Original contribution
Ulnar artery versus radial artery approach for arterial cannulation: a prospective, comparative study

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Abstract

Study Objective

To compare the ease of cannulation, success/failure rate, and complication rate between ulnar and radial arteries.

Design

Randomized, controlled study.

Setting

Operating room.

Patients

100 ASA physical status I, II, and III patients undergoing general anesthesia and requiring arterial cannulation.

Interventions

Patients were divided randomly into two separate groups of 50 patients each according to cannulation site: ulnar artery (group U) or radial artery (group R) group.

Measurements

The presence and fullness of the arterial pulses (strong/weak/absent), ease of cannulation (cases in which cannulation was successful on the first attempt and those that which required more than one cannulation attempt), success rate of cannulation, and complications (early/late) were all recorded.

Main Results

The radial artery was stronger in pulse (83% vs 73%). The success rates of cannulations for the ulnar and radial arteries were 82% and 90%, respectively (P > 0.05). The overall success rate of cannulation in the ulnar group with a strong pulse was 100%. There were significant differences in the success rate of cannulation between the patients with strong and weak pulses in the ulnar group (P < 0.0001). Ease of cannulation and complication rates of cannulations were not statistically different in both groups.

Conclusions

The success rate of an arterial cannulation in a patient with a strong ulnar pulse is the same as for radial artery cannulation.

Introduction

Arterial cannulation is a common intervention for frequent arterial blood gas measurements and continuous blood pressure monitoring in the operating room and intensive care unit. Various factors determine the artery used preferentially, including accessibility, ease of placement, presence of collateral flow, and risk of infection and serious embolic phenomena [1]. Although the radial, femoral, dorsalis pedis, brachial, ulnar, and axillary arteries are all accessible sites for cannulation, the literature focuses much more on cannulation of the radial artery. Many anesthesiologists consider radial artery cannulation as the standard technique for hemodynamic monitoring among the upper extremity arteries [2]. There is a tendency to choose the ulnar artery if the radial artery is unsuitable for cannulation [3]. The radial artery is the dominant vessel of the hand [4]. Although the ulnar artery has been mentioned as an alternative site for cannulation, to date, little data exist as to its efficacy and complications. Therefore, this study compared the feasibility, success/fail rate, and safety of the ulnar and radial approaches for arterial cannulation.

Section snippets

Materials and methods

After obtaining the approval of the Ondokuz Mayis University Hospital's local ethics committee and written, informed consent, 100 ASA physical status I, II, and III patients aged 18 to 65 years, undergoing general anesthesia and requiring arterial cannulation, were enrolled in the study. Exclusion criteria included diabetes mellitus, an abnormal Allen test, Raynaud syndrome, and other vascular diseases. For patients who were finally selected for the study, a balanced randomization method, which

Results

Demographic data and duration of cannulation of the study groups are summarized in Table 1. There was no difference between groups in age, gender distribution, ASA physical status, or BMI (P > 0.05).

Evaluation of radial arterial pulses rated 83% as strong, 15% as weak, and 2% as absent (Table 2). Examination of ulnar arterial pulses showed that 73% were strong, 26% weak, and 1% absent. The success rates of cannulation for the ulnar and radial arteries were 82% and 90%, respectively (P > 0.05).

Discussion

The results of this study suggest that although the overall success rate of cannulation in the ulnar group (82%) was lower than that of the radial group (90%), the success rate of ulnar cannulation in patients with a strong pulse was extremely high (100%), and complication rates of cannulations were not statistically different in the ulnar or radial artery cannulation groups.

Anatomical dissections and radionucleotide flow studies of the ulnar and radial arteries at the wrist have shown that the

Acknowledgment

The authors thank Prof. Dr. YS Baris for his critical review of this manuscript.

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