Surgeries Requiring Arterial Lines Clinical Trial
Official title:
A Prospective Study Comparing Palpation Guided and Ultrasound Guided Arterial Catheter Placement by Anesthesiology Residents in Training
When surgery is performed under general anesthesia, a catheter is placed in a vein to
administer drugs and saline. During major operations, an additional catheter is placed in an
artery in order to measure the blood pressure closely and withdraw blood samples at frequent
intervals for various laboratory tests. This arterial catheter is usually placed by feeling
the patient's artery at the wrist and inserting the guide-needle in a blind fashion. This
procedure, at times, leads to delays and failures due to an inability to feel the arterial
pulsation well either due to the patients' anatomy or the anesthetic effect. This study will
determine whether training Anesthesiology Residents in the use of ultrasound technology and
its application in identifying an artery can prevent the problems associated with the
conventional palpation technique. Our finding will lead to better and safer anesthetic
management of patients presenting for a major surgical procedure. Furthermore, the finding
will help us in introducing the education and training of ultrasound-guided arterial
catheter placement in our Residency Program.
The investigators propose to follow anesthesia residents over a course of 3 years assessing
their skill level for both palpation and ultrasound technique.
This is an updated study on a previous IRB-approved research (0120070296) which was
terminated prior to conclusion as the principal investigator terminated his employment at
the UNDNJ. An arterial catheter is routinely placed immediately following induction of
anesthesia, in major operative procedures, in order to measure blood pressure continuously,
perform frequent blood-gas analysis and withdraw blood for repeated laboratory testing. The
arterial catheter is traditionally placed blindly by palpating the radial artery of the
patient. This way of placing a radial artery catheter can encounter delay or failure due to
conditions such as obesity, arteriosclerosis, arterial spasm and anesthesia-induced
hypotension. Our study will compare the performance of Anesthesiology Residents in placing
an arterial catheter by the traditional palpation-guided technique and by the
ultrasound-guided technique after training in ultrasound usage. The comparison will utilize
the following parameters:
- Time taken to successfully place a catheter
- Number of attempts needed to place a catheter
- Number of puncture site changes encountered
- Failure rate of the resident with each technique
- The need for replacement of the catheter during surgery The data collection will be
done by an independent observer, who is not a member of the anesthesia care team or
research team. The Residents performing the catheter placement will not be members of
the research team and will not have access to the data. If the Resident fails to place
the catheter, the attending anesthesiologist will rescue by placing the arterial
catheter himself by a method of his choice. In the previous study, there was a trend
toward a reduced failure rate and a decreased time for insertion with the ultrasound
technique. In this study, the investigators will introduce the research to the
first-year Residents and repeat the exercise during their second and third year of
training in a longitudinal fashion to assess the progress during anesthesia training.
The investigators plan to enroll eight residents from the first-year class. Each
resident will perform eight arterial catheter placements with each technique. In
addition, compared to the previous study, a more advanced ultrasound machine will be
used which will provide better visualization of the radial artery.
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Observational Model: Cohort, Time Perspective: Prospective