The effect of the arterial catheter insertion technique on the success of radial artery cannulation: A prospective and randomized study

Purpose: The main objective of the current investigation was to compare a single wall puncture to vessel transfixing on the success of radial artery cannulation by resident physicians. Material and Methods: The study was a prospective and randomized investigation. Twelve anesthesiology residents performed radial arterial insertions in 126 patients using both the single wall and vessel transfixing technique in random order. The primary outcome was successful cannulation of the radial artery in 4 or less attempts. Other data collected included the total number of attempts and total time to catheter cannulation. Results: Successful radial artery cannulation was achieved in 88% and 86% of patients using the transfixing technique and single wall group, respectively (difference 2%; 95% CI, 14-9, P = 0.8, Fisher exact test). Cannulation was successfully on the first attempt in 38% of the transfixing compared to 54% using the single wall technique (difference - 16%; 95% CI, 32-2, P = 0.1, Fisher Exact test). The median (interquartile range) time to successful cannulation was longer inthe transfixing group, 105 (69-176) seconds compared to 65 (25-114) seconds in the single puncture group (P =.009, log-rank test). Conclusions: Our findings suggest that there does not appear to be an advantage of the transfixing technique over the single wall puncture method for cannulating the radial artery by resident physicians. Cannulation was achieved in shorter time using the single wall puncture technique even after accounting for differences between residents and prior levels of experience. (C) 2014 Elsevier Inc. All rights reserved.