Ultrasound-Guided Long-Axis Versus Short-Axis Femoral Artery Catheterization in Neonates and Infants Undergoing Cardiac Surgery: A Randomized Controlled Study

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 36; no. 3; pp. 677 - 683
• Main Authors: Abdelbaser, Ibrahim, Mageed, Nabil A., Elmorsy, Mohamed M., Elfayoumy, Sherif I.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2022
• Subjects: Cardiac Surgical Procedures; catheterization; Catheterization, Central Venous - methods; Catheterization, Peripheral - methods; Child; femoral artery; Femoral Artery - diagnostic imaging; Femoral Artery - surgery; Humans; Infant; Infant, Newborn; infants; long axis; neonate; Prospective Studies; Ultrasonography, Interventional - methods; ultrasound; catheterization; neonate; infants; femoral artery; ultrasound; long axis
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2021.05.036

•Femoral artery is a good alternative to radial artery catheterization in neonates and infants.•Ultrasound guidance increases the success rate and reduces the rate of complications of arterial catheterization.•LAX technique resulted in a higher first puncture success rate and shorter time to cannulation than the SAX. The objective of the present study was to compare ultrasound-guided long-axis (LAX) and short-axis (SAX) femoral artery catheterization in neonates and infants undergoing cardiac surgery. A single-center, prospective, randomized, single-blinded, controlled study. This study was conducted in the operating room and intensive care unit of the division of cardiac surgery, Mansoura University Children's Hospital, Egypt. Ninety neonates and infants undergoing elective cardiac surgery were enrolled in this study and randomly allocated to ultrasound-guided LAX and SAX groups. Ultrasound-guided femoral artery catheterization was done using either LAX (in-plane) or SAX (out-of-plane) technique. The primary outcome measure was the rate of a successful first puncture. The secondary outcome measures were the rates of mechanical complications, failure rate, time to a successful first, second, and third puncture, total time of catheterization, and imaging time. The first puncture success rate was significantly higher (p = 0.048) in the LAX group (34 of 41, 82.9%) than in the SAX group (25 of 41, 60.9%). The mean time to a successful first puncture was significantly shorter (p < 0.001) in the LAX group (153.1 ± 30.1 seconds) than in the SAX group (227.2 ± 48.8 seconds). The total catheterization time was significantly shorter in the LAX group than in the SAX group. There was no significant difference in the rate of complication. With a single experienced operator performing the ultrasound-guided femoral artery cannulation, the LAX technique resulted in a higher first puncture success rate and shorter time to cannulation than the SAX technique.