Novel techniques for increasing the size of the radial artery during ultrasound-guided cannulation

Kelsheimer, Bradley; Maheshwari, Praveen

doi:10.1007/s12630-015-0545-2

Cited by 6 publications

(4 citation statements)

References 2 publications

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“…A similar technique of distal obstruction to increase the radial artery size has been described. 5 The second maneuver involves occlusion of the contralateral IJV by an assistant applying gentle pressure ( Figure E). We hypothesize that the increase in diameter of the ipsilateral IJV ( Figure F) is due to obstruction of the outflow of the contralateral IJV, leading to back pressure and increased flow through the unobstructed IJV.…”

Section: To the Editormentioning

confidence: 99%

Novel maneuvers to increase the internal jugular vein diameter during ultrasound-guided cannulation

Kelsheimer

Maheshwari

2016

Can J Anesth/J Can Anesth

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Central venous catheterization is routinely performed during the perioperative period. Ultrasound (US)-guided catheterization has been recommended to increase the success rate while decreasing the time to cannulation and the complication rate of internal jugular vein (IJV) cannulation. 1 Despite the potential benefits of using US to guide IJV cannulation, it is often reserved for difficult situations when the traditional anatomical landmark-based technique is unsuccessful. However, strongly worded recommendations have prompted the increased availability of US equipment for this purpose, and its utility as a first choice ''go to'' method is gaining popularity. 2 Even with US, however, cannulation of the IJV can be challenging in patients with hypovolemia, an unstable cervical spine, a short thick neck, increased intracranial pressure, end-stage renal disease, previous IJV cannulations, and/or intraluminal obstruction. Techniques previously suggested to increase the diameter of the IJV, improve the cannulation success rate, and minimize complications include passive leg elevation, application of positive end-expiratory pressure, the Valsalva maneuver, and Trendelenburg positioning. 3 We suggest two novel occlusive techniques to increase the IJV diameter that may be helpful when conventional methods have failed.The spontaneously breathing patient is placed in the supine position with head turned away from the side of the cannulation. A pre-procedural US examination of the neck is then performed to locate the optimal site for IJV cannulation. Considerations include the location of the carotid artery and its distance from the IJV, IJV size, and luminal occlusion or obstruction. Additionally, the patency of the infraclavicular portion of the IJV and superior vena cava may be assessed by maneuvering the US probe toward the thoracic cavity at the superior end of the clavicle. 4 Once the optimal cannulation site is located, the US probe is then placed in a perpendicular position over the IJV ( Figure A) to obtain a short axis image ( Figure B).The first maneuver involves holding the US probe to obtain a short axis view of the IJV while an assistant applies gentle pressure to occlude the IJV at the superior end of the clavicle and inferior to the scanning plane ( Figure C). Pressure should be applied with just enough force to occlude the IJV lumen, which can be confirmed by sliding the US probe inferiorly. The increased IJV diameter-due to obstruction of the outflow of the IJV, leading to increased back pressure and subsequent IJV enlargement-is typically observed within a few seconds ( Figure D). A similar technique of distal obstruction to increase the radial artery size has been described. 5 The second maneuver involves occlusion of the contralateral IJV by an assistant applying gentle pressure ( Figure E). We hypothesize that the increase in diameter of the ipsilateral IJV ( Figure F) is due to obstruction of the outflow of the contralateral IJV, leading to back pressure and increased flow through the unobstructed IJV...

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Section: To the Editormentioning

confidence: 99%

Novel maneuvers to increase the internal jugular vein diameter during ultrasound-guided cannulation

Kelsheimer

Maheshwari

2016

Can J Anesth/J Can Anesth

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“…However, in some patients the convergence time needs to be extended for difficult catheterization, and this delays the surgery procedure. In recent years, several studies have suggested that ultrasonography-guided radial artery catheterization can increase the first-attempt success rate for cannula insertion while decreasing the total procedure duration and the incidence of complications attributable to cannulation in adult patients, particularly in extremely challenging patients and neonates [4–12]. However, some authors have raised concerns regarding the benefits of the ultrasonography-guided technique in radial artery cannulation and the potential increase in risk of infection at the puncture site [13].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Artery Cannulation Technique Versus Palpation Technique in Adult Patients in Pre-Anesthesia Room: A Randomized Controlled Trial

Xue-ying

Fang

et al. 2019

Med Sci Monit

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BackgroundThe ultrasonography-guided technique is superior to the traditional palpation technique for artery cannulation. However, considering the complexity of assembling the ultrasonography machine, this technique has not been extensively used. Here, we compared the ultrasonography-guided technique with the traditional palpation technique in adult patients in the pre-anesthesia room.Material/MethodsA total of 66 patients were enrolled and divided into 2 groups: the ultrasonography group and the palpation group. Anesthesiologists then cannulated the radial artery via either method. The primary outcomes included the first-attempt success and total success rates, as well as the cannulation duration and total procedure duration. The secondary outcome was the rate of complications attributable to cannulation.ResultsOverall, 60 patients were analyzed in the present study. The first-attempt success rate in the ultrasonography group (96.6%) was significantly higher than that in the palpation group (73.3%; P=0.03). There was no significant difference in the cannulation duration and the total procedure duration between the 2 groups. The rate of complications caused by cannulation in 2 groups was similar.ConclusionsThe ultrasonography-guided radial artery cannulation technique is more efficient for arterial cannulation in the pre-anesthesia room compared with the traditional palpation method.

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“…It should be noted that we added ''and arterial catheters'' to the first sentence. The rationale for the change is that ultrasound may be useful for placing arterial catheters 5 but also other central venous catheters. Therefore, ultrasound should available when needed.…”

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confidence: 99%

“…» Il convient de noter que nous avons ajouté « et [cathéters] artériels » à la première phrase. La justification de cette modification est que l'échoguidage peut être utile pour le positionnement des cathéters artériels, 5 mais également pour d'autres cathéters veineux centraux. Ainsi, l'échoguidage devrait être disponible au besoin.…”

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Special announcement: Guidelines to the Practice of Anesthesia – Revised Edition 2017

Dobson¹

2016

Can J Anesth/J Can Anesth

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Novel techniques for increasing the size of the radial artery during ultrasound-guided cannulation

Cited by 6 publications

References 2 publications

Novel maneuvers to increase the internal jugular vein diameter during ultrasound-guided cannulation

Novel maneuvers to increase the internal jugular vein diameter during ultrasound-guided cannulation

Ultrasound-Guided Artery Cannulation Technique Versus Palpation Technique in Adult Patients in Pre-Anesthesia Room: A Randomized Controlled Trial

Special announcement: Guidelines to the Practice of Anesthesia – Revised Edition 2017

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