Comparison of an Ultrasound guided Dynamic Needle Tip Positioning Technique and a Long axis In plane Technique for Radial Artery Cannulation in Elderly Patients: A Prospective Randomized Controlled Study

Abstract

Abstract Purpose Changes in thickening or hardening of blood vessel walls due to aging can hinder arterial catheter placement in elderly patients. We compared the dynamic needle tip positioning (DNTP) technique and the long-axis in-plane (LAIP) technique in elderly patients. Methods This study was conducted on elderly patients aged 75 years or older who underwent general anesthesia requiring placement of an arterial catheter. A total of 160 patients was randomly allocated to the DNTP group or LAIP group. The primary outcome was success rate of first attempt. Additionally, overall success rate, cannulation time, numbers of total redirections and attempts, and occurrence of complications were investigated. Results In the DNTP group, the success rate of the first attempt (85% vs. 48.8%, P < 0.001, relative risk = 1.74, 95% CI = 1.37–2.22) and the overall success rate (97.5% vs. 86.3%, P = 0.01, relative risk = 1.13, 95% CI = 1.03–1.24) were significantly higher than in the LAIP group. Fewer redirections (P < 0.001) and attempts (P < 0.001) and a decreased cannulation time (58.8 ± 22.4 seconds vs. 89.6 ± 37.9 seconds, P < 0.001) were detected in the DNTP group. A decreased occurrence of hematoma in the DNTP group was also detected (7.5% vs. 18.8%, P = 0.035, relative risk = 0.40, 95% CI = 0.16–0.98). Conclusions The DNTP technique has better efficiency and safety compared with the LAIP technique for radial artery catheterization in the elderly.