Abstract
Background:
Radial artery catheterization (RAC) remains challenging, with a high failure rate. This study investigated whether ultrasound-measured radial artery (RA) diameter could predict RAC failure in patients undergoing major cardiac or vascular surgery.
Methods:
Consecutive patients scheduled for major cardiac or vascular surgery were prospectively included. Ultrasound images of the left RA were acquired by one operator, while a second operator, blinded to these images, performed RAC using the palpation method. RAC failure was defined as three or more attempts, a change in operator, or cannulation site. All ultrasound images were subsequently analyzed by an expert vascular physician, also blinded. RA internal diameter and depth were measured. Intra- and inter-observer reproducibility were assessed.
Results:
Of 247 patients, 58 (23%) experienced RAC failure. Absent or weak radial pulse (OR 6.36, 95% CI 2.59–15.65; p < 0.001), female sex (OR 2.55, 95% CI 1.36–4.77; p = 0.003), and wrist circumference <18 cm (OR 1.96, 95% CI 1.08–3.54; p = 0.03) each significantly increased RAC failure risk. The RA internal diameter was significantly smaller in the failure group (1.9 ± 0.4 vs 2.1 ± 0.4 mm, p < 0.01). RA was also deeper in the failure group (3.4 ± 1.6 vs 2.9 ± 1.1 mm, p = 0.05). The area under the curve for RA internal diameter to predict RAC failure was 0.62 (95% CI 0.53–0.70, p = 0.007), with an optimal threshold of 1.8 mm. RAC failure prolonged anesthesia induction and doubled the risk of hematoma (p < 0.001). Intra- and inter-observer agreement for RA internal diameter were excellent (ICC 0.86, 95% CI 0.78–0.92 and 0.94, 95% CI 0.91–0.97, respectively).
Conclusion:
A small RA internal diameter significantly increases RAC failure risk. These findings should inform cannulation site selection, technique, and operator choice to improve procedural success and patient safety.
Keywords
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