Long-term Effects of Radial Artery Cannulation on Vessel Diameter, Blood Flow and Fine Motor Skills

Kartal City Hospital103 enrolled

Overview

This observational study examined changes in blood vessel diameter, blood flow, and fine motor performance after ultrasound-guided radial artery cannulation in adults undergoing elective cardiac surgery. Ultrasound measurements of the radial and ulnar arteries and Purdue Pegboard tests of hand performance were obtained before cannulation and during follow-up for three months. Measurements were compared over time within each participant and between the relevant arteries or hands.

This single-centre prospective longitudinal observational study was conducted in the Department of Cardiovascular Surgery at Pamukkale University Faculty of Medicine. Adults aged 18-80 years with American Society of Anesthesiologists physical status I-III who required radial arterial monitoring during elective cardiac surgery were recruited consecutively from 22 July to 2 September 2016. Baseline assessments were performed in all 103 enrolled participants. Radial and ulnar artery internal diameter, peak systolic velocity, end-diastolic velocity, resistive index, pulsatility index, and mean volume flow were assessed before cannulation and at seven subsequent time points over three months. Purdue Pegboard performance was assessed before cannulation, 10 days after baseline, and three months after baseline. Comparisons were made within participants over time, between the radial and ulnar arteries of the cannulated arm, and between the cannulated left and non-cannulated right hands; bimanual performance was assessed separately. Fifty participants completed all reported assessments and were included in the complete-case analysis. The other 53 participants did not complete follow-up because of death (7), severe postoperative morbidity (13), incomplete follow-up attendance (22), or technical or organizational reasons (11). Individual-level partial records for these 53 participants were unavailable for reanalysis. The study received ethics committee approval on 19 July 2016, and written informed consent was obtained before study procedures. The investigation originated as a medical specialty thesis completed in 2017 and was retrospectively registered in 2025.

Study Type

OBSERVATIONAL

Enrollment

103

Conditions

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age 18-80 years. * American Society of Anesthesiologists physical status I-III. * Scheduled for elective cardiac surgery, including coronary artery bypass grafting, valve surgery, the Bentall procedure, or atrial septal defect repair. * Requirement for radial arterial monitoring. Exclusion Criteria: * Emergency surgery. * Haemodynamic instability. * Planned femoral arterial cannulation. * Body mass index \>35 kg/m². * Peripheral vascular disease. * Infection at the puncture site. * An abnormal pulse-oximetry-assisted modified Allen screening result.

Outcomes

Primary Outcomes

Changes in radial and ulnar artery diameter and Doppler parameters over three months

Internal anteroposterior diameter (mm), peak systolic velocity (cm/s), end-diastolic velocity (cm/s), resistive index (unitless), pulsatility index (unitless), and mean volume flow (mL/min) of the radial and ulnar arteries in the cannulated arm were measured by ultrasound. Each value was the mean of three independent acquisitions. Each parameter was analysed separately for changes from baseline and differences between arteries. T1 was 1 minute after anesthesia induction following cannulation; T2 was 30 minutes after cannulation; T3 was postoperative day 1; T4 was 3 days after cannulation; T5, T6 and T7 were 10 days, 1 month and 3 months after baseline, respectively.

Time frame: Before cannulation (T0); 1 minute after anesthesia induction (T1); 30 minutes after cannulation (T2); postoperative day 1 (T3); 3 days after cannulation (T4); 10 days (T5), 1 month (T6), and 3 months (T7) after T0.

Changes in Purdue Pegboard fine motor performance over three months

Fine motor performance was assessed using the Purdue Pegboard Test (Model 32020). The right hand, left hand, and both hands together were tested in separate 30-second subtests. Unilateral scores counted successfully inserted pins; bimanual scores counted completed pin pairs, with one pin placed by each hand. Each subtest was repeated three times and the mean score was analysed. Higher scores indicate better performance. The left hand was the cannulated hand and the right hand was the non-cannulated hand. Unilateral performance was compared between hands and over time; bimanual performance was analysed separately over time. The 60-second assembly subtest was not performed.

Time frame: Before cannulation (T0), 10 days after T0 (T5), and 3 months after T0 (T7).