Patitent Risk Factors And Predictive Model For The Failure Of Radial Artery Puncture And Catheterization

Objectives:Radial artery catheterization can be used for continuous and accurate monitoring of blood pressure,and it has become one of the most important techniques in perioperative monitoring.This study aims to explore the radial artery catheterization,the risk factors of the patients with failure on the first needle,and to develop a predictive model for the high efficiency of clinical evaluation before operation,at the same time for the clinical teaching work and ultrasound assisted radial artery cannulation.Method:239 patients who underwent radial artery puncture and catheterization were selected and divided into 2 groups according to the first puncture and catheter placement:(1)radial artery first puncture catheterization successfully group(n=171);(2)radial artery first puncture catheter failure group(n=68).The patients who underwent radial artery puncture and catheterization in our hospital from March 2017 to September 2017 were selected.The ASA I to III levels were collected,and relevant factors such as patients,operators and operation facilities were collected,and the operation of radial artery puncture and catheterization was recorded.A statistical method was used to analyze the risk factors of the failure of the radial artery first needle puncture and set up a prediction model.Result:The number of cases included in the experiment was 239 cases,the first needle puncture catheter successful group was 171 cases,the first needle puncture tube failure group had 68 cases,and the success rate of the first needle puncture catheterization was 71.5%.All the patients in the failure group were successfully punctured with ultrasound guidance.Comparing the first needle puncture success group and the first needle puncture failure group,we choose the risk factor which P is less than 0.2 to Logistic regression analysis: patients older than 70 years of age,preoperative hypotension,vascular anatomic abnormalities,obesity,hyperlipidemia,coronary heart disease,and patients with arrhythmia.There was no statistical significance between sex,BMI light and normal,hypertension,diabetes,smoking,peripheral vascular disease and renal insufficiency.Logistic regression analysis of the risk factors were operated again,and older than 70 years(P<0.05),preoperative hypotension(P<0.05),abnormal vascular anatomy(P<0.05)and coronary heart disease(P<0.05)are risk factors for the first radial artery needle puncture failure.The forecast models are as follows: the first prediction model: the dangerous quantity model and the second forecast model: the multiple regression forecasting model of the risk factors.Model two formula: Logit(P)=0.819*over 70 years of age(older than 70 years older than =1,less than 70 year old =0)+1.566*preoperative hypotension(hypotension =1,non hypotension =0)+1.659*abnormal vascular anatomy(abnormal =1,normal =0)+1.469*coronary heart disease(CHD =1,normal =0)-1.693.The area under the ROC curve of the two models is 0.660 and 0.728,respectively.Conclusion:After screening and analyzing many factors,we found that the risk factors for failure of the first puncture catheter for radial artery were: over 70 years old,hypotension before operation,anatomic abnormalities of blood vessels and coronary heart disease.At the same time,the multiple regression prediction model is suitable for the clinician to carry out the risk assessment tool before the puncture and catheterization.