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A1237
October 12, 2013
11:00:00 AM - 12:00:00 PM
Room Room 104-Area D
A Novel Method for Ultrasound Guided Radial Arterial Catheterization in Pediatric Patients
Yoshinobu Nakayama, M.D., Yasufumi Nakajima, M.D.,Ph.D., Daniel I. Sessler, M.D., Jun Takeshita, M.D., Satoru Ogawa, M.D., Masayuki Shibasaki, M.D.,Ph.D., Toshiki Mizobe, M.D.,Ph.D.
Kyoto Prefectural University of Medicine, Kyoto, Japan
Background

Ultrasound-guided radial arterial catheterization in pediatric patient remains poorly validated. We therefore assessed factors affecting catheterization and tested an intervention designed to improve its

success.

Methods

For initial assessment, we performed multiple logistic regression analyses using 102 pediatric patients. Dependent variables included first attempt and overall success or failure, and insertion time; independent variables were systolic blood pressure, weight, sex, American Society of Anesthesiologists Physical Status, cyanosis, trisomy 21, arterial diameter, and subcutaneous depth of the radial artery (<2, 2-4, ≥4 mm) . The effect of subcutaneous arterial depth on cannulation success was assessed using univariate Kaplan-Meier curves. We then assessed catheterization success in 40 patients who were randomized to no treatment or subcutaneous saline injection, as necessary, to increase the subcutaneous arterial depth to 2-4 mm.

Results

Subcutaneous arterial depth of 2-4 mm was a significant predictor of overall success (odds ratio (OR) = 6.4, p = 0.001) and first-attempt success (OR = 6.2, p < 0.001). Among the 3 depth ranges, only the 2-4 mm group had a significantly greater success rate and shorter catheterization time (Fig.1). Injecting subcutaneous saline to bring arterial depth to 2-4 mm (Fig.2) significantly improved the success rate and shortened catheterization time (Fig.3).

Conclusions

An artery location depth of 2-4 mm resulted in the fastest and most reliable ultrasound-guided radial artery catheterization in pediatric patients. For arteries located <2 mm below the skin surface, increasing the depth by

subcutaneous saline injection reduced catheterization time and improved the success rate.





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