title: Femoral arterial cannulation performed by residents: a comparison between ultrasound-guided and palpation technique in infants and children undergoing cardiac surgery.
abstract: BACKGROUND
  Percutaneous cannulation of the femoral artery in the pediatric age group can be technically challenging, especially when performed by residents in training.
  
  
  OBJECTIVE
  We examined whether the use of real-time ultrasound guidance is superior to a palpation landmark technique for femoral artery catheterization in children undergoing heart surgery.
  
  
  METHODS
  Patients were prospectively randomized into two groups. In the palpation group, the femoral artery was cannulated using the traditional landmark method of palpation of arterial pulse. In the ultrasound group, cannulation was guided by real-time scanning with an ultrasound probe. Ten minutes were set as time limit for the resident's trials during which the time taken for attempted cannulation (primary outcome), number of attempts, number of successful cannulations on first attempt, and success rate were compared between the two groups. Adverse events were monitored on postoperative days 1 and 3.
  
  
  RESULTS
  A total of 106 patients were included in the study. The time taken for attempted femoral artery cannulation was shorter (301 ± 234 vs 420 ± 248 s; difference in mean: 119; 95% confidence interval (CI) of difference: 26-212; P = 0.012) and the number of attempts was lower [1 (1-10) vs 2 (1-5); difference in median: 1, 95% CI of difference: 0.28-1.72; P = 0.003] in the ultrasound group compared with the palpation group. The number of successful cannulations on first attempt was higher in the ultrasound group compared with palpation group [24/53 (45%) vs 13/53 (25%); odds ratio (OR): 2.54, 95% CI: 1.11-5.82; P = 0.025]. The number of patients who had successful cannulation was 31 of 55 (58%) in the palpation group and 40 of 53 (75%) in the ultrasound group (OR: 2.18, 95% CI: 0.95-5.01; P = 0.06). None of the patients had adverse events at days 1 and 3.
  
  
  CONCLUSIONS
  Ultrasound-guided femoral arterial cannulation in children when performed by anesthesia residents is superior to the palpation technique based on the reduction of the time taken for attempted cannulation and the number of attempts, and improvement in first attempt success.
authors.affiliation: Department of Anesthesiology, American University of Beirut - Medical Center, Beirut, Lebanon.
authors.forename: Sahar M
authors.initials: SM
authors.lastname: Siddik-Sayyid
authors.affiliation: Department of Anesthesiology, American University of Beirut - Medical Center, Beirut, Lebanon.
authors.forename: Marie T
authors.initials: MT
authors.lastname: Aouad
authors.affiliation: Department of Anesthesiology, American University of Beirut - Medical Center, Beirut, Lebanon.
authors.forename: Muhammad H
authors.initials: MH
authors.lastname: Ibrahim
authors.affiliation: Department of Anesthesiology, American University of Beirut - Medical Center, Beirut, Lebanon.
authors.forename: Samar K
authors.initials: SK
authors.lastname: Taha
authors.affiliation: Department of Anesthesiology, American University of Beirut - Medical Center, Beirut, Lebanon.
authors.forename: Maud F
authors.initials: MF
authors.lastname: Nawfal
authors.affiliation: Department of Anesthesiology, American University of Beirut - Medical Center, Beirut, Lebanon.
authors.forename: Youssef J
authors.initials: YJ
authors.lastname: Tfaili
authors.affiliation: Department of Anesthesiology, American University of Beirut - Medical Center, Beirut, Lebanon.
authors.forename: Roland N
authors.initials: RN
authors.lastname: Kaddoum
mesh_terms: D006348:Cardiac Surgical Procedures; D002406:Catheterization, Peripheral / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007223:Infant; D007396:Internship and Residency; D008297:Male; D010173:Palpation / Q000379:methods*; D011446:Prospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: cardiac surgery; femoral artery; palpation; pediatric; residents; ultrasound