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Letter to the Editor | Volume 29 Issue:1 (Jan-March, 2024) | Pages 46 - 47
SK-TRAC: A Technique for Radial Artery Cannulation - There is Always an Alternative
 ,
1
MD, DM Cardiac Anaesthesia, Professor, Department of Anaesthesiology and Critical Care, Command Hospital Airforce, Bangalore, India
2
MBBS, Junior Resident, Department of Anaesthesiology and Critical Care, Command Hospital Airforce, Bangalore, India
Under a Creative Commons license
Open Access
Received
Feb. 1, 2024
Revised
Feb. 29, 2024
Accepted
March 31, 2024
Published
April 10, 2024
Abstract
Dear Editor

Radial artery cannulation is indispensable for continuous beat-to-beat blood pressure monitoring, arterial blood gas analysis, and guiding fluid therapy by measuring stroke volume variation and pulse pressure variation. However, challenges such as the artery's small size, posterior wall puncture, hematoma formation, and vasospasm can result in complications. To address these concerns, we introduce the SK-TRAC technique, (SK Technique of Radial Artery Cannulation) prioritizing precision and safety. This technique introduces an innovative approach, offering a comprehensive overview of SK-TRAC's potential advantages in enhancing the safety of radial artery cannulation.

 

            The SK-TRAC technique involves several key steps. First, strict aseptic precautions are followed to minimize the risk of infection. The patient is placed in a supine position with their hands alongside their body. Next, the patient's hand is dorsiflexed at the wrist and positioned over the operator’s abdomen (figure 1). This positioning allows manipulation of the wrist's angle for accurate identification of the radial artery's area of maximum   pulsation.

 

            Once the maximum pulsation area is identified, local anesthesia is administered to ensure patient comfort. A 20 G intravenous cannula is then inserted at an angle of 20 to 45 degrees relative to the skin's surface (figure 2). As the radial artery is accessed, blood confluence in the needle's tail is observed. The angle is gradually reduced by 10 degrees, and the needle is advanced further into the artery. Successful cannulation is confirmed by verifying backflow of blood when the cannula is connected to the transducer. Finally, the cannula is secured with a sterile dressing, and the patient's hand is gently returned to its original position for comfort and stability.

 

Comparing SK-TRAC to other techniques, it distinguishes itself with precision, reduced complications, and cost-effectiveness. Although ultrasound-guided methods are considered the gold standard, their distinct advantages in peripheral and low-resource settings underscore their significant value [1]. It requires minimal equipment and can be performed by a single professional, making it a practical choice. Additionally, its cost-effectiveness highlights its economic advantages for resource optimization. In contrast, techniques like the Seldinger Technique and Catheter-Over-Needle Technique may involve multiple steps, additional equipment, and potential complications, diminishing their overall appeal.

 

The Dynamic Needle Tip Positioning (DNTP) Technique, relying on ultrasound guidance, provides real-time visualization but requires specific skills and equipment. Ultrasound-guided techniques offer precise placement but may have a challenging learning curve and limited availability in some clinical settings [2] In summary, while each technique has its advantages, the SK-TRAC technique excels in simplicity, precision, and cost-effectiveness, making it valuable in resource optimization and maintaining a high standard of patient care.

 

            This technique relies on operator skill and may not be suitable for all patients, particularly those with limited wrist mobility. Variability in radial artery anatomy and minimal blood spillage are considerations. Transitioning to this technique may require training for professionals accustomed to other methods.

 

In conclusion, the SK-TRAC technique introduces an innovative and promising approach to enhance the precision, safety, and cost effectiveness of radial artery cannulation. While the ultrasound-guided method is widely acknowledged as the gold standard, this method's distinct advantages in peripheral settings without access to ultrasound and in low-resource environments underscore its significant value. Further research, training, and clinical experience will likely contribute to its successful integration into medical practice, benefiting both professionals and patients.  

References

 

  1. Moussa Pacha, H., Alahdab, F., Al-Khadra, Y., Idris, A., Rabbat, F., Darmoch, F., Soud, M., Zaitoun, A., Kaki, A., Rao, S. V., Kwok, C. S., Mamas, M. A., & Alraies, M. C. (2018). Ultrasound-guided versus palpation-guided radial artery catheterization in adult population: A systematic review and meta-analysis of randomized controlled trials. American heart journal, 204, 1–8.
  2. Kiberenge, R. K., Ueda, K., & Rosauer, B. (2018). Ultrasound-Guided Dynamic Needle Tip Positioning Technique Versus Palpation Technique for Radial Arterial Cannulation in Adult Surgical Patients: A Randomized Controlled Trial. Anesthesia and analgesia, 126(1), 120–126.
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