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When a patient undergoes heart surgery, their Anesthesiologist will insert a tiny plastic tube, called a catheter, in the artery of the patient's wrist. This is called a radial artery catheter. A radial artery catheter allows accurate measurement of the patient's blood pressure during surgery. There are two common techniques for placing the radial artery catheter. The first is a "blind" technique whereby the Anesthesiologist feels for the pulse in the patient's wrist and places the catheter using the location of the pulse as a guide. The second technique, less commonly used, is one whereby the Anesthesiologist uses an ultrasound machine (painless to the patient) to "see" the artery, and thereby uses the ultrasound to guide the catheter placement. Our study will test the hypothesis that ultrasound-guided radial artery catheterization will have faster insertion times, with fewer complications compared with palpation-guided insertion.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| direct palpation | Active Comparator | Radial artery catheter insertion will be conducted by direct palpation and use of anatomic knowledge by the Anesthesiologist. |
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| Ultrasound | Active Comparator | Radial artery catheter insertion will be conducted by ultrasound guidance. A Sono-site ilook 25 Ultrasound (Sono-site, Inc., Bothell, WA, USA) with a 10-5 MHz linear array ultrasound transducer will be used. At the discretion on the Anesthesiologist, an out-of-plane (i.e. needle plane at right angles to ultrasound plane) will be used. Colour flow doppler may also be used to identify the artery if necessary. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ultrasound-guided Radial Artery Catheter Insertion | Device |
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| Direct Palpation-guided Radial Artery Catheter insertion |
| Measure | Description | Time Frame |
|---|---|---|
| Time to Successful Radial Arterial Catheterization | The time to successful radial arterial catheterization was defined as time zero to time of placement. Time zero for the DP group began when the anesthesiologist's fingers were placed on the patient with the purpose of palpating the artery. Time zero for the US group began when the US transducer was first placed on the patient's skin for the purpose of identifying the radial artery. Time to placement was defined as the interval from time zero until the time at which an arterial tracing was viewed on the monitor. | up to 5 minutes |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Attempts | An attempt was defined as a new purposeful penetration of the skin with the needle (i.e., following complete withdrawal of the needle from the skin). | up to 5 minutes |
| Number of Re-directions |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Stephen Head, MD | Providence Health & Services | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| St. Paul's Hospital | Vancouver | British Columbia | V6Z 1Y6 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34637140 | Derived | Flumignan RL, Trevisani VF, Lopes RD, Baptista-Silva JC, Flumignan CD, Nakano LC. Ultrasound guidance for arterial (other than femoral) catheterisation in adults. Cochrane Database Syst Rev. 2021 Oct 12;10(10):CD013585. doi: 10.1002/14651858.CD013585.pub2. | |
| 26159436 | Derived | Peters C, Schwarz SK, Yarnold CH, Kojic K, Kojic S, Head SJ. Ultrasound guidance versus direct palpation for radial artery catheterization by expert operators: a randomized trial among Canadian cardiac anesthesiologists. Can J Anaesth. 2015 Nov;62(11):1161-8. doi: 10.1007/s12630-015-0426-8. Epub 2015 Jul 10. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Direct Palpation | Radial artery catheter insertion was conducted by direct palpation and use of anatomic knowledge by the Anesthesiologist. Direct Palpation-guided Radial Artery Catheter insertion |
| FG001 | Ultrasound |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| Device |
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A re-direct was defined as the needle being purposefully withdrawn at least 5 mm and re-directed (but not removed from the skin entirely).
| up to 5 minutes |
| Complication Rate (Hematoma) | A hematoma was defined a collection of blood or formation of a bruise surrounding the site of radial artery catheterization | up to 5 minutes |
Radial artery catheter insertion was conducted by ultrasound guidance. A Sono-site ilook 25 Ultrasound (Sono-site, Inc., Bothell, WA, USA) with a 10-5 MHz linear array ultrasound transducer was used.
At the discretion on the Anesthesiologist, an out-of-plane (i.e. needle plane at right angles to ultrasound plane) was used. Colour flow doppler may have also been used to identify the artery if necessary.
Ultrasound-guided Radial Artery Catheter Insertion
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| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | Direct Palpation | Radial artery catheter insertion will be conducted by direct palpation and use of anatomic knowledge by the Anesthesiologist. Direct Palpation-guided Radial Artery Catheter insertion |
| BG001 | Ultrasound | Radial artery catheter insertion will be conducted by ultrasound guidance. A Sono-site ilook 25 Ultrasound (Sono-site, Inc., Bothell, WA, USA) with a 10-5 MHz linear array ultrasound transducer will be used. At the discretion on the Anesthesiologist, an out-of-plane (i.e. needle plane at right angles to ultrasound plane) will be used. Colour flow doppler may also be used to identify the artery if necessary. Ultrasound-guided Radial Artery Catheter Insertion |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Body Mass Index | Mean | Standard Deviation | kg/m^2 |
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| ASA physical status IV | American Society of Anesthesiologists (ASA) status is a system for assessing fitness for surgery. Class IV refers to patients who have severe systemic disease that is a constant threat to life. Status I refers to a healthy patient. Status II refers to patients with mild systemic disease. Status III refers to patients who have severe systemic disease. Thus ASA class IV patients are associated with higher morbidity and mortality compared to ASA 1 patients. | Number | participants |
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| Peripheral vascular disease | Number | participants |
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| Systolic Blood Pressure | Mean | Standard Deviation | mm Hg |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Time to Successful Radial Arterial Catheterization | The time to successful radial arterial catheterization was defined as time zero to time of placement. Time zero for the DP group began when the anesthesiologist's fingers were placed on the patient with the purpose of palpating the artery. Time zero for the US group began when the US transducer was first placed on the patient's skin for the purpose of identifying the radial artery. Time to placement was defined as the interval from time zero until the time at which an arterial tracing was viewed on the monitor. | Posted | Median | Inter-Quartile Range | seconds | up to 5 minutes |
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| Secondary | Number of Attempts | An attempt was defined as a new purposeful penetration of the skin with the needle (i.e., following complete withdrawal of the needle from the skin). | Posted | Median | Inter-Quartile Range | number of attempts | up to 5 minutes |
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| Secondary | Number of Re-directions | A re-direct was defined as the needle being purposefully withdrawn at least 5 mm and re-directed (but not removed from the skin entirely). | Posted | Median | Inter-Quartile Range | number of re-directs | up to 5 minutes |
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| Secondary | Complication Rate (Hematoma) | A hematoma was defined a collection of blood or formation of a bruise surrounding the site of radial artery catheterization | Posted | Number | percentage of participants | up to 5 minutes |
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Direct Palpation | Radial artery catheter insertion was conducted by direct palpation and use of anatomic knowledge by the Anesthesiologist. Direct Palpation-guided Radial Artery Catheter insertion | 0 | 62 | 14 | 62 | ||
| EG001 | Ultrasound | Radial artery catheter insertion was conducted by ultrasound guidance. A Sono-site ilook 25 Ultrasound (Sono-site, Inc., Bothell, WA, USA) with a 10-5 MHz linear array ultrasound transducer was used. At the discretion on the Anesthesiologist, an out-of-plane (i.e. needle plane at right angles to ultrasound plane) was used. Colour flow doppler may also have been used to identify the artery if necessary. Ultrasound-guided Radial Artery Catheter Insertion | 0 | 63 | 7 | 63 |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| hematoma | Vascular disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| S. K. W. Schwarz, MD, PhD | Department of Anesthesia, St. Paul's Hospital | 604-806-8337 | stephan.schwarz@ubc.ca |
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