Radial artery catheters are frequently placed in the emergency department (ED) and intensive care unit (ICU) for hemodynamic monitoring and arterial blood gas analysis. A number of small studies have compared ultrasound-guided placement of radial artery catheters to traditional placement via palpation. These authors conducted a meta-analysis of randomized, controlled trials comparing the two techniques to determine the relative success rates of first-attempt arterial cannulation.
Eleven trials involving 803 patients (502 adults in seven studies and 301 children in four) met the inclusion criteria. Ultrasound guidance was associated with a significantly higher rate of first-attempt success than palpation (relative risk, 1.47). This result held true in subgroup analyses of both adults and children. Notably, there was significant heterogeneity among studies in terms of care locations (ED vs. ICU), experience of operators, and ultrasound devices used.
I have been doing exclusively ultrasound-guided radial arterial lines for the past three years and no longer do I have to struggle placing lines in my patients in profound shock. There is a learning curve to master the technical aspects of the technique; however, it is well worth the effort.
