title: Ultrasound visual image-guided vs Doppler auditory-assisted radial artery cannulation in infants and small children by non-expert anaesthesiologists: a randomized prospective study.
abstract: BACKGROUND
  Cannulation of the radial artery in infants and small children can be challenging, even for the most experienced providers. Utilizing Doppler to aid in radial artery cannulation has been well described. Recent studies have demonstrated the efficacy of ultrasound (US) image-guided vascular access techniques in the paediatric population. The utility of these two techniques, when used by non-expert personnel, has not been studied.
  
  
  METHODS
  This is a randomized prospective study to compare the utility of two different radial arterial cannulation techniques in paediatric patients weighing <12 kg: US-guided technique (US group) vs Doppler-assisted technique (Doppler group) when used by trainees with limited experience. The primary objective was to compare the first-attempt success rate between each group. As a secondary objective, success rate within 10 min was compared.
  
  
  RESULTS
  The trial was prematurely terminated after 50% of paediatric patients (n=104) were included in the study and 52 of each were randomized to the US or Doppler group. A total of 12 anaesthesia trainees performed radial arterial cannulations. The first-attempt success rate was greater in the US group compared with the Doppler group [17/52 (33%) vs 8/52 (15%), P=0.039, odds ratio (OR): 2.67, confidence interval (CI): 1.03-6.91]. The overall success rate within 10 min was 34/52 (65%) in the US group and 24/52 (46%) in the Doppler group (P=0.048, OR: 2.20, CI: 1.00-4.85).
  
  
  CONCLUSIONS
  US-guided radial arterial cannulation in infants and small children provided a greater chance for success at the first attempt compared with the Doppler-assisted technique.
authors.affiliation: Department of Anaesthesia, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. kenichi-ueda@uiowa.edu
authors.forename: K
authors.initials: K
authors.lastname: Ueda
authors.forename: S
authors.initials: S
authors.lastname: Puangsuvan
authors.forename: M A
authors.initials: MA
authors.lastname: Hove
authors.forename: E O
authors.initials: EO
authors.lastname: Bayman
mesh_terms: D000776:Anesthesiology / Q000193:education; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007223:Infant; D007396:Internship and Residency; D008297:Male; D011446:Prospective Studies; D017534:Radial Artery / Q000000981:diagnostic imaging*; D018401:Sample Size; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional / Q000379:methods*