Efficacy of ultrasound-guided technique for radial artery catheterization in pediatric populations: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: The use of an ultrasound-guided technique for radial arterial catheterization has not been well established in pediatric patients. We conducted a systematic review and meta-analysis to evaluate the efficacy of the ultrasound-guided technique for radial artery catheterization in pediatric populations. Method: A systematic review of PubMed, Medline, Embase, and the Cochrane library was performed from their date of inception to December 2019. In this meta-analysis, we conducted online searches using the search terms "ultrasonography," "ultrasonics," "ultrasound-guided," "ultrasound," "radial artery," "radial arterial," "catheter," "cannula," and "catheterization." The rate of the first-attempt and total success, mean attempts to success, mean time to success, and incidence of complications (hematomas) were extracted. Data analysis was performed with RevMan 5.3.5. Results: From 7 relevant studies, 558 radial artery catheterizations were enrolled, including 274 ultrasound-guided and 284 palpation catheterizations. The ultrasound-guided technique could significantly improve the rate of firstattempt and total success (RR 1.78, 95% CI 1.46 to 2.18, P < 0.00001; RR 1.33; 95% CI 1.20 to 1.48; P < 0.00001). However, there was significant heterogeneity for the total success rate among the included studies (I 2 = 67%). The ultrasound-guided radial artery catheterization was also associated with less mean attempts and mean time to success (WMD − 1.13, 95% CI − 1.58 to − 0.69; WMD − 72.97 s, 95% CI − 134.41 to − 11.52) and lower incidence of the hematomas (RR 0.17, 95% CI 0.07 to 0.41). Conclusions: The use of the ultrasound-guided technique could improve the success rate of radial arterial catheterization and reduce the incidence of hematomas in pediatric patients. However, the results should be interpreted cautiously due to the heterogeneity among the studies.

Modified Long-Axis In-plane Technique for Radial Artery Cannulation in Children: A Randomized Controlled Trial

“…Moreover, it is convenient to draw arterial blood for blood gas analysis. In the pediatric population, radial artery catheterization is a challenge for anesthetists due to the smaller diameter of the vessel ( 2 , 3 ). Even for the skilled operators, it may cause vasospasm or hematoma at multiple attempts, thus significantly reducing the success rate of cannulation ( 4 ).…”

Comparison of the Success Rate of Radial Arterial Cannulation with Palpation Techniques and Ultrasound Guidance in Patients Undergoing Major Surgery with General Anesthesia

“…This can be caused by the position of the radial artery puncture that is not optimal by the needle tip, anatomical variations in the radial artery, and vasospasm during the puncture. [16][17][18] The palpation technique is quite good in identifying and confirming puncture of the radial artery by the cannula needle. The success of the puncture can be seen from the backflow of blood seen in the catheter needle tube.…”

A Randomized Controlled Trial of Radial Artery Cannulation Guided by Modified Long Axis Ultrasound Versus Short Axis Ultrasound Versus Palpation

“…Minimal experience with US guidance may have prevented operators from realizing their full bene t [30]. For cases with di cult cannulation, operator experience in using ultrasound-guided techniques plays a key role in successful arterial cannulation, especially for novices who need a procedure with a learning curve [16,31].…”