title: Analysis of radial artery catheter placement by respiratory therapists using ultrasound guidance.
abstract: BACKGROUND
  The use of ultrasound (US) guidance for radial artery cannulation has been shown to improve first attempt success rate, reduce time to successful cannulation, and reduce complications. We sought to determine whether properly trained respiratory therapists (RTs) could utilize US guidance for the placement of radial artery catheters. Primary outcome measurements were successful cannulation and first attempt success rate. Secondary outcomes included the effect of systolic blood pressure, prior attempts, palpable pulse strength, and gender in relation to US-guided radial artery cannulation success rates.
  
  
  METHODS
  RTs certified in arterial catheter insertion were trained in radial artery catheterization using US by emergency medicine physicians. Subjects were enrolled based on the need for an arterial catheter placement. The catheters and US devices used were standardized. Data recorded included pulse strength, systolic and diastolic blood pressure, number of attempts, and successful/unsuccessful artery cannulation. All catheterization attempts were performed according to institutional policy and procedure.
  
  
  RESULTS
  One hundred twenty-two radial artery catheter insertion attempts were made between December of 2008 and October of 2011, in patients in whom the treating physician requested RT radial artery cannulation. The overall success rate was 86.1%, whereas the first attempt success rate was 63.1%. There was no difference found between the overall mean success rate for weak or absent pulses, age, systolic blood pressure, gender, or prior attempts.
  
  
  CONCLUSIONS
  RTs can effectively utilize US technology to place radial artery catheters. Systolic blood pressure, prior attempts, and gender are not reliable predictors of success for US-guided radial artery cannulation. Training on the use of US should be strongly encouraged for all practitioners who place radial artery catheters.
authors.affiliation: Respiratory Care Services Andrew.g.miller@duke.edu.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Miller
authors.affiliation: Respiratory Care Services.
authors.forename: Jhaymie L
authors.initials: JL
authors.lastname: Cappiello
authors.affiliation: Division of Critical Care.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gentile
authors.affiliation: Respiratory Care Services.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Almond
authors.affiliation: Respiratory Care Services.
authors.forename: Janice J
authors.initials: JJ
authors.lastname: Thalman
authors.affiliation: Division of Pulmonary and Critical Care, Duke University Medical Center, Durham, North Carolina.
authors.forename: Neil R
authors.initials: NR
authors.lastname: MacIntyre
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002404:Catheterization / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011674:Pulse; D017534:Radial Artery / Q000000981:diagnostic imaging*; D012138:Respiratory Therapy / Q000193:education; D012737:Sex Factors; D018084:Ultrasonography, Interventional
keywords: radial artery cannulation; radial artery catheter; respiratory therapist; ultrasound guidance