Radial Artery Access: Palpation Vs Ultrasound
Presenter
Ramy Sadek, M.D., Olive View-UCLA Medical Center, Sylmar, CA
Ramy Sadek, M.D.1, Quynh Vu, M.D.1, Jonathan Gordin, M.D.2, Daniel Sanchez, M.D.2, Ronney Shantouf, M.D.3 and Jonathan Soverow, M.D.4, (1)Olive View-UCLA Medical Center, Sylmar, CA, (2)Ronald Reagan UCLA Medical Center, Los Angeles, CA, (3)Cleveland Clinic Abu Dhabi, Abu Dhabi, CA, United Arab Emirates, (4)-, Sylmar, CA
Keywords: Peripheral Vascular Disease (PVD) and Vascular Access, Management, and Closure
Background
:
Ultrasound improves first-pass radial access in decreased time but may not be available. (1) By comparing palpation vs. ultrasound-guided location of the radial artery, this study aims to develop a clinical algorithm to improve access technique and to identify patient characteristics that counsel ultrasound use.
Methods
:
All adults undergoing angiography by radial access at a single center were included. We measured the deviation in radial artery location by palpation vs. ultrasound localization. Any needle location not above the radial artery was classified as a ‘miss’. Covariates included age, body mass index, sex, ethnicity, diabetes mellitus, hypertension, hypotension, severe aortic insufficiency (AI), atrial fibrillation, smoking, ejection fraction, and the use of vasodilators. Forward stepwise logistic regression was done to identify variables associated with arterial ‘miss’.
Results
:
Average radial artery diameter was 2.9 mm (SD 0.69 mm). Out of 187 needle locations, 113 (60.4%) were identified as a ‘miss’ with a mean deviation of 1.78 mm outside the vessel wall. Junior (<100 cases) and senior fellows’ deviations differed significantly (2.50 mm vs 1.50 mm respectively, p<0.001). Elders, females, and patients who had AI were more likely to have medially biased access locations (p=0.034). A goodness of fit prediction of medial arterial ‘miss’ based on those variables had a statistically significant Chi square value of 29.9 compared to a model based on chance alone.
Conclusions:
The use of palpation alone was associated with over 60% chance of deviation from the arterial location. Patients who were elderly, female, and had AI were more likely to have medial deviation from the artery.