME-D-18-00592.1