| Part ⅠThe associations of increasing depth and diameter with improved success rates in ultrasound-guided dynamic needle tip positioning technique for radial artery catheterizationObjective:To investigate the associations between the success rate and operative time and the diameter and anterior wall depth of radial artery,and further explored the cut-off value when performing the ultrasound guided dynamic needle tip positioning(DNTP).Methods:The data of radial artery puncture and catheterization by DNTP from March 2019 to July 2020 were extracted from the institutional database,including the general characteristics of patients,ultrasonic imaging characteristics of radial artery and puncture and catheterization records.Univariate and multivariate analysis were conducted to explore the correlation between the depth and diameter of the anterior wall of radial artery and the success rate and operation time of first puncture and catheterization.Hosmer lemeshow goodness of fit was used to statistically analyze the goodness of fit of the model.The receiver operating characteristic(ROC)curve was analyzed,and the yoden index was used to define the best boundary value of radial artery depth.Patients were grouped according to the cut-off value,and Kaplan Meier curve analysis was used to comprehensively compare the similarities and differences of success rate and operation time between groups.Results:A total of 119 patients were included.The success rate of first puncture and catheterization was related to the patient’s age(OR 0.94,p=0.033),history of coronary artery disease(CAD)(OR 3.58,p=0.043),radial artery diameter(OR 4.17,p=0.022)and anterior wall depth(OR 6.47,p<0.01).Arterial diameter(p=0.485)and anterior wall depth(p=0.485)significantly increased the fitting degree of the model.The depth of the anterior wall of the artery had a good predictive effect on the success rate of the first puncture(AUC 0.774,p<0.01).The estimated depth cut-off value was 2.25 mm(sensitivity 0.592,specificity 0.333).The depth greater than 2.25mm was significantly correlated with the improvement of the success rate of the first puncture(p<0.028),and with the reduction of the operation time required for the success of the first puncture(log rank,p<0.01).Conclusion:For adult patients with radial artery puncture and catheterization by dNTP method,the depth of the anterior wall is more than 2.25 mm,which can improve the success of the first puncture and catheterization and reduce the operation time.Part ⅡApplication of modified dynamic needle tip positioning in radial catheterization without posterior wall puncture in adults with cardiovascular complicationsObjectives:To investigate the effect of ultrasound-guided modified dynamic needle tip positioning(DNTP)on the success rate and time of radial catheterization in adult patients with cardiovascular disease.Methods:This prospective randomized controlled study was conducted from March 2019 to August 2019.The patients were randomly divided into group A(the depth of the anterior wall of the radial artery at the puncture site was less than 2.25 mm),group B(no less than 2.25 mm)and group C(modified DNTP,the depth of the initial puncture site was less than 2.25 mm,and improved to more than 2.25 mm by subcutaneous injection of saline).The radial artery catheterization were performed by DNTP or modified DNTP,and the success of catheterization without posterior wall puncture,the first-attempt and overall successful catheterization,operation time was recorded.Chi square test and Fisher test,or t test were used to compare the similarities and differences between groups.Kaplan Meier analysis curve was used to analyze the similarities and differences of the operation time required for successful catheterization without posterior wall puncture between the groups.Results:A total of 90 patients were included,with 30 patients in each group.In group C(modified DNTP),compared with group A,the successful catheterization without posterior wall puncture was significantly higher(86.7%vs 56.7%,χ2 6.54,p=0.020),and the operation time required for successful catheterization without posterior wall puncture was reduced(87 seconds vs 106 seconds,χ2 3.23,p=0.072,log rank).There was no significant difference in the first-attempt and overall success rate or catheterization operation time between Group C and A.There was no significant difference in the successful catheterization without posterior wall puncture,first-attempt and overall success rate or catheterization operation time between Group C and B.Conclusions:The modified DNTP is associated with the improved successful catheterization without posterior wall penetration and reduced time required.Part ⅢAnalysis of CUSUM learning curve of radial artery catheterization by ultrasound-guided dynamic needle tip positioning techniqueObjectives:Analyze and describe the learning curve of radial artery catheterization under ultrasound-guided dynamic needle tip positioning(DNTP)by anesthesia residents in Peking Union Medical College Hospital,and explore the learning intensity of supervision practice required to master this technique.Methods:From January 2018 to June 2018,the learning records of two anesthesia residents in the Peking Union Medical College Hospital who perform radial artery catheterization under ultrasound-guided DNTP technique were used to describe the learning curve of cumulative sum analysis(CUSUM).The learning intensities were explored to improve the attempts and time needed for successful catheterization,and first-attempt and overall success rates.The evaluation indexes before and after reaching the learning intensity were compared.Results:Taking the attempts and time needed for successful catheterization,and the first and overall success rate as the evaluation indexes,the learning intensity required for the two trainees to master DNTP was 29/36,29/29,29/36 and 14/11 cases.After reaching this learning intensity,the number of operations required for successful puncture and catheterization decreased significantly(p<0.05),and the time required,the first time and the overall success rate improved.Conclusions:Considering the attempts and time needed for successful catheterization,and first-attempt and overall success rates the learning intensity of the supervision practice needs to reach 36 cases. |
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