• Nigopan Gopalasingam, Marlene A Hansen, Sofie Thorn, Erik Sloth, and Peter Juhl-Olsen.
• Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus N - Denmark.
• J Vasc Access. 2017 Nov 17; 18 (6): 546-551.

IntroductionThe palpation technique is generally used for radial artery catheterisation, but is associated with a high rate of failure and complications. Dynamic needle tip positioning (DNTP) is a new ultrasound-guided technique. We aimed to compare the traditional palpation technique with DNTP performed by four anaesthesiology residents.MethodsThe study was a randomised, controlled, patient-blinded, crossover study. Fourty patients underwent bilateral radial artery catheterisation using both techniques. The primary endpoint was the first attempt success rate. The secondary endpoints were: 1) number of skin perforations, 2) number of needle retractions, 3) needle manipulation time, 4) total time, 5) attempts lasting >180 seconds, 6) number of catheters used, 7) frequency of aborted attempts or crossovers, and 8) pain scores (VAS).ResultsThe first attempt success rate was significantly higher in the DNTP group compared with the palpation group (36/40 vs. 28/40, p = 0.022).The palpation technique group required a higher number of skin perforations (44 vs. 60, p = 0.016), needle retractions (p = 0.001) and catheters (42 vs. 52, p = 0.011) compared with the DNTP group. Neither the total time required for arterial catheterisation, the needle manipulation time nor the VAS scores were significantly different between the groups (all p>0.407). Aborted attempts were only seen in the palpation group (7/40, p = 0.016).ConclusionsUltrasound-guided arterial catheterisation using the DNTP technique is superior to the standard palpation technique. This study favours the ultrasound-guided DNTP technique as the first choice rather than merely being viewed as a rescue procedure.

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