• Jun Takeshita, Takayuki Yoshida, Yasufumi Nakajima, Yoshinobu Nakayama, Kei Nishiyama, Yukie Ito, Yoshiyuki Shimizu, Muneyuki Takeuchi, and Nobuaki Shime.
• Department of Intensive Care Medicine, Osaka Prefectural Hospital Organization, Osaka Women's and Children's Hospital, Osaka, Japan. Electronic address: t-k-s-t@koto.kpu-m.ac.jp.
• J. Cardiothorac. Vasc. Anesth. 2019 Jul 1; 33 (7): 1919-1925.

ObjectiveArterial catheterization for infants and small children is technically challenging. This study evaluated whether the dynamic needle tip positioning (DNTP) technique improved the success rate of ultrasound-guided radial artery catheterization in patients with a radial artery depth ≥4 mm compared with the conventional ultrasound-guided technique.DesignRandomized controlled study.SettingSingle institution, Osaka Women's and Children's Hospital.ParticipantsPatients (n = 40; age <3 years) with artery depth ≥4 mm.InterventionsPatients were divided randomly into 2 groups. The DNTP group received ultrasound-guided radial artery catheterization with DNTP; the conventional group received catheterization without DNTP.Measurements And Main ResultsFirst-attempt success rates were 85% and 50% in the DNTP and conventional groups, respectively (p = 0.018; relative risk = 1.7; 95% CI: 1.06-2.73). Overall success rates within 10 minutes were 95% and 60% in the DNTP and conventional groups, respectively (p = 0.008; relative risk = 1.58; 95% CI: 1.09-2.3). Posterior wall puncture rates were 5% and 50% in the DNTP and conventional groups, respectively (p = 0.0014; relative risk = 0.1; 95% CI: 0.014-0.71). Significantly fewer attempts were made in the DNTP group (median = 1 v 1.5; p = 0.01). The median catheterization times were 38 seconds (34-55.5) and 149 seconds (49.5-600) in the DNTP and conventional groups, respectively (p = 0.0003).ConclusionDynamic needle tip positioning improved first-attempt and overall success rates of ultrasound-guided radial artery catheterization in pediatric patients with a radial artery depth ≥4 mm.Copyright © 2018 Elsevier Inc. All rights reserved.

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