临床操作：动脉外科新方法

cannulation. The patients were randomly assigned to the DNTP (group D, n = 76) or the conventional short-axis view(group C, n = 75) group. The arterial depth, diameter, and arterial conditions(calcification, segmental stenosis, and tortuosity) were evaluated using ultrasound, before puncture. We recorded the first attempt success, cannulation time, the number of attempts, and cannulation-related complications.

Results: A total of 151 patients were enrolled in this study. The first attempt success rate in group D was significantly higher than that in group C (89% versus 72%; P = 0.0168). The median cannulation time per last attempt in group D versus group C was 25 versus 30 sec(P = 0.0001), and the overall cannulation time was 25 versus 35 sec(P = 0.0001), respectively. Arterial cannulation per last attempt and overall cannulation time were shorter in group D. The number of attempts was higher in group C (P = 0.0038). The occurrence rate of hematoma was significantly lower in group D (16% versus 47%, relative risk = 3.0, P = 0.0001).

Conclusions: The DNTP method may improve the first attempt success rate of arterial cannulation and reduce complications in elderly patients over 70 years of age.

Fig 1. Illustrations for two ultrasound-guided radial artery cannulation methods. A. Conventional method (a) Confirmation of needle tip visualization in the centre of intra-arterial lumen on the ultrasound screen. After confirming that blood has been aspirated into the catheter hub, the needle is advanced slightly whilst reducing the puncture angle, and an external catheter was inserted into the artery. Then, after the inner guide needle is removed, the (b)and (c) process are performed sequentially if the blood return is not observed. (b) The outer catheter was withdrawn by applying negative pressure until the blood aspiration is observed again, (c)If blood aspiration continued, an outer- catheter is inserted into the artery. B. DNTP (dynamic needle tip positioning) method (a) The skin and radial artery are punctured, and the tip of the needle is seen in the centre of the intra-arterial lumen. (b) The probe is moved forward slightly until the needle tip disappears in the intra-arterial lumen. (c) The needle tip is slightly advanced tip of the needle. Repeat steps (a)-(c) 2 or more times to ensure that the entire catheter of the outer cannula is advanced into the artery.

Fig 2. CONSORT flow diagram.

Fig 3. Kaplan–Meier curves for the overall catheterization success time. D: Group D, dynamic needle tip positioning method. C: Group C, conventional short-axis method. Time(x-axis) is defined as the time from the start of ultrasound scanning during the first attempt to the appearance of an arterial weform on the monitor. If cannulation was not successful with the assigned method after 10 min, it was defined as cannulation failure.

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