title: Optimal wrist angulation shortens time needed for radial artery catheterization: a prospective, randomized, and blinded study.
abstract: BACKGROUND
  Optimal wrist position is essential for successful catheterization of the radial artery. We planned to study the success rate of radial artery catheterization at various degrees of wrist extension angulations.
  
  
  METHODS
  This prospective, randomized study was performed in 60 consenting patients aged between 18-65 years and undergoing variable surgeries where the anesthetic management required an arterial catheterization. All patients were randomized into three groups of 20 patients each, according to wrist angulation during radial artery catheterization : either 30 degrees (Group 30), 45 degrees (Group 45), or 60 degrees (Group 60). Three metallic angulated wrist boards with angles of 30 degrees, 45 degrees, and 60 degrees (angle measured with calipers) were prepared, on which patient's wrist was kept at the above-mentioned angles of extension. Radial artery catheterization success rate, catheterization time, and numbers of attempts were recorded.
  
  
  RESULTS
  The catheterization time was minimal in group 45 (30.50 +/- 16.82 sec) as compared to 36.00 +/- 14.19 sec and 43.50 +/- 13.80 sec in group 30 and 60, respectively. Radial artery was catheterized at first attempt in 60% of Group 45 and Group 60 patients, and in 50% of Group 30 patients. The arterial catheterization was successful in 14/20 patients in Group 30, 19/20 patients in group 45, and 16/20 patients in group 60.
  
  
  CONCLUSIONS
  We conclude that a wrist extension of 450 appears to be the optimal wrist joint extension for a successful radial artery cannula insertion.
authors.affiliation: Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi -110029, India. trips22003@yahoo.co.in
authors.forename: R
authors.initials: R
authors.lastname: Pandey
authors.forename: H
authors.initials: H
authors.lastname: Ashraf
authors.forename: A P
authors.initials: AP
authors.lastname: Bhalla
authors.forename: R
authors.initials: R
authors.lastname: Garg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002406:Catheterization, Peripheral / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods*; D011187:Posture; D011446:Prospective Studies; D017534:Radial Artery; D016037:Single-Blind Method; D014955:Wrist Joint; D055815:Young Adult