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Background and Aims Many studies have compared the short-axis out-of-plane (SA-OOP) to long-axis in-plane (LA-IP) approaches for arterial cannulation, why not combine both techniques in sequence? The SA-OOP approach aligns the site of needle puncture until a bulls-eye configuration is achieved, however the final needle tip position is often missed and sometimes passes through the adventitial tissues. LA-IP imaging ensures that the needle remains centered within the artery and does not drift beyond the vessel.
Methods Radial arterial cannulation was performed using the SA-OOP followed by LA-IP technique with a 20G (3Fr) 8cm Arterial Leadercath (Vygon, Eccoen, France) catheter and a linear 15MHz Aloka ultrasound probe (Toshiba, Japan). The skin entry point was identified by passing an unbeveled needle under the probe until the shadow cast is aligned middle to the artery. The puncture needle was inserted at the identified point 30-45° and advanced 1-3mm until the needle tip was visualized centre to the artery on the SA-OOP view. The ultrasound probe was then rotated 90° to visualize the LA-IP view with the needle in full profile and centered within the artery. The guidewire was inserted, and the cannula threaded over the guidewire.
Results This sequential approach of ultrasound guided SA-OOP followed by LA-IP resulted in a successful first pass radial arterial cannulation using Seldinger technique and a total catherisation time of seven minutes.
Conclusions Doctors can benefit from the advantages of each approach while minimizing its respective limitations. Further studies should be done to assess the overall procedural and patient outcomes.
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