Comparing arterial catheterisation by palpation or ultrasound guidance by novice nurses in an adult intensive care unit: Aprospective cohort study

Abstract

Background: Arterial catheterisation is a common procedure in intensive care units (ICUs), typicallyperformed using the palpation technique. Ultrasound (US)-guided catheterisation remains underutilised,particularly when performed by nonphysician operators. Objective: The objective of this study was to assess the effectiveness of US-guided arterial catheterisationperformed by nurses in critically ill patients. Methods: This prospective cohort study took place in a medical ICU at a tertiary university hospital,comparing outcomes before and after a training program. Critically ill patients requiring arterial catheterisationwere included. The study examined the performance and complications associated with twocatheterisation techniques used by critical care nurses: palpation (PP) and US-guided. Nurses inexperiencedwith the US technique completed a brief training program consisting of two 3-h workshops followedby supervised clinical practice before performing the procedure. Collected data included the firstattemptsuccess rate (primary endpoint), overall success rate, procedure time, the number of attempts,the number of cannulas used, complication rate, and catheter durability. Results: The study included 175 patients, with 89 in the PP group and 86 in the US group. Baselinecharacteristics were similar between groups. The first-attempt success rate was 50% in the PP group and58% in the US group (p ¼ 0.39, 95% confidence interval -23.4% to þ8.3%). No significant differences wereobserved between groups in terms of failed attempts (21.3% vs. 14%, p ¼ 0.28), procedure time (284 s vs350 s, p ¼ 0.44), or rates of immediate (haematoma) and late (catheter infection or dysfunction) complications.Catheter durability was also comparable. Although radial artery cannulation was preferred inboth groups, femoral and brachial access were more frequently used in the US group (12.9% and 2.9% vs.17.6% and 14.9%, respectively, p ¼ 0.02). Conclusions: Arterial catheterisation using US guidance, performed by nurses with limited prior experienceafter a brief training course, demonstrated similar performance and complications rates comparedto the traditional PP technique in a medical ICU setting.