Comparative evaluation of longitudinal axis and longitudinal oblique axis approaches for ultrasound guided radial artery cannulation in adults- A Randomised control study at a tertiary care centre

INTERVENTION: Intervention1: Ultrasound guided Radial artery cannulation‐ Longitudinal Group: Once the patient is selected based on the inclusion criteria, standard ASA monitors are attached to the patient. The arm is placed on an arm rest in slight abduction and dorsiflexion (30 45 ), by placing a support roll under the dorsal aspect of wrist and secured using tape. Under strict aseptic precautions, cannulation is done under ultrasound guidance with GE Healthcare LOGIQ V1 AND LOGIQ V2 ultrasound using a linear array transducer probe (6 13 Hz) and a PUR ART‐CAN arterial catheter. In both the groups, the USG probe will first be placed perpendicular to the artery. Artery will be identified by a circular anechoic pulsatile structure, which will be confirmed by Doppler and pulse wave. The anteroposterior diameter of the artery will then be measured following which the probe will be rotated by 90 to place it parallel to the course of artery, making it the longitudinal axis‐ Group A. Local anaesthetic will be injected and the artery will be pierced at an angle of 30‐45 degrees to the skin under real‐ time guidance at the midpoint of the short axis of the probe. Once a flash of blood is seen, the cannula will be lowered to 10‐15 degrees and then advanced by 2‐3 mm more into the artery and then connected to a pressure transducer. Successful cannulation will be confirmed by pressure waveform on the monitor. Control Intervention1: Ultrasound guided Radial artery cannulation‐ Longitudinal oblique group: The second group B. The arm is placed on an arm rest in slight abduction and dorsiflexion (30 45 ), by placing a support roll under the dorsal aspect of wrist and secured using tape. Under strict aseptic precautions, cannulation is done under ultrasound guidance with GE Healthcare LOGIQ CONDITION: Health Condition 1: 8‐ Other Procedures PRIMARY OUTCOME: To assess and compare the first pass success rates in longitudinal approach (LA) and longitudinal oblique approach (LOA) using ultrasound guidance for radial artery cannulation.Timepoint: Time to cannukate will be taken from the point of identification of the artery to the waveforms on the monitor SECONDARY OUTCOME: To assess & compare the time of cannulation, failure rates & complications between the two groups‐ longitudinal approach (LA) & longitudinal oblique approach (LOA) using ultrasound guidance for radial artery cannulation.Timepoint: Total cannulation time is calculated from identification of artery on the probe to waveforms on the monitor. patients will be observed for 48 hour for complications like hematoma, thrombosis or infection INCLUSION CRITERIA: Age 18‐ 65 years American Society of Anesthesiologists [ASA] physical status classification I and II. Patients with valid informed consent