DRA vs PRA for US-guided Radial Artery Catheterization in ICU

Study Overview
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Brief Summary
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Patients were randomly divided into two groups: ultrasound-guided (US-guided) in-plane distal radial access (IP-DRA) and in-plane proximal radial access (IP-PRA) catheterization. For IP-DRA , a linear transducer is placed in the radial fossa, which is known as the snuff-box. After obtaining a long-axis view of the radial artery ,the needle is inserted in the midpoint of the small footprint transducer. Then,the needle is advanced under real-time US guidance until visualizing the tip of the needle inside the artery . For IP-PRA , a linear transducer is placed in the standard conventional forearm radial. After obtaining a long-axis view of the radial artery ,the needle is inserted in the midpoint of the small footprint transducer. Then,the needle is advanced under real-time US guidance until visualizing the tip of the needle inside the artery .

Detailed Description
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*Ultrasound-guided catheterization of the radial artery, by proximal approach: Patient's hand in hyperextension with slight dorsiflexion of the wrist. The placement of the ultrasound probe initially linear in order to obtain the short axis image of the artery; then a quarter turn until obtaining a longitudinal long axis view. The operator must identify the artery using the pulsed wave Doppler; Insertion of the needle in the middle of the transducer providing an in plane orientation. Thus the needle was advanced slowly and its tip was visualized throughout the procedure. *Ultrasound-guided catheterization of the radial artery, by distal approach: If the right hand is along the body / if the left hand is on the trunk. The ultrasound probe placed at the level of the anatomical snuffbox by placing the transducer in a linear fashion then rotated coronally until a longitudinal image is obtained *In the 2 groups: - The longitudinal in plane approach is used - After visualization of the penetration of the bevel of the needle into the lumen of the artery and the jet of arterial blood into the syringe on aspiration, a flexible metal guide was introduced into the artery through the trocar according to the Seldinger's method. - The correct positioning of the guide in the artery was then confirmed by ultrasound. Any obstacle preventing insertion of the guide system always led to a new puncture.

Official Title
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Comparaison Between Ultrasound-guided Distal and Proximal Approaches for Radial Artery Catheterization in Intensive Care Unit

Conditions
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Ultrasonography

Intervention / Treatment
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* Procedure: IP-DRA vs IP- PRA


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients admitted in intensive care unit requiring a central venous catheter (CVC) Exclusion Criteria: Patients with radial AV shunt for hemodialysis Patients with Renaud phenomenon or lymphedema Congenital or acquired deformity of arms Cannulation site infection, hematoma and surgery

Ages Eligible for Study
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Minimum Age: 15 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

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: IP-DRA<br>In plane distal radial artery catherterization | Procedure: IP-DRA vs IP- PRA<br>* Catetherization approach in plane : distal radial artery VS proximal radial artery<br>|
| Other: IP-PRA<br>In plane proximal radial artery catherterization | Procedure: IP-DRA vs IP- PRA<br>* Catetherization approach in plane : distal radial artery VS proximal radial artery<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The overall access time | Time from the ultrasound scanning to the ultrasound confirmation of the correct position of the guidewire . | During the cannulation procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 2. Puncture Attempts | Which is the number of puncture attempts from first one until the successful one | During the procedure | 
| 3. The guidewire time | Time from the first skin puncture to the ultrasound confirmation of the correct placement of the guidewire | during the procedure | 
| 4. The access time | time between the first skin puncture and the jet of arterial blood | during the procedure | 
| 5. Rare complications | Pseudo-aneurysm, AV fistula formation, radial artery dissection, which are assessed by Doppler US. In addition to radial artery eversion or perforation. | After 01 weeks of the procedure. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Catheter, radial artery