Feasibility Analysis Of Ultrasound-Guided Posterior Tibial Artery Cannulation In Adults

Research BackgroundArterial cannulation is a common operation in anesthesiology department,and mainly used for dynamic pressure measurement and establishment of blood gas analysis channels.At present,the dorsalis pedis artery is usually used for blood pressure monitoring of the lower extremities in adults.However,the dorsalis pedis artery is usually slender and irregular,so it is not an ideal approach for cannulation.The posterior tibial artery is a branch of the popliteal artery.It has a relatively fixed walking in the medial malleolus and few branches.As an approach for artery cannulation,it has been used safely in severe pediatric for many years.However,in adults,the posterior tibial artery is not easily palpable because of its deep position,thus it is rarely used in clinical practice.The development of ultrasound visualization provides convenience for clinical operation and makes it possible for adults to have high-quality posterior tibial artery puncture.Ultrasound-guided posterior tibial artery cannulation has been studied in young children,revealing that anatomical characteristics are more advantageous than that of the dorsalis pedis artery,and the success rate of ultrasound-guided cannulation is higher than the dorsalis pedis artery.Therefore,it is an ideal appraoch for artery cannulation in young children.However,in the adult population,there is no relevant report.This study aims to evaluate the feasibility of the posterior tibial artery as an approach for ultrasound-guided lower-extremity arterial cannulation in adults.This study is divided into two parts.The first part is to evaluate whether the posterior tibial artery as an approach for arterial cannulation is comparable with the radial and dorsalis pedis artery in terms of anatomical dates using an observational study.In the second part,the data on ultrasound-guided cannulation of the posterior tibial and dorsalis pedis artery are compared by a prospective randomized controlled study,to evaluate the feasibility of ultrasound-guided cannulation of the posterior tibial artery in adults.Part I Observational Study on Anatomical Data of Posterior Tibial ArteryAims:To evaluate whether the posterior tibial artery as an approach for arterial cannulation is comparable with the radial artery and the dorsalis pedis artery in terms of anatomical dates.Methods:Observational study was used to measure the arterial depth(D)and arterial inner diameter(d)of the radial arteries,dorsalis pedis arteries and posterior tibial arteries under ultrasound guidance on sixty patients.Results:An observational study of sixty patients found that the total loss rate of the dorsalis pedis arteries was 3.3%.There was no significant difference between the right and the left side dates of arterial depth and arterial inner diameter among three kinds of arteries(P>0.05).The posterior tibial artery(4.23 ±1.52mm)was deeper than the radial artery(2.48±0.70mm)and dorsalis pedis artery(1.72 ± 0.63mm),the difference was statistically significant(P<0.001).The inner diameter of the posterior tibial artery(2.68±0.51mm)was similar to that of the radial artery(2.62±0.49mm),and was significantly larger than that of the dorsalis pedis artery(2.11±0.49mm,P<0.001).The correlation analysis between general data and anatomical data suggested that the body height and BSA were positively correlated with the inner diameter of these arteries(P<0.05),but not correlated with their arterial depth(P>0.05).The correlation between the BSA and the inner diameter in the radial,dorsalis pedis or posterior tibial artery was higher with the pereason coefficients of 0.533(P<0.001),0.281(P<0.05)and 0.534(P<0.001)respectively.Body weight was positively correlated with the inner diameter of each artery(P<0.05),and positively correlated with the arterial depth of the radial and dorsalis pedis artery(P<0.05)but not posterior tibial artery(P>0.05).Age,cuff blood pressure and heart rate were not related to the arterial depth and inner diameter of each artery(P>0.05).Conclusion:Compared with the dorsalis pedis artery,the posterior tibial artery has more stable anatomical characteristics and thicker inner diameters,which can be considered as anatomical advantages of ultrasound-guided arterial cannulation in adults.Part? Prospective Randomized Controlled Study on Arterial Cannulation in Posterior Tibial ArteryAims:To evaluate the feasibility of ultrasound-guided posterior tibial artery cannulation in adults.Methods:Prospective randomized controlled study was used.Sixty patients were randomly divided into dorsalis pedis artery group(group D)and posterior tibial artery group(group P),used ultrasound-guided long-axis in-plane technique to puncture dorsalis pedis artery or posterior tibial artery respectively.The success rate and the time of initial cannulation,the rate of artery posterior wall puncture and the incidence of complications were recorded.Results:A prospective randomized controlled study of sixty patients found that there were no significant difference in the initial cannulation success rate,the total failure rate and the incidence of hematoma between two groups(93%vs 83%,3%vs 0%,10%vs 0%,P>0.05).Compared with D group,P group had a lower artery posterior wall puncture rate(17%vs 41%)and a longer initial cannulation time(33.04±6.67s vs 28.96 ± 4.71s),the differences between two groups were statistically significant(P<0.05).Conclusion:Ultrasound-guided arterial cannulation of posterior tibial artery is a feasible method for lower-limb artery cannulation in adults.