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The aim of the present study is to compare between Dynamic Needle Tip Positioning Modification Technique in Short Axis Approach (DNTP - SA) and Long Axis (LA) Approach for Ultrasound-guided Arterial Cannulation as regard time to successful arterial cannula insertion as well as the success rate in the first trial of insertion, number of attempts till successful arterial line placemen, complications, and operators' satisfaction.
Intraoperative Arterial cannulation is recently frequently required especially in high-risk patients or patients with expected major fluid shift.
The most common site for arterial cannulation is the radial artery because of ease of accessibility, dual blood supply to the hand via the ulnar artery, and a low rate of complications. Complications from arterial cannulation include thrombosis, hematoma formation, edema and vasospasm.
Two approaches are basically identified for ultrasound-guided radial artery cannulation, i.e., short-axis out-of-plane (SA-OOP) and long-axis in-plane (LA-IP) techniques.
The dynamic needle tip positioning (DNTP) technique uses the short-axis view of the radial artery with gradual advancing of the needle till reaching the radial artery. Meanwhile, the ultrasound probe is being moved proximally in advance of the needle tip until it disappears from the ultrasound image. The cannula then advanced in the direction of the artery
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Dynamic Needle Tip Positioning Technique in Short Axis Approach (DNTP - SA) | Experimental | Ultrasound guided radial artery cannulation by Dynamic Needle Tip Positioning Technique in Short Axis Approach (DNTP - SA) will be performed by an experienced anesthesiologist who has no subsequent role in the study. The ultrasound transducer is oriented transversely to the radial artery at the wrist, and the vessel appears as a circular anechoic structure in the ultrasound screen with gradual advancing of the needle till reaching the radial artery. Meanwhile, the ultrasound probe is being moved proximally in advance of the needle tip until it disappears from the ultrasound image. The cannula then advanced in the direction of the artery. |
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| Long Axis Approach (LA) | Active Comparator | Ultrasound guided radial artery cannulation in Long Axis Approach (LA) will be performed by an experienced anesthesiologist who has no subsequent role in the study. In the LA-IP approach, an ultrasound probe is placed parallel to the radial artery and the artery appears as a tubular anechoic structure in ultrasound. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dynamic Needle Tip Positioning Technique in Short Axis Approach (DNTP - SA) | Other | Ultrasound guided radial artery cannulation by Dynamic Needle Tip Positioning Technique in Short Axis Approach (DNTP - SA) will be performed by an experienced anesthesiologist who has no subsequent role in the study. The ultrasound transducer is oriented transversely to the radial artery at the wrist, and the vessel appears as a circular anechoic structure in the ultrasound screen with gradual advancing of the needle till reaching the radial artery. Meanwhile, the ultrasound probe is being moved proximally in advance of the needle tip until it disappears from the ultrasound image. The cannula then advanced in the direction of the artery. |
| Measure | Description | Time Frame |
|---|---|---|
| Time to achieve successful cannulation | Time to achieve successful cannulation will be measured from initial skin puncture until the catheter is placed into the radial artery. | Immediately after catheterization |
| Measure | Description | Time Frame |
|---|---|---|
| The success rate | The success rate in the first trial of insertion between the two different approaches will be assessed. | Immediately after catheterization |
| Number of attempts till successful arterial cannula insertion |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Tanta University | Tanta | El-Gharbia | 31527 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41239242 | Derived | Elmazny MI, Ahmed S, Afifi S. Dynamic needle tip positioning in short-axis versus long-axis ultrasound-guided arterial cannulation: a randomised controlled trial. BMC Anesthesiol. 2025 Nov 14;25(1):561. doi: 10.1186/s12871-025-03413-3. |
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The data will be available upon a reasonable request from the corresponding author after the end of study for one year.
After the end of study for one year.
The data will be available upon a reasonable request from the corresponding author.
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| Long Axis Approach (LA) | Other | Ultrasound guided radial artery cannulation in Long Axis Approach (LA) will be performed by an experienced anesthesiologist who has no subsequent role in the study. In the LA-IP approach, an ultrasound probe is placed parallel to the radial artery and the artery appears as a tubular anechoic structure in ultrasound. |
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Number of attempts till successful arterial cannula insertion will be recorded.
| Immediately after catheterization |
| Incidence of complications | Complications including edema, hematoma, vasospasm, ischemia, thrombosis and nerve injury will be recorded. | 24 hours postoperatively |
| Operators' satisfaction | Operators' satisfaction (Level of operators' satisfaction will be assessed with a Scale from 1-5) | Immediately after catheterization |