title: Ultrasound guidance for radial arterial puncture: a randomized controlled trial.
abstract: STUDY OBJECTIVE AND BACKGROUND: Arterial puncture for blood gas analysis is a frequent procedure and could be difficult in the emergency setting. The aim of the study was to compare ultrasonographically guided arterial radial puncture vs conventional sampling.
  
  
  METHODS
  This is a prospective, randomized study. The inclusion criteria are all patients needing arterial blood gas at admission in the emergency unit. The exclusion criteria are the following: Hallen test positive, local sepsis, local trauma, known sever local arteriopathy, refusal of consent by the patient, participation in another study, and cardiac arrest. Patients were randomized into 2 groups: radial arterial puncture obtained through an ultrasonographically guided technique (group 1) or radial arterial puncture by conventional method (group 2). The main objective is the number of attempts after enrollment. The secondary objectives are time to success, patient satisfaction and pain, and physician satisfaction. Immediate complications were collected. Groups were compared with nonparametric analysis.
  
  
  RESULTS
  The data were usable for 72 of 74 patients included. Lung disease (acute exacerbation of chronic obstructive pulmonary disease and pneumonia) at 45% (n = 32) and suspicion of pulmonary embolism in 31% (n = 22) were the most common reasons. Demographics data were comparable in the 2 groups. In group 1, the number of attempts significantly increased (2.35 [1-3] vs 1.66 [1-2] [P = .017]), and the sample was 2.4 times longer (132 seconds [50-200] vs 55 [20-65] [P < .01] by standard method). There was no significant difference in terms of pain (visual analog scale [VAS], 3.6 [2-5] for both groups [P = .743]), patient satisfaction (VAS, 7.2 [5-9] vs 6.8 [5-9] [P = .494]), and physician satisfaction (VAS, 6.0 [3.5-8] vs 6.9 [5-9] [P = .233]). No immediate complications were found in the 2 groups.
  
  
  CONCLUSIONS
  Ultrasonographically guided arterial puncture increases the number and duration of implementations. This technique, however, does not alter the patient's pain, the number of immediate complications, or patient and physician satisfaction.
authors.affiliation: Division Anesthésie Réanimation Douleur Urgences, GHU Carémeau, Place du Professeur Robert Debré, CHU Nîmes, 30 029 Nîmes Cedex 9, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bobbia
authors.forename: Romain Genre
authors.initials: RG
authors.lastname: Grandpierre
authors.forename: Pierre-Géraud
authors.initials: PG
authors.lastname: Claret
authors.forename: Alexandre
authors.initials: A
authors.lastname: Moreau
authors.forename: Stéphane
authors.initials: S
authors.lastname: Pommet
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Bonnec
authors.forename: Rémi Perrin
authors.initials: RP
authors.lastname: Bayard
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Lefrant
authors.forename: Laurent
authors.initials: L
authors.lastname: Muller
authors.forename: Jean-Emmanuel
authors.initials: JE
authors.lastname: de La Coussaye
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001784:Blood Gas Analysis; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000209:etiology; D017060:Patient Satisfaction; D011446:Prospective Studies; D011677:Punctures / Q000009:adverse effects / Q000379:methods*; D017534:Radial Artery / Q000000981:diagnostic imaging*; D018084:Ultrasonography, Interventional; D055815:Young Adult