Continuous invasive blood pressure monitoring and blood gas analysis are essential for critically ill patients and major operations [1–2]. The radial artery, due to its fixed position, superficial nature, and low complication rate, is often chosen as the primary site for arterial puncture [3]. As radial artery puncture becomes more prevalent, it is crucial to establish a safe and effective puncture method. The development of clinical ultrasound technology has allowed for the full utilization of the ultrasound visualization of the radial artery during puncture. Numerous research studies [4–6] have demonstrated that ultrasound technology offers a higher success rate of catheterization and lower complications compared to blind puncture methods.
At present, the application of arterial puncture ultrasound technology is more in-plane and out-of-plane techniques. Currently, in-plane and out-of-plane techniques are commonly used in arterial puncture ultrasound technology. A meta-analysis conducted in 2022 indicated that there is no significant difference in the success rate of first-time arterial puncture between these two techniques [7]. Hence, both techniques can be employed for arterial puncture. However, as ultrasound provides two-dimensional images, there is a possibility of slice thickness artifacts in the plane. Observing the puncture needle within the blood vessel may suggest that it is close to or has penetrated the vessel wall. On the other hand, out-of-plane ultrasound techniques also have limitations as they struggle to accurately identify the position of the needle tip and needle body. Consequently, the success rate of the initial puncture of the radial artery under ultrasound guidance remains somewhat restricted [8]. The depth of the artery from the skin can also impact the relationship between the puncture needle and the artery, leading to a decrease in the success rate of puncture catheterization [9]. Furthermore, the complexity of ultrasound technology has hindered its widespread use, as it requires expertise to operate. As a result, blind puncture catheterization is still considered a dependable and often preferred method in clinical practice [10]. The use of ultrasound technology is only considered after repeated puncture and catheterization failures. At this time, the existing puncture injuries, vasospasm, and hematoma may greatly increase the difficulty of puncture and catheterization [11–12].
Despite the presence of ultrasound technology, researchers both domestically and internationally have continued their efforts to improve the success rate of radial artery puncture and catheterization. Various methods have been explored, including increasing the diameter of the radial artery [13], utilizing ultrasound probe marking[14], selecting the appropriate angle for the ultrasound probe[15], investigating new ultrasound technologies[16], employing laser-assisted technology[17], and utilizing nerve block methods[18–20]. Ultrasound-guided radial artery puncture involves two main steps: puncture and catheterization. The primary challenge in both steps lies in accurately positioning the puncture needle within the arterial vessel and ensuring the stability of the needle core throughout the catheterization process. The current arterial puncture needle has no imaging effect, which also increases the difficulty of positioning the puncture needle under ultrasound, and the diameter of the radial artery is not large [21–22]. The puncture needle is too deep or too shallow, which may lead to the failure of catheterization. At the same time, it is regrettable that most operators usually abandon ultrasound during catheterization, which is completely blind catheterization. Ultrasound technology is more for the puncture process than the catheterization process, and the movement of the needle core caused by any reason All may lead to failure of catheterization. It is worth noting that the catheter can sense hemodynamic changes in the artery [23], and the slight depth change of the puncture needle can be monitored, which is also the basis of the invasive arterial waveform [24], so it can be predicted in advance. Connect the pressure sensor to observe the pressure waveform changes of the radial artery for judgment, and at the same time, it can be determined whether the punctured blood vessel is an artery.
Therefore, we propose a hypothesis, pre-connect the pressure sensor, observe the changes in the arterial pressure waveform, guide the puncture of the radial artery under ultrasound, and explore its impact on the first-time success rate of radial artery puncture.