Arterial Catheterization
Conditions
Keywords
pediatric anesthesia, pediatric patient, Arterial catheterization, arterial catheter, ultrasound-guided cannulation, Arterial cannulation
Brief summary
Arterial cannulation is indicated in several clinical settings: high-risk surgery, respiratory failure, circulatory failure. The possible anatomical sites of cannulation are: a.radialis, a.brachialis, a. femoralis. However, the most reported complications in preschool-aged children are associated with femoral and brachial arteries. Therefore, alternative cannulation sites are being searched as ulnar artery, tibial posterior artery.
Detailed description
In pediatric patients, artery cannulation may be associated with a higher risk of complications. The preferred puncture site is the radial artery or the femoral artery. However, puncture of the femoral artery in comparison with the radial artery is based on observational data as a significant risk side of post-puncture complications. The radial artery is the dominant artery of the hand, and the collateral supply (via the ulnar artery) is often unable to provide adequate peripheral perfusion. Therefore, other potential sites suitable for artery cannulation in paediatric patients are currently being investigated with the primary goal of increasing safety and reducing the risk of post-puncture complications. According to published studies, the potential alternatives are: posterior tibial artery and ulnar artery. Both arteries have comparable dimensions with radial artery and can be used for USG-guided cannulation. In this prospective randomized trial, patients with clinical indication for arterial cannulation (high-risk surgery, respiratory failure, circulatory failure) undergoing surgery under general anesthesia and pediatric patients admitted into the pediatric intensive care unit (PICU) will be randomized in form of sealed envelopes into a.radialis and a.ulnaris group as the initial site of arterial catheterization. Ultrasound (USG) measurement of both arteries will be performed before the cannulation. The catheterization success rate (number of percutaneous punctures) and overall success rate will be evaluated. The artery will be cannulated under USG control, initially in in-plane view, only in case of insufficient image, or after 2 unsuccessful attempts, the out-of-plane approach could be used. The maximum 5 percutaneous attempts and 10 minutes could be used for the initial (randomized) site of cannulation). In case of cannulation failure, the other artery could be used for cannulation. The rate of complications in 24 hours after cannulation will be evaluated. The arterial catheter will stay in place until the clinical indication remained. .
Interventions
PROCEDUREUlnar artery cannulation
Ulnar artery will be cannulated under USG guidance
PROCEDURERadial artery cannulation
Radial artery will be cannulated under USG guidance
Sponsors
Masaryk University
Brno University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
randomization after general anesthesia induction, or deep sedation in PICU
Intervention model description
Non-inferiority randomized trial
Eligibility
Sex/Gender
ALL
Age
1 Years to 6 Years
Healthy volunteers
No
Inclusion criteria
* Paediatric patients (1 - 6 years) * high risk surgery (significant blood loss or hemodynamic instability) * critically ill patients at PICU (respiratory failure, circulatory failure) * informed consent
Exclusion criteria
* refused to participate * arterial catheterization not clinically relevant
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| overall puncture success in different arterial sites | intraoperatively | defined by number of required percutaneous punctures and overall site success rate |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Arteries anatomical description | intraoperatively | Defined by USG measurement of depth of the artery - (distance from the skin to the upper wall of the artery), cross-sectional area, diameter of the artery. |
| Technique of the ultrasound-guided cannulation (in-plane/out-of-plane) | intraoperatively | The USG guidance approach will be evaluated |
| Incidence of complications | 24 hours postoperatively | Blood supply disorder, trophic changes, hematoma, arterial wall injury (aneurysm etc.), thrombosis. |
| Duration of catheterization | Intraoperatively | Time needed for successful catheterization |
| Interval between catheterization and catheter removal | 24 hours postoperatively | Interval between catheterization and catheter removal will be evaluated |
Countries
Czechia
Contacts
Primary ContactJozef UO Klučka, assoc.prof.MD., Ph.D.
Backup ContactVáclav Vafek, MD
Outcome results
None listed