Ultrasound Guided Arterial Line Placement in Long Axis Versus Short Axis in Pediatric Patients

NCT ID: NCT00859846

Last Updated: 2018-10-12

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 29 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2009-03-17
• Study Completion Date: 2018-09-25

Brief Summary

The use of ultrasound is becoming widespread to guide the placement of arterial lines for both vascular access and regional anesthesia in the field of anesthesia. Arterial line placement can be challenging, especially in the pediatric population. Frequently multiple attempts are required with relatively high failure rates. This can result in excessive needle punctures and extended OR times. A few studies have looked at the use of ultrasound to decrease OR time and increase success rates both in adult and pediatric populations. These studies compared the traditional palpation method with either short axis or long axis views of the vessel using ultrasound guidance. No study to date has compared short axis and long axis views for arterial line placement in either the pediatric or adult population. Our study compares success rates and OR times when long and short axis methods of arterial line insertion are employed in the pediatric population.

Detailed Description

An Arterial line is an intraoperative monitor that is frequently placed in the pediatric population. Due to their smaller anatomy and more compliant skin, arterial lines can be more difficult to insert in the pediatric population than in adults. Additionally, lower perfusion pressure and larger subcutaneous adipose tissue can make pulse palpation more difficult. Ultrasound is a modality that can directly image the radial, ulnar, or brachial artery. Along with 2D ultrasound, doppler ultrasound can be utilized to confirm that an artery is not a vein. Once the vessel is identified, the vessel can be viewed in either the long or short access. The ultrasound beam is only 1 millimeter thick so a practitioner must stabilize the probe to view the vessel, especially in the long axis view. Once the artery is viewed in long axis, the needle can be directly visualized all the way into the vessel. Visualization of a guidewire or catheter in the vessel can confirm proper arterial access. In a short access ultrasound view, it is possible to see tissue movement and sometimes a hyperechoic (bright) dot which represents the needle. Tissue movement can help confirm the needle is immediately above the artery at all times. The advantage of the short axis view is that less precision is needed to hold and position the transducer than with the long axis view. The disadvantage of the short axis view is that the operator cannot see the tip of the angiocatheter as it enters the vessel. As a result, the proximal portion of the angiocatheter can be above the artery but the distal tip could be to the side of the artery.

Conditions

General Anesthesia

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Long Axis arterial line placement

Twenty four patients will undergo arterial line placements using long axis arterial line placement under ultrasound.

Group Type: EXPERIMENTAL

Arterial line placement

Intervention Type: PROCEDURE

The following measures will be collected and compared.

1. Time (in seconds) required for successful placement of the arterial line. This is the time elapsed between either palpation or placement of ultrasound probe on the patient's wrist and the successful demonstration of arterial waveform on the anesthesia monitor.

2. number of attempts, defined as forward advancements of needle, required to cannulate the artery.

3. number of separate skin punctures.

4. number of arteries into which entry is attempted.

Short Axis arterial line placement

Twenty four patients will undergo arterial line placements using short axis arterial line placement under ultrasound.

Group Type: EXPERIMENTAL

Arterial line placement

Intervention Type: PROCEDURE

The following measures will be collected and compared.

1. Time (in seconds) required for successful placement of the arterial line. This is the time elapsed between either palpation or placement of ultrasound probe on the patient's wrist and the successful demonstration of arterial waveform on the anesthesia monitor.

2. number of attempts, defined as forward advancements of needle, required to cannulate the artery.

3. number of separate skin punctures.

4. number of arteries into which entry is attempted.

Palpation arterial line placement

Twenty four patients will undergo arterial line placements using Traditional palpation arterial line placement.

Group Type: ACTIVE_COMPARATOR

Arterial line placement

Intervention Type: PROCEDURE

The following measures will be collected and compared.

1. Time (in seconds) required for successful placement of the arterial line. This is the time elapsed between either palpation or placement of ultrasound probe on the patient's wrist and the successful demonstration of arterial waveform on the anesthesia monitor.

2. number of attempts, defined as forward advancements of needle, required to cannulate the artery.

3. number of separate skin punctures.

4. number of arteries into which entry is attempted.

Interventions

Arterial line placement

The following measures will be collected and compared.

1. Time (in seconds) required for successful placement of the arterial line. This is the time elapsed between either palpation or placement of ultrasound probe on the patient's wrist and the successful demonstration of arterial waveform on the anesthesia monitor.

2. number of attempts, defined as forward advancements of needle, required to cannulate the artery.

3. number of separate skin punctures.

4. number of arteries into which entry is attempted.

Intervention Type: PROCEDURE

Other Intervention Names

Ultrasound guided (short vs Long axis)

Eligibility Criteria

Inclusion Criteria

• The investigators will identify patients 0 to 14 years of age who are classified as ASA physical status ≤4 and scheduled to have surgery under general anesthesia

Exclusion Criteria

• History of vasculitis, autoimmune disease, Reynauds phenomenon or disease
• History of no collateral perfusion
• The absence of an upper extremity artery to cannulate such as a bilateral amputee
• A child in DHS custody
• Infection at the site of insertion
• Patient refusal.

• Minimum Eligible Age: 1 Day
• Maximum Eligible Age: 14 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

University of Oklahoma

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Alberto J de Armendi, MD

Role: PRINCIPAL_INVESTIGATOR

Oklahoma University Health Sciences Center

Locations

The University of Oklahoma Health Sciences Center Deparment of Anesthesiology

Oklahoma City, Oklahoma, United States

Countries

United States

References

Schwemmer U, Brederlau J. [Ultrasound techniques in anesthesiology--guided vascular access using sonography]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2006 Nov;41(11):740-9. doi: 10.1055/s-2006-958847. German.

Reference Type: BACKGROUND

PMID: 17151988 (View on PubMed)

Shiver S, Blaivas M, Lyon M. A prospective comparison of ultrasound-guided and blindly placed radial arterial catheters. Acad Emerg Med. 2006 Dec;13(12):1275-9. doi: 10.1197/j.aem.2006.07.015. Epub 2006 Nov 1.

Reference Type: BACKGROUND

PMID: 17079789 (View on PubMed)

Other Identifiers

2340

Identifier Type: -

Identifier Source: org_study_id