Conventional vs Ultrasound Guided Arteria Cannulation.

Study Overview
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Brief Summary
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The aim of the project is to compare two methods for arterial cannulation. The traditional method with ultrasound guided cannulation. The investigators goal is to improve this procedure to reduce pain and complications.

Detailed Description
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The practice of placing vascular catheters is used many times every day at almost every hospital. It is a safe procedure which generally does not imply problems. Though the procedural optimum aren't reached. The procedure still fails some times and induce complications. When the catheter is placed using the traditional method the pulse is palpated by the operator's fingers. This is only to be done near the hand wrist. In this position the catheter steadiness is fragile but because the pulse can't be sensed more proximal the operator is forced to choose this position. This it though a problem that can be solved by non invasive visualization technology. Ultrasound-guidance for central vascular access is already well-established. However, in recent years ultrasound-guidance for peripheral vascular access has gained popularity too. The evidence of multiple studies demonstrates increased success rate and reduced complication rate with ultrasound compared to blind landmark technique for vascular catheter placement. In recent years there have been both procedural technique and technology improvements in the field of ultrasound. This has led to the improvement of procedural catheterisation techniques that now can be done by novices with higher attempt success rate than traditional method. One technique that is gaining success is the short-axis-out-of-plane technique (SAX-OOP) with dynamic-needle-tip-tracking (DNTT).Using the ultrasound machine the needle can be placed in a more proximal direction on the forearm and the investigators believe that by the help of the exposed procedure on the monitor many complications can be reduced. It has been shown that inexperienced trainees lear the technique SAX-OOP and DNTT very quickly. First investigators hypothesize that the number of attempts, the number of withdrawals, the time spend and the number of utilized catheters will be decreased using ultrasound vs. the traditional method. Secondly investigators hypothesize that the pain induced by the conventional method inclusive preoperational lidocaine injection will be the same or more intense than using DNTT with local anesthesia. Thirdly investigators claim that the best anatomical place to put the catheter isn't always corresponding with the spot chosen by palpation, which increase the number of failures. Fourthly investigators hypothesize that the use of ultrasound will increase the operator's subjective feeling of having accomplished a successful procedure.

Official Title
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Conventional vs Ultrasound Guided Arteria Cannulation

Conditions
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Disorder of Cardiac Function

Intervention / Treatment
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* Procedure: Traditional palpation technique
* Procedure: Ultrasound DNTP


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 20-90 years Fulfill the criteria of an operation Routine need of an arterial needle Exclusion Criteria: Lack of patient consent Ultrasound identified plaques in the radial artery or ultrasound verified compromised flow in either the radial or ulnar artery.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Ultrasound DNTP<br>the catheter will be placed using ultrasound and DNTT and Lidocaine as local anesthesia, by the same fellow as the one who performs the puncture with the traditional method | Procedure: Traditional palpation technique<br> <br> Procedure: Ultrasound DNTP<br> <br> |
| Active Comparator: Traditional palpation technique<br>arteria cannulation by traditional palpation technique, using preprocedural lidocaine for anesthetic and palpation method by a fellow | Procedure: Traditional palpation technique<br> <br> Procedure: Ultrasound DNTP<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Attempts | The number of attempts (skin punctures) per catheterization | 1 hour | 
| Withdrawals | The number of withdrawals of the guide-needle per catheterization | 1 hour | 
| Time consume | The time spend for the catheterization procedure | minutes | 
| Catheters | The number of utilized catheters | 1 hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain | The pain induced by the conventional method inclusive preoperational lidocaine injection will be the same or more intense than using DNTT with local anesthesia measured on a VAS-score. | momentan | 
| Ease of method for the operator | The use of ultrasound will increase the operator's subjective feeling of having accomplished a successful procedure on a Likert scale. | momentan |