The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

RADIAL ARTERY CATHETERIZATION BY RESPIRATORY CARE PRACTITIONERS WITH ULTRASOUND GUIDANCE

Andrew G. Miller, Andrew Almond, Jhaymie L. Cappiello, Michael A. Gentile, Janice J. Thalman, Neil R. MacIntyre; Duke Medical Center, Durham, NC

Background: Respiratory Care Practitioners (RCP) commonly place indwelling radial artery catheters. Ultrasound devices have emerged as an adjunct to assist clinicians with line placement. The purpose of this study was to review the use of ultrasonic guidance by RCPs in the placement of radial artery catheters. Methods: RCPs certified in arterial line insertion were trained in radial artery catheterization using ultrasound by Emergency Medicine physicians. After obtaining IRB approval for this study, patients were enrolled based on the need for an arterial line placement. The catheters used were Sharps Radial Artery Catherization Set with a 20 gauge catheter, 22 gauge introducer wire, and spring wire guide with integral needle protection. The ultrasound devices were the Sonosite iLook and the Sonosite MicroMaxx. Data recorded included strength of pulse, number of attempts (2 or less punctures per attempt), number of previous attempts, and successful/unsuccessful artery cannulation. Catheterizations were performed according to institutional policy and procedure. Results This review covers a 6 month period (12/08 - 5/09). The age of the patients was 56 ± 14 years. Their systolic blood pressure was 111 ± 32.9 mmHg. There were a total of 50 attempts at cannulation with 44 arteries successfully cannulated. 33 were placed on the first puncture with the ultrasound while the remaining 11 were placed on the second puncture. The unsuccessful attempts were due to: difficulty threading two wires, unable to penetrate two arteries, unable to advance one catheter due to calcification, and one artery was difficult to visualize with the ultrasound. Of note, 14 arterial lines were placed following multiple attempts by other practitioners. Conclusion: Ultrasound guided arterial line placement can be safely and effectively performed by RCPs. The radial artery was successfully cannulated in 85.7% of patients without a palpable radial pulse. The 100% success rate in patients with a normal palpable radial pulse suggests ultrasound may be a beneficial teaching tool to instruct other clinicians in line placement. Sponsored Research - None

0 = Unable to palpate

1+ = Weak and Thready

2+ = Normal

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