COMPARISON OF THE OUTCOME OF THE SHORT-AXIS OUT-OF-PLANE ULTRASOUND VERSUS LONG-AXIS IN-PLANE ULTRASOUND GUIDE RADIAL ARTERY CANNULATION AT TERTIARY CARE HOSPITAL, KARACHI
Main Article Content
Keywords
Radial artery cannulation, short-axis out-of-plane, long-axis in-plane, ultrasound guidance
Abstract
Introduction: Radial artery cannulation is essential for hemodynamic monitoring and blood sampling in critical care. Ultrasound guidance improves success rates over palpation, with short-axis out-of-plane (SA-OOP) and long-axis in-plane (LA-IP) as primary techniques. This study compares their outcomes in a tertiary care setting.
Objective: To compare the outcomes of SA-OOP versus LA-IP ultrasound-guided radial artery cannulation at a tertiary care hospital in Karachi.
Materials and Methods: A randomized controlled trial at the Department of Anesthesia, National Institute of Cardiovascular Diseases, Karachi, from 21st July, 2022 to 22nd January, 2023, enrolled 152 patients (76 per group). Patients aged 18–70 years, ASA II-IV, were included; those with non-consent, negative Modified Allen’s test, or local infection were excluded. Outcomes included first-attempt success, ultrasound location time, and cannulation time, analyzed using SPSS Version 20.
Results: SA-OOP showed higher first-attempt success (89.5% vs. 73.7%, p = 0.012), shorter ultrasound location time (6.03 ± 1.81 vs. 15.09 ± 2.45 seconds, p < 0.001), but longer cannulation time (29.47 ± 7.78 vs. 26.29 ± 4.02 seconds, p = 0.002).
Conclusion: SA-OOP enhances first-attempt success and localization efficiency, making it preferable for radial artery cannulation.
References
2. Cao, L., Tan, Y.T., Wei, T. and Li, H., 2023. Comparison between the long-axis in-plane and short-axis out-of-plane approaches for ultrasound-guided arterial cannulation: a meta-analysis and systematic review. BMC anesthesiology, 23(1), p.120.
3. Rajasekar, M., Sukumar, S. and Selvaraj, V., 2022. Comparison of success rates of different methods of ultrasound-guided radial artery cannulation (short-axis and long-axis methods) against the traditional palpatory method: a prospective randomized study. Turkish Journal of Anaesthesiology and Reanimation, 50(1), p.52.
4. Wang, J., Weng, X., Huang, Q., Lai, Z., Zhao, Z., Lan, J., Wu, G., Lin, L., Su, J., Liu, J. and Zhang, L., 2022. Modified long-axis in-plane ultrasound-guided radial artery cannulation in adult patients: a randomized controlled trial. Anaesthesia Critical Care & Pain Medicine, 41(1), p.100989.
5. Bhandari, B.M., Shuja, H., Ali, S.M., Bokhari, S. and Ali, L., 2023. To compare the frequency of first attempt successful ultrasound guided radial artery cannulation by modified short axis out-of-plane technique versus conventional long axis in-plane technique. The Professional Medical Journal, 30(10), pp.1235-1240.
6. Tan, Y., Tu, Z., Ye, P., Xu, Y., Ye, M., Bai, L. and Liu, L., 2022. Ultrasound guidance for internal jugular vein cannulation in neonates: modified dynamic needle tip positioning short-axis out-of-plane technique versus long-axis in-plane technique, a randomized controlled trial. The Journal of Vascular Access, 23(6), pp.922-929.
7. Mesa, B.K., Sinha, M., Kumar, M., Ramchandani, S., Dey, C., Agrawal, N. and Khetarpal, M., 2024. Radial arterial cannulation by ultrasound-guided dynamic needle-tip positioning using the short-axis out-of-plane approach versus the long-axis in-plane approach: a randomized controlled study. Cureus, 16(2).
8. Wang, H.H., Wang, J.J. and Chen, W.T., 2022. Ultrasound-guided short-axis out-of-plane vs. long-axis in-plane technique for radial artery catheterization: an updated meta-analysis of randomized controlled trials. European Review for Medical & Pharmacological Sciences, 26(6).
9. Sung, J.M., Jun, Y.E., Do Jung, Y. and Kim, K.N., 2023. Comparison of an ultrasound-guided dynamic needle tip positioning technique and a Long-Axis In-Plane technique for Radial Artery Cannulation in older patients: a prospective, randomized, controlled study. Journal of Cardiothoracic and Vascular Anesthesia, 37(12), pp.2475-2481.
10. Mishra, A., Kumar, M., Kumar, N., Goyal, K., Soni, K.D. and Yadav, A., 2023. Short-axis versus long-axis approach for ultrasound-guided vascular access: An updated systematic review and meta-analysis of randomised controlled trials. Indian Journal of Anaesthesia, 67(Suppl 4), pp.S208-S217.
11. Sultana, S., Sharma, A., Mukesh, A., Goyal, S., Rathod, D., Kumari, K., Meshram, T., Bhatia, P., Kothari, N. and Goel, A.D., 2024. Ultrasound-guided short-axis out-of-plane versus long-axis in-plane technique of Posterior Tibial Artery Cannulation in adult patients: The POTACUT (POsterior Tibial Artery Access with Ultrasound Trial) Randomized Trial. The Journal of Vascular Access, p.11297298241276248.
12. Cao, Y., Su, J., Fan, H., Kang, K., Zhang, J. and Cui, M., 2021. Comparison of three ultrasound-guided radial artery cannulation methods performed by anaesthesia residents: A prospective randomized controlled trial.
13. Arul, A.R., Kumara, V. and Rai, G., 2024. Prospective Randomized Study of Ultrasound Guided In-Plane Versus Out-Of-Plane Radial Artery Cannulation in Adult Cardiac Surgery Patients. Sri Lankan Journal of Anaesthesiology, 32(2).
14. Sethuraman, R.M., 2025. Reflections on:“Comparison of in-plane versus out-of-plane ultrasound-guided radial artery cannulation”.
15. Yu, L., Zhong, H., Jiang, Y., Zhang, W. and Liu, Z., 2022. Modified long-axis in-plane technique for radial artery cannulation in children: A randomized controlled trial. Frontiers in Medicine, 8, p.780375.
16. Baidya, M., Sinha, M., Kumar, M., Agrawal, N., Ramchandani, S., Sandeep, G. and Vijapurkar, S., 2024. A Randomized Study Comparing Ultrasound-Guided Internal Jugular Vein Cannulation Using Two Techniques: Short-Axis Out-of-Plane With Dynamic Needle Tip Positioning Versus Long-Axis In-Plane. Cureus, 16(6).
17. Chiew, A.W.L., Macachor, J. and Leong, G.H., 2023. # 35799 Real time ultrasound guided radial artery cannulation: case report sequential short-axis out of plane followed by long-axis in-plane insertion using a seldinger technique with vygon.
18. Huang, H.P., Zhao, W.J., Wen, F. and Li, X.Y., 2021. Application of ultrasound-guided radial artery cannulation in paediatric patients: a systematic review and meta-analysis. Australian Critical Care, 34(4), pp.388-394.