The primary objective of the study is to evaluate the vasodilative effect of subcutaneous nitroglycerin to prevent radial arterial occlusion(RAO) after removal of the radial arterial catheter in pediatric patients. The hypothesis of this study is that subcutaneous nitroglycerin will decrease the incidence of radial arterial occlusion after radial arterial catheter removal in pediatric patients by increasing the radial artery size. This is a single-center, double-blind, randomized, placebo-controlled study comparing the effect of subcutaneous nitroglycerin and saline on radial artery cannulation and catheter removal in pediatric patients. Prior to the procedure, each patient will be randomized into either the control arm, saline, or the study arm, nitroglycerin.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
200
Subcutaneous nitroglycerin injection to decrease the incidence of radial arterial occlusion after arterial catheter removal in pediatric patients.
Subcutaneous normal saline injection to decrease the incidence of radial arterial occlusion after arterial catheter removal in pediatric patients.
Seoul National University Hospital
Seoul, South Korea
The incidence of radial arterial occlusion (RAO) (%)
RAO is defined as no pulse oximeter wave at the index finger during compression of the ipsilateral ulnar artery.
Time frame: After removal of the radial artery catheter (up to 24 hour)
First attempt success rate (%)
Success at the first skin puncture
Time frame: During radial artery cannulation (up to 1 hour)
Size of radial artery (mm)
Internal diameter of radial artery
Time frame: Before and after subcutaneous injection of drugs / Before and after catheterization / Before and after removal of the catheter (up to 1 hour)
depth of radial artery (mm)
depth of radial artery from the skin
Time frame: Before and after subcutaneous injection of drugs / Before and after catheterization / Before and after removal of the catheter (up to 1 hour)
flow velocity of the radial artery (cm/s)
flow velocity of the radial artery measured by Doppler ultrasound
Time frame: Before and after subcutaneous injection of drugs / Before and after catheterization / Before and after removal of the catheter (up to 1 hour)
Perfusion index
Perfusion index measured by pulse oximeter sensor at the distally located index finger of radial arterial catheterization
Time frame: Before and after subcutaneous injection of drugs / Before and after catheterization / Before and after removal of the catheter (up to 1 hour)
Overall attempt (number)
Number of attempt of radial artery cannulation
Time frame: During radial artery cannulation (up to 1 hour)
Overall Procedure time (seconds)
From ultrasound guidance, to Arterial waveform
Time frame: During radial artery cannulation (up to 1 hour)
Overall success rate (%)
Success within 2 skin puncture and within 10 minutes
Time frame: During radial artery cannulation (up to 1 hour)
Incidence of posterior wall puncture (%)
Incidence of posterior wall (transfixation technique) puncture during radial arterial catherization
Time frame: During radial artery cannulation (up to 1 hour)
Number of arteries cannulated
Number of arteries cannulated for peripheral arterial catheterization
Time frame: During radial artery cannulation (up to 1 hour)
Malfunction of radial artery catheter
Invasive blood pressure monitoring, Sampling (%)
Time frame: After radial artery cannulation assessed during anesthesia (per 24hour, up to 480 hour)
Complication rate
Hematoma, Distal ischemia, Spasm accessed by ultrasound (%)
Time frame: After radial artery cannulation assessed up to PACU, PICU stay (per 24hour, up to 480 hour)
Duration of radial arterial catherization
Duration of radial arterial catherization (hours, minutes)
Time frame: After radial artery cannulation assessed during anesthesia (up to 480 hour)
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