Application of radial arterial puncture cannulation under ultrasonic guidance in patients with critical diseases / 中南大学学报(医学版)

Objective:To explore the clinicaleffect of radial arterial puncture cannulationunder ultrasonic guidance in patients with critical diseases.Methods:From December 2016 to May 2017,120 patients under critical conditions in Department of Intensive Care Unit,Xiangya Hospital,Central South University,who received arterial cannulation,were randomly divided into 2 groups:a control group (traditional blind puncture method) and an observation group (ultrasound-guided radial arterial cannulation) (60 cases in each group).The success ratio of radial arterial puncture cannulation by one time,total success ratio of radial arterial puncture cannulation,numbers of puncture,the rate of complications and the time of consumption were compared between the 2 groups.Results:There was no statistically significant difference in the total success ratio of radial arterial puncture cannulationin the 2 groups (P＞0.05).The success ratio radial arterial puncture cannulation by one time was significantly greater in the observation group than that in the control group (P＜0.05);the numbers of puncture,the rate of complications and the time of consumption in the observation group were lower than those in the control group,with statistically significant (all P＜0.05).Conclusion:The application of ultrasound-guided radial arterial puncturecannulation can improve the success ratio of radial arterial puncturecannulation by one time,decrease the numbers of puncture,reduce the incidence of complications and save operation time.

Punción de la arteria radial guiada por ultrasonido para obtención de gases arteriales / Puncture of the radial artery guided by ultrasound for the obtaining of arterial blood gases

Introducción: La punción de la arteria radial es utilizada para tomar muestras de sangre arterial y realizar exàmentes gasométricos. Es un procedimiento que se realiza de manera frecuente en el área de emergencias, sin embargo, no está exento de complicaciones, por lo que es necesario evaluar técnicas accesorias que permitan reducir los riesgos para el paciente. El objetivo del estudio fue comparar la técnica de punción arterial convencional guiada por palpación con la punción arterial guiada por ultrasonido. Materiales y métodos: Estudio prospectivo en pacientes que ingresaron al Servicio de Emergencia del Hospital Carlos Andrade Marín a quienes se les solicitó gasometría arterial. Para obtener la muestra de sangre arterial se asignó en forma aleatoria a cada paciente a uno de los dos grupos de estudio, el primero en el que se utilizó el método convencional, guiados por palpación y el segundo, guiados por ultrasonido. Los participantes fueron pacientes adultos a quienes se les solicitó gasometría arterial, excluyendo aquellos que tenían alguna contraindicación para el procedimiento. El enrolamiento tuvo lugar en un período de 2 meses. El desenlace primario fue la punción arterial exitosa en el primer intento. Se consideró fracaso, cuando los pacientes requirieron 2 o más punciones para obtener la muestra. Resultados: Noventa y ocho pacientes, fueron enrolados. Cincuenta asignados al grupo guiado por ultrasonido y 48 al grupo control. La punción arterial fue exitosa al primer intento en el 92% del grupo guiado por ultrasonido y 9.6% en el grupo control. El tiempo requerido para obtener la muestra fue similar en los dos grupos (p=0.91). Discusión: La punción arterial guiada por ultrasonido no fue más efectiva que la técnica convencional.

Introduction: Arterial blood gas (ABG) sampling by direct vascular puncture guided by pulse palpation is a common procedure performed in the emergency setting. Reducing the number of attempts to draw arterial blood samples was one of our main goals. The other goal was comparing the standard technique with the ultrasound-guided arterial puncture. Methods: Prospective study in patients admitted to the Emergency Department at Carlos Andrade Marín Hospital, who needed arterial blood gas exams. Patients allocation to draw arterial blood by palpation or guided by ultrasound was chosen at random. Participants were adult patients who needed ABG analysis and excluded patients with any contraindication. The enrollment period lasted two months. The primary endpoint was the successful arterial blood gas sample obtained at first attempt. Failure was taken when patients required more than two punctures to obtain the blood sample. Surrogate endpoint was the amount of time employed in the procedure. Statistical analysis, including Fisher's exact test for categorical variables and independent t-test for quantitative variables, was performed. Results: Ninety-eight patients were enrolled. Fifty were assigned to the ultrasound-guided group and 48 to the control group. The proportion of successful first attempts was 92% in the ultrasound group, and 91.6% in the control group . The amount of time required to draw the blood sample was similar in both groups (p= 0.91). Discusion: Arterial puncture guided by ultrasound was not more effective than the conventional technique to draw arterial blood sample by pulse palpation.

Effect of arterial blood collection from different spots in infants / 现代临床护理

ObjectiveTo investigate effects of the arterial blood collection from radial artery,brachial artery,femoral artery and orsalis pedis artery for gas analysis of infants.Methods Three hundred and fifty two infants receiving blood collection were divided into four groups radial artery (n=92),brachial artery (n=94),femoral artery (n=73) and dorsal artery (n=53).Comparisons were done between them in terms of one-time success rate of puncturing and rate of complications from puncturing.Result The radial artery group had lowest rates of hematoma and mistaken puncturing into veins (P<0.05) and higher rate of one-time successful puncturing (P<0.001).Conclusion The radial artery is the first choice for infants undergoing arterial puncturing.

Radial Artery Pseudoaneurysm after Arterial Blood Gas Analysis: A Case Report

Pseudoaneurysms might be caused by perforation of an artery with hematoma formation between the arterial wall and the surrounding tissue after penetrating injury, intervention or operation. The frequency of radial artery pseudoaneurysm as a complication of cannulation is known for 0.048%. We report one case of radial artery pseudoaneurysm after single arterial blood gas analysis at wrist, which was managed by excision followed by vein graft.

Arterial Puncture Unrecognized by Pressure Waveform Monitoring after Central Venous Catheterization: A case report / 대한마취과학회지

Central venous catheters are useful for acute hemodynamic monitoring, fluid resuscitation, drug administration, the aspiration of air embolism and total parenteral nutrition. However, various complications may occur during central venous catheterization and the most common complication of the internal jugular approach is arterial puncture. Arterial puncture can be easily identified by a pulsatile blood flow and the bright red color of blood. It is usually confirmed by connecting catheter to a pressure transducer and observing venous waveforms and venous pressure. We experienced a patient in whom arterial cannulation was unrecognized by pressure recording, but was confirmed by blood gas analysis.

Three strategies for hemostasis at femoral artery access site: a comparison of safety and efficacy / 第二军医大学学报

Objective:To assess the safety and efficacy of the standard manual compression and 2 arterial puncture closing devices,Angioseal and Perclose,for hemostasis at the femoral artery access site in patients undergoing coronary angiography(CAG) or percutaneous coronary interventions(PCI).Methods: Totally 366 patients undergoing coronary angiography or PCI were assigned to receive either Angioseal(n=128),Perclose(n=110) or standard manual compression(n=128).The efficacy endpoint(immediate hemostasis,successful hemostasis rate,operating time,time of leg immobilization and time to hemostasis) and safety endpoint(vasovagal reflex,major complications,local complications,hematocrit drop,etc.) were evaluated.Risk factors(gender,age,body mass index,comorbid conditions,antiplatelet agents,and anticoagulant agents,etc.) were also analyzed.Results: The successful hemostasis rates were similar between Angioseal group and Perclose group,but the rate of immediate hemostasis of Angioseal group was higher than that of Perclose group(P