Dynamic Needle Tip Positioning Modification Technique in Short Axis Approach

Intraoperative Arterial cannulation is recently frequently required especially in high-risk patients or patients with expected major fluid shift.

The most common site for arterial cannulation is the radial artery because of ease of accessibility, dual blood supply to the hand via the ulnar artery, and a low rate of complications. Complications from arterial cannulation include thrombosis, hematoma formation, edema and vasospasm.

Two approaches are basically identified for ultrasound-guided radial artery cannulation, i.e., short-axis out-of-plane (SA-OOP) and long-axis in-plane (LA-IP) techniques.

The dynamic needle tip positioning (DNTP) technique uses the short-axis view of the radial artery with gradual advancing of the needle till reaching the radial artery. Meanwhile, the ultrasound probe is being moved proximally in advance of the needle tip until it disappears from the ultrasound image. The cannula then advanced in the direction of the artery

Inclusion criteria

• Age between 18 and 70 years.
• Both sexes.
• American Society of Anesthesiologists physical status II-IV.
• Patients scheduled for elective surgery procedure that requires the use of invasive arterial pressure monitoring, as determined by the attending anesthesiologist.

Exclusion criteria

• Emergency patients or with Hemodynamic instability.
• Patients who have cellulitis or infection at the site of insertion.
• Patients with a positive modified Allen test.
• Raynaud disease or any Peripheral vascular disease.
• Patients with Multiple previous radial artery interventional therapies in the previous 30 days.
• Patients scheduled for Surgery at site of insertion like forearm flap.
• Refusal to participate by the patient.