Ultrasound for Radial Arterial Line?
Do I really need to use an ultrasound for radial arterial lines? For years I have used ultrasound guidance for brachial and femoral arterial line placement because the risk associated with puncturing or lacerating a large end artery are great. However, it has always seemed like such a chore to find the ultrasound, position the machine in the room, apply the sterile sheath etc. all for a little radial arterial line. And I have always had success with radial arterial lines. Then I had a few misses: couldn’t get a flash, got a flash but couldn’t thread, threaded but no blood return. So after I reviewed a few articles including a metaanalysis that showed improved first attempt success rates using ultrasound, I decided to give it a try. I now use the ultrasound every time I place a radial arterial line. I use a longitudinal approach in which I visualize the needle, then the guide wire then the catheter as they puncture and cannulate the vessel. I have yet to fail using this technique, and learned a few things as well. For example, did you know that you can puncture the radial artery and not get a flash? On several occasions I have watched the needle into the vessels, seen no blood in the flash chamber, successfully threaded the catheter and obtained pulsatile blood with an arterial waveform. I wonder how many times I punctured (or lacerated) the radial artery using a blind technique but did not attempt to thread the catheter because did not obtain a flash. Ultrasound adds a small amount of preparation time to radial arterial line insertion. When considering the increased success rate and safety, this is time well spent.
Ultrasound-guided arterial line catheterization in the critically il: technique and review. J Vasc Access. 2010 Apr-Jun;11(2):106-11.
A prospective comparison of ultrasound-guided and blindly placed radial arterial catheters. Acad Emerg Med. 2006 Dec;13(12):1275-9.