title: The impact of two arterial catheters, different in diameter and length, on postcannulation radial artery diameter, blood flow, and occlusion in atherosclerotic patients.
abstract: OBJECTIVE
  Arterial cannulation is a common intervention in anesthesia practice. However, the success rates and complications of radial arterial cannulation with 20-G or smaller catheters in patients with atherosclerosis have been underevaluated. The aim of this prospective randomized study was to compare the efficacy of and complications with 20- and 22-G catheters for radial arterial cannulation in atherosclerotic patients.
  
  
  METHODS
  Thirty patients with atherosclerosis, American Society of Anesthesiologists (ASA) III-IV, undergoing general anesthesia were enrolled in the study. Radial artery cannulation was performed in group 20G (n = 15) with a 20-gauge (20 x 1.1 x 33 mm; flow, 61 ml.min(-1)) catheter and in group 22G (n = 15) with a 22-gauge (22 x 0.9 x 25 mm; flow, 36 ml.min(-1)) catheter. Radial artery systolic blood flow (SBF) and radial artery diameter (RAD) were assessed by a Doppler ultrasound probe before cannulation and 24 h after decannulation for vascular complications. The number of puncture attempts, arterial blood gas samples, and manual flushes; total heparinized solution consumption; duration of cannulation; decannulated radial arterial systolic blood flow; postcannulation RAD; and vascular complications such as occlusion, hematoma, pseudoaneurysm, bleeding, and thrombosis were noted. The Mann Whitney U-test, chi(2) test, and one-sample t-test were used. Values are expressed as medians and quartiles and P < 0.05 was considered as significant.
  
  
  RESULTS
  The number of puncture attempts was greater in group 20G (range, 1 to 4) than in group 22G (range, 1 to 2; P = 0.02). In group 20G patients, postoperative RAD was larger than preoperative RAD (P = 0.02) and postoperative SBF was lower than preoperative SBF (P = 0.03). In group 22G patients postoperative SBF was higher than preoperative SBF (P = 0.03), while there was no significant difference between preoperative and postoperative RAD. The occlusion rate of atherosclerotic radial arteries was 6% with the 22-gauge catheter and 26% with the 20-gauge catheter (P = 0.02).
  
  
  CONCLUSIONS
  A 22-gauge catheter for radial arterial cannulation in patients with atherosclerosis provides unchanged postcannulated radial artery diameter, decreases postcannulation complications, and improves the first-attempt success rate.
authors.affiliation: Department of Anesthesiology and ICM, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: H Evren
authors.initials: HE
authors.lastname: Eker
authors.forename: Acar
authors.initials: A
authors.lastname: Tuzuner
authors.forename: Ali Abbas
authors.initials: AA
authors.lastname: Yilmaz
authors.forename: Zekeriyya
authors.initials: Z
authors.lastname: Alanoglu
authors.forename: Yesim
authors.initials: Y
authors.lastname: Ates
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000473:pathology*; D001784:Blood Gas Analysis; D002404:Catheterization; D002406:Catheterization, Peripheral; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017534:Radial Artery / Q000473:pathology* / Q000502:physiology*; D012039:Regional Blood Flow / Q000502:physiology; D014463:Ultrasonography
chemical_list: D008055:Lipids
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