Is There More To Wrist Extension Using SonicEye Finger Probe versus Classic Linear Probe Ultrasound to Assess Radial Artery Movement Prior To Cannulation and Blood Draw?

MOUSSELLI Robert1, Cody LAVERDIERE1, Brion BENNINGER1-9. Medical Anatomy Center1, Departments of Medical Anatomical Sciences2, Neuromuscular Medicine3, Family Practice4, Western University of Health Sciences, COMP–Northwest,... [ view full abstract ]

MOUSSELLI Robert1, Cody LAVERDIERE1, Brion BENNINGER1-9. Medical Anatomy Center1, Departments of Medical Anatomical Sciences2, Neuromuscular Medicine3, Family Practice4, Western University of Health Sciences, COMP–Northwest, Lebanon, OR. USA. Departments of Orthopaedics5, General Surgery6 and Sports Medicine7, Samaritan Health Services, Corvallis, OR. USA. Departments of Surgery8, Orthopaedics & Rehabilitation9, Oregon Health & Science University, Portland, OR. USA.

INTRODUCTION. "Extend the wrist and the radial artery will come to the surface and make that cannulation or arterial blood gas draw easier.” Often spoken words, but are they an old wives tale or accurate? The radial artery (RA) has gained popularity within the cardiac arteriogram discipline. Many users are shifting from the old gold standard of the femoral artery to the RA. The anatomy just proximal to the wrist is dense in structures. Each structure lives within a plane that is relatively finite. The objective of this study was to use ultrasound to investigate if the RA moves significantly to the surface during wrist movement enabling invasive procedures. METHODS. Literature search was conducted to investigate dynamic RA measurements in multiple positions during wrist movement with different ultrasound probes. Healthy volunteers (N=152:304 sides, Age 20-42) were used. Exclusion criteria consisted of wrist or upper limb vascular surgery. Fukuda-Denshi ultrasound system UF760-AG was used with a classic linear probe (5-12 MHz) and a novel SonicEye finger probe (5-12 MHz). Two examiners performed 3 measurements at 3 positions of the RA from a set proximal wrist point to skin surface (wrist in neutral, 45 degrees flexion and extension). RESULTS. Literature search revealed no dynamic measurement studies of RA in multiple positions. RA moved up to 2.5mm deeper or posterior from the neutral position during 45 degrees flexion and moved up to 0.7mm superficially or anteriorly during 45 degrees wrist extension. DISCUSSION. Statistical analysis of RA depth demonstrated no statistical significance between Rt and Lt sides in neutral position. Extension may also reduce risk of damage to neighboring structures (median nerve). which may also be beneficial. Compression of veins during extension, which lie adjacent to the RA could also be useful. CONCLUSION. Ultrasound can be used to determine RA location, depth and relation to intimate anatomic structures in various positions to allow safe, confident and consistent cannulation and ABG draws. Wrist extension may protect the surrounding structures more than causing anterior RA movement.