Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Comparison of Ultrasound-guided Versus Blind Insertion of Radial Artery Catheters.
Brief Summary: Arterial catheterization is frequently performed on critically ill patients for invasive blood pressure monitoring and/or frequent blood draws, especially arterial blood gas analysis. The distal part of the radial artery (wrist) is the preferred access site.

The potential complications of the procedure are mostly minor and comprise temporary occlusion of the radial artery (RA), hematoma, local infection or bleeding from the puncture site. Major complications including vessel aneurysm or occlusion with threat to hand viability are rare.

The standard approach to catheterization is "blind" puncture of the RA while locating its pulse by palpation, followed by threading a 20 Gauge (20G) angio-catheter into the vessel. Alternatively ultrasound can be used to locate the vessel and guide needle insertion.

To our knowledge, four prospective randomized trials (PRT)5-8 comparing palpation with ultrasound-guided RA catheterization have been conducted so far and one meta-analysis looked at the pooled data obtained from these. The results showed that ultrasound guidance increased the first-attempt success rate at RA catheterization by 71% compared to palpation. The use of ultrasound also significantly reduced the time to successful catheterization, the number of punctures as well as the amount of catheters required per procedure.

None of the prior randomized trials has been conducted in an ICU setting and in three out of the four studies the arterial lines were placed in patients undergoing elective surgery. The investigators hypothesized that ultrasound could improve first attempt success rate while placing arterial catheters in an ICU setting. Ultrasound may also reduce total time to successful insertion and reduce complications.

The investigators plan to randomize patients to either a palpation technique or ultrasound guided catheter insertion and record the above outcomes.


Options:
A: Arm Label: Oblique; Type: EXPERIMENTAL; Interventions: Procedure: radial artery Catheterization | Arm Label: Transverse group; Type: ACTIVE_COMPARATOR; Interventions: Procedure: radial artery Catheterization | Arm Label: Longitudinal group; Type: ACTIVE_COMPARATOR; Interventions: Procedure: radial artery Catheterization | Intervention Type: PROCEDURE; Name: radial artery Catheterization; Assigned to Arm(s): Longitudinal group, Oblique, Transverse group
B: Arm Label: Seldinger; Type: EXPERIMENTAL; Interventions: Device: Ultrasound, Other: General anesthesia | Arm Label: Modified Seldinger; Type: EXPERIMENTAL; Interventions: Device: Ultrasound, Other: General anesthesia | Intervention Type: DEVICE; Name: Ultrasound; Assigned to Arm(s): Modified Seldinger, Seldinger | Intervention Type: OTHER; Name: General anesthesia; Assigned to Arm(s): Modified Seldinger, Seldinger
C: Arm Label: Distal radial artery access; Type: EXPERIMENTAL; Interventions: Procedure: Distal radial artery access | Arm Label: Proximal radial artery access; Type: ACTIVE_COMPARATOR; Interventions: Procedure: Proximal radial artery surgery | Intervention Type: PROCEDURE; Name: Distal radial artery access; Assigned to Arm(s): Distal radial artery access | Intervention Type: PROCEDURE; Name: Proximal radial artery surgery; Assigned to Arm(s): Proximal radial artery access
D: Arm Label: Ultrasound radial artery catheter; Type: EXPERIMENTAL; Interventions: Procedure: Ultrasound guided radial artery catheterization. | Arm Label: Palpation based artery catheterization; Type: ACTIVE_COMPARATOR; Interventions: Procedure: Blind insertion of radial artery catheterization | Intervention Type: PROCEDURE; Name: Ultrasound guided radial artery catheterization.; Assigned to Arm(s): Ultrasound radial artery catheter | Intervention Type: PROCEDURE; Name: Blind insertion of radial artery catheterization; Assigned to Arm(s): Palpation based artery catheterization

Answer: D