Ultrasound beats touch for quick, accurate transradial access

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First-pass success for transradial access of cardiac catheterization improved by more than 20 percent when ultrasound was used to guide the puncture, according to a study published online Jan. 14 in Journal of the American College of Cardiology: Cardiovascular Interventions.

The multicenter trial randomized 698 patients undergoing transradial cardiac catheterization to either real-time ultrasound-assisted or palpation-needle insertion. Arnold H. Seto, MD, MPA, a cardiologist at the Long Beach Veterans Affairs Medical Center in California., and colleagues compared the number of forward attempts required for access, first-pass success rate and time to access for the two techniques.

They found that the mean number of attempts was nearly halved by ultrasound guidance (1.65 vs. 3.05). Success at the first pass occurred in 64.8 percent of ultrasound cases as opposed to 43.9 percent of palpation cases. Physicians took less time to access the artery with ultrasound (88 seconds vs. 108 seconds). Difficult access procedures decreased significantly between the two groups; five or more attempts were made in 18.6 percent of palpation cases while in ultrasound only 2.4 percent.

They found there were no significant differences between the two groups in bleeding complications, patient reported pain scores following the procedure or operator-reported spasm. Ten patients who were initially in the palpation group switched over to ultrasound guidance when access attempts failed through five minutes. Of these patients, 80 percent were ultimately successfully accessed via ultrasound.

Seto et al wrote that the findings of the RAUST (Radial Artery access with Ultrasound Trial) study were generalizable. They noted that as ultrasound screening could detect small arteries, occlusions, calcifications or anatomical variations, early use “may aid in the selection of sheath sizes or access site to minimize spasm or procedural failure.”