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Original Research: CRITICAL CARE |

Ultrasound-Guided Catheterization of the Radial Artery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Ariel L. Shiloh, MD; Richard H. Savel, MD; Laura M. Paulin, MD, MHS; Lewis A. Eisen, MD, FCCP
Author and Funding Information

From the Division of Critical Care Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY.

Correspondence to: Ariel L. Shiloh, MD, Division of Critical Care Medicine, Montefiore Medical Center and The Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; e-mail: arielshiloh@gmail.com


Part of this article has been presented in abstract form at the American College of Chest Physicians 2010 Annual Meeting, Vancouver, BC, Canada, on November 3, 2010 (Shiloh AL, Savel RH, Paulin LM, Eisen LA. Chest. 2010;138:833A).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(3):524-529. doi:10.1378/chest.10-0919
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Published online

Background:  Ultrasound guidance commonly is used for the placement of central venous catheters (CVCs). The Agency for Healthcare Research and Quality recommends the use of ultrasound for CVC placement as one of its 11 practices to improve patient care. Despite increased access to portable ultrasound machines and comfort with ultrasound-guided CVC access, fewer clinicians are familiar with ultrasound-guided techniques of arterial catheterization. The goal of this systematic review and meta-analysis was to determine the utility of real-time two-dimensional ultrasound guidance for radial artery catheterization.

Methods:  A comprehensive literature search of Medline, Excerpta Medica Database, and the Cochrane Central Register of Controlled Trials by two independent reviewers identified prospective, randomized controlled trials comparing ultrasound guidance with traditional palpation techniques of radial artery catheterization. Data were extracted on study design, study size, operator and patient characteristics, and the rate of first-attempt success. A meta-analysis was constructed to analyze the data.

Results:  Four trials with a total of 311 subjects were included in the review, with 152 subjects included in the palpation group and 159 in the ultrasound-guided group. Compared with the palpation method, ultrasound guidance for arterial catheterization was associated with a 71% improvement in the likelihood of first-attempt success (relative risk, 1.71; 95% CI, 1.25-2.32).

Conclusions:  The use of real-time two-dimensional ultrasound guidance for radial artery catheterization improved first-pass success rate.

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