Please select the eligibility criteria that correspond 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: Inclusion Criteria:

* American Society of Anesthesiologists 1, 2, 3 BMI ≥ 30 bariatic surgery

Exclusion Criteria:

* refusal infection or surgery history in wrist
B: Inclusion Criteria:

* All surgical intensive care unit patients at Yale New Haven Hospital in whom the indication for arterial catheterization has been established by the attending physician will be eligible for consented randomization to either the "Palpation" or the "Ultrasound" group.

Exclusion Criteria:

* The patient or his/her surrogate declines to participate or the patient lacks a radial artery into which a catheter can be place.
C: Inclusion Criteria:

* The patient must have given his/her informed and signed consent
* The patient must be insured or beneficiary of a health insurance plan
* The patient's health status necessitates an arterial blood sample AND his/her radial arteries are deemed unpalpable OR two previous attempts at radial arterial puncture by a nurse resulted in failure

Exclusion Criteria:

* The patient is participating in another study
* The patient is in an exclusion period determined by a previous study
* The patient is under judicial protection, or any kind of guardianship
* The patient refuses to sign the consent
* It is impossible to correctly inform the patient
* The patient is pregnant, parturient, or breastfeeding
* Arterial puncture is required on femoral, humeral or axillary arteries
* The patient is in cardiac arrest
* The patient has known circulatory problems, ischemia, local infection
* The patient has a severe bleeding or hemostasis disorder (hemophilia, hypoprothrombinemia, platelets \<50,000)
* The patient is an upper limb amputee, or his/her arm is in a cast
* The patient has known allergies to methyl or propylbenzoate, propylene glycol or chlorexhidine gluconate
D: Inclusion Criteria:

* Age over 18 years;
* Hospitalization in resuscitation;
* Necessity of installation of an arterial catheter
* Signed informed consent.
* Affiliation to a social security scheme

Exclusion Criteria:

* Patient under tutorship or curatorship
* Minor Patient

Answer: B