PT  - JOURNAL ARTICLE
AU  - Chiew, Alyssa Wan-ling
AU  - Macachor, Joselo
AU  - Leong, Gee Huey
TI  - #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
AID  - 10.1136/rapm-2023-ESRA.645
DP  - 2023 Sep 01
TA  - Regional Anesthesia & Pain Medicine
PG  - A340--A341
VI  - 48
IP  - Suppl 1
4099  - http://rapm.bmj.com/content/48/Suppl_1/A340.2.short
4100  - http://rapm.bmj.com/content/48/Suppl_1/A340.2.full
SO  - Reg Anesth Pain Med2023 Sep 01; 48
AB  - Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA PrizesBackground 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.Abstract #35799 Figure 1 Short-axis out-of-plane approachAbstract #35799 Figure 2 Arterial Leadercath catheterAbstract #35799 Figure 3 Long-axis in-plane approachConclusions 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.