Ultrasound-guided arterial catheterization with acoustic shadowing technique: A randomized controlled trial

Background: Ultrasound-guided dynamic needle tip positioning (DNTP) and acoustic shadowing technologies demonstrate superior efficacy to palpation in improving radial artery catheterization success rates. This study aimed to evaluate the benefits of combining DNTP with acoustic shadowing technology for patients undergoing radial artery catheterization. Method: In this randomized controlled study conducted at a single center, 152 patients requiring radial artery catheterization during anesthesia were enrolled. Participants were randomly assigned to either the ultrasound-guided acoustic shadowing combined with dynamic needle tip positioning (AS-DNTP) group or the DNTP group (1:1). All procedures were performed by experienced operators. The primary outcome was the number of needle tip retractions and directional corrections, while the secondary outcomes included the first-pass success rate, total number of attempts, ultrasound localization time, overall operating time, length of the intra-arterial catheter, needle tip position score, and overall complications. Results: The AS-DNTP group demonstrated fewer total needle tip retractions and directional corrections (2.22 ± 1.06 vs 2.84 ± 1.18, p = 0.001), and a higher first-pass success rate (96.10%, 74/77 cases) compared to the DNTP group (86.67%, 65/75 cases), with an absolute difference of 9.44% (95% confidence interval (CI): 0.31%–19.28%; p = 0.038). Additionally, the AS-DNTP group had a lower overall number of attempts (1.04 ± 0.195 vs 1.13 ± 0.342, p = 0.038) and a shorter ultrasound localization time (6.78 ± 2.28 s vs 7.57 ± 2.55 s, p = 0.045). Conclusion: AS-DNTP technology holds the potential to reduce the need for needle tip retractions and directional corrections during radial artery catheterization while increasing the first-pass success rate and decreasing the ultrasound localization time.