US Guidance for Radial Arterial Puncture in Shock

Ismail Erkan Aydin100 enrolled

Overview

Doctors in the emergency department often need to take blood samples from an artery to understand how well a patient is breathing and how the body is responding to serious illness. This is usually done by inserting a needle into an artery at the wrist. In patients with shock, this procedure can be difficult because blood pressure is low and the pulse may be hard to feel. In this study, two different methods for obtaining arterial blood samples were compared in adult patients presenting to the emergency department with shock. In one group, the radial artery puncture was performed with ultrasound guidance, allowing direct visualization of the artery. In the other group, the procedure was carried out using the conventional palpation technique based on manual detection of the pulse. Patients were randomly assigned to one of the two techniques. The study assessed the success of the procedure on the first attempt, the total number of attempts required, the time needed to obtain a successful sample, and whether puncture of the femoral artery was required when radial access could not be achieved. The aim of the study was to evaluate whether the use of ultrasound improves the efficiency and success of radial artery blood sampling in patients with shock treated in the emergency department.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

100

Conditions

Shock Shock Circulatory

Interventions

Ultrasound-guided radial arterial puncture for arterial blood gas samplingPROCEDURE

Radial artery puncture for arterial blood gas sampling performed under real-time ultrasound guidance. The artery is visualized on the screen and the needle is advanced under direct visualization until arterial blood flow is obtained.

Conventional radial artery puncture for arterial blood gas samplingPROCEDURE

Radial artery puncture for arterial blood gas sampling performed using the conventional palpation technique. The artery is identified by manual palpation and the needle is advanced until arterial blood flow is obtained.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients aged 18 years and older * Patients diagnosed with shock * Patients with an indication for arterial blood gas analysis due to respiratory or metabolic disorders * Patients who provided written informed consent, either personally or through their legal representatives. Exclusion Criteria: * Patients who declined to participate * Patients presenting with cardiac arrest * Patients with a positive Allen test * Patients with a history of coagulopathy * Patients with evidence of infection at the puncture site * Patients with evidence of trauma at the puncture site * Patients with an arteriovenous fistula at the puncture site

Outcomes

Primary Outcomes

First-Attempt Success of Radial Artery Puncture

In the ultrasound-guided group, a stopwatch was started when the ultrasound transducer made contact with the skin over the radial artery. The artery was visualized on the screen, and the needle was advanced under real-time ultrasound guidance until arterial blood flow was obtained. The stopwatch was stopped when arterial blood flow was observed in the syringe, and the procedure was considered successful. Each new puncture attempt was recorded as a separate attempt. In the conventional palpation group, a stopwatch was started when the physician made skin contact after identifying the radial artery by palpation. The needle was advanced into the radial artery until arterial blood flow was obtained. The stopwatch was stopped when arterial blood flow was observed in the syringe, and the procedure was considered successful. Each new puncture attempt was recorded as a separate attempt.

Time frame: During procedure

Secondary Outcomes

The Number of Attempts

Secondary outcomes included the number of attempts until successful puncture, time to successful puncture, and the need for a rescue femoral artery puncture.