Ultrasound-guided dynamic needle tip positioning technique for radial artery cannulation
Main Article Content
Abstract
Arterial cannulation remains a cornerstone in the management of critically ill and surgical patients, facilitating continuous blood pressure monitoring, blood gas analysis, and titration of vasoactive drugs. Among the available sites for arterial access, the radial artery is most commonly preferred due to its superficial location, ease of cannulation, and dual blood supply to the hand, which lowers the risk of ischemic complications. Invasive arterial pressure monitoring is regarded as the gold standard, despite potential errors from transducer systems. Cannulation can be guided either by palpation or ultrasound. Although the traditional palpation method remains widely used, ultrasound-guided techniques, particularly Dynamic Needle Tip Positioning, have demonstrated superior first-pass success rates, reduced complications, and faster cannulation times. Dynamic Needle Tip Positioning, a modified short-axis ultrasound approach, enhances needle tip visualization and control during insertion. Across multiple studies, Dynamic Needle Tip Positioning outperformed palpation and some ultrasound methods, though its effectiveness is operator-dependent. Overall, Dynamic Needle Tip Positioning represents a safer, more efficient advancement in arterial line placement.
Keywords:
catheterization, palpation, radial artery, ultrasonography, vascular access devices
Article Details
How to Cite
M K, Dr Safiya Sherrin et al.
Ultrasound-guided dynamic needle tip positioning technique for radial artery cannulation.
Medical Research Archives, [S.l.], v. 13, n. 8, aug. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6889>. Date accessed: 06 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i8.6889.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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11. Ueda K, Bayman EO, Johnson C, Odum NJ, Lee JJ. A randomized controlled trial of radial artery cannulation guided by Doppler vs palpation vs ultrasound. Anaesthesia. 2015;70:1039–1044.
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14. Levin PD, Sheinin O, Gozal Y. Use of ultrasound guidance in the insertion of radial artery catheters. Critical care medicine. 2003;31:481–484.
15. Hasegawa D, Sato R, Duggal A, et al. Comparison of central and peripheral arterial blood pressure gradients in critically ill patients: a systematic review and meta-analysis. Critical care explorations. 2024;6(6):e1096.
16. Vegas A, Wells B, Braum P, et al. Guidelines for Performing Ultrasound-Guided Vascular Cannulation: Recommendations of the American Society of Echocardiography. Journal of the American society of echocardiography. 2025;38(2):57-91.
17. Brzezinski M, Luisetti T, London MJ. Radial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations. Anesthsia & analgesia. 2009;109(6):1763-1781.
18. Nunes RS, Tamaki CM, Penha HH, Terra JC, Figueiredo GL, Teixeira GC. Dorsal radial artery catheterization for invasive blood pressure monitoring. Revista brasileira de terapia intensiva. 2020;32(1): 153-155.
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21. Yu Y, Lu X, Fang W, Liu X, Lu Y. Ultrasound-guided artery cannulation technique versus palpation technique in adult patients in pre-anesthesia room: a randomized controlled trial. Medical science monitor. 2019;25:7306-7311.
22. Eda J, Gupta P, Kaushal A. Comparison of ultrasound-guided versus palpatory method of posterior tibial artery cannulation: a prospective randomized controlled study. Cureus. 2023;15(12): e51087.
23. Takeshita J, Yoshida T, Nakajima Y, et al. Dynamic needle tip positioning for ultrasound-guided arterial catheterization in infants and small children with deep arteries: a randomized controlled trial. Journal of cardiothoracic and vascular anesthesia. 2019;33: 1919-1925.
24. Clemmesen L, Knudsen L, Sloth E, Bendtsen T. Dynamic needle tip positioning - ultrasound guidance for peripheral vascular access. A randomized, controlled and blinded study in phantoms performed by ultrasound novices. Ultraschall in der medizin. 2012;33:E321–E325.
25. Mesa B, Sinha M, Kumar M, et al. Radial arterial cannulation by ultrasound-guided dynamic needle-tip positioning using the short-axis out-of-plane approach versus the long-axis in-plane approach: a randomized controlled study. Cureus. 2024;16(2): e54183.
26. Gopalasingam N, Hansen MA, Thorn S, Sloth E, Juhl-Olsen P. Ultrasound-guided radial artery catheterisation increases the success rate among anaesthesiology residents: a randomised study. Journal of the association for vascular access. 2017; 18(6):546-551.
27. Nam K, Jeon Y, Yoon S, et al. Ultrasound-guided radial artery cannulation using dynamic needle tip positioning versus conventional long-axis in-plane techniques in cardiac surgery patients: a randomized, controlled trial. Minerva anestesiologica. 2020;86(1):30-37.
28. Bai B, Tian Y, Zhang Y, Yu C, Huang Y. Dynamic needle tip positioning versus the angle-distance technique for ultrasound-guided radial artery cannulation in adults: a randomized controlled trial. Biomed central anesthesiology. 2020;20(1):231.
29. Siddaramaiah MN, Sharma A, Goyal S, et al. Comparison of ultrasound-guided dynamic needle tip positioning and acoustic shadowing technique with palpation technique for radial arterial cannulation by experienced clinicians: A randomized controlled trial. Journal of the association for vascular access. 2024;25(5):1618-1626.
30. Baidya M, Sinha M, Kumar M, et al. A randomized study comparing ultrasound-guided internal jugular vein cannulation using two techniques: short-axis out-of-plane with dynamic needle tip positioning versus long-axis in-plane. Cureus. 2024;16(6):e63004.
2. Wisanusattra H, Khwannimit B. Agreements between mean arterial pressure from radial and femoral artery measurements in refractory shock patients. Scientific reports. 2022;12(1):8825.
3. Kim SY, Kim KN, Jeong MA, Lee BS, Lim HJ. Ultrasound-guided dynamic needle tip positioning technique for radial artery cannulation in elderly patients: a prospective randomized controlled study. Public library of science one. 2021;16(5):e0251712.
4. Kiberenge RK, Ueda K, Rosauer B. Ultrasound-guided dynamic needle tip positioning technique versus palpation technique for radial arterial cannulation in adult surgical patients: a randomized controlled trial. Anesthesia & analgesia. 2018;126 (1):120-126.
5. Blanco P. Ultrasound-guided vascular cannulation in critical care patients: a practical review. Medicina intensiva. 2016;40(9):560-571.
6. Abdel-Kader A, Kaushal N, Shah R, Gomulka M, Wang T, Shulman S. A novel technique to maintain radial arterial catheter position: the arterial catheter stabilizer. Open journal of anesthesiology. 2016;6: 193-197.
7. Safiya Sherrin MK, Raphael PO, Chacko L. Comparison of two ultrasound-guided techniques for radial arterial cannulation in adults: observational cross-sectional study. Indian journal of anaesthesia. 2023;67(4):376-381.
8. Troianos CA, Hartman GS, Glas KE, et al. Guidelines for performing ultrasound-guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Journal of the American society of echocardiography. 2011;24: 1291-1318.
9. AIUM Practice Parameter for the Use of Ultrasound to Guide Vascular Access Procedures. Journal of
ultrasound in medicine. 2019;38:E4–E18.
10. Tang L, Wang F, Li Y, et al. Ultrasound guidance for radial artery catheterization: an updated meta-analysis of randomized controlled trials. Public library of science one. 2014;9:e111527.
11. Ueda K, Bayman EO, Johnson C, Odum NJ, Lee JJ. A randomized controlled trial of radial artery cannulation guided by Doppler vs palpation vs ultrasound. Anaesthesia. 2015;70:1039–1044.
12. Hansen MA, Juhl-Olsen P, Thorn S, Frederiksen CA, Sloth E. Ultrasonography-guided radial artery catheterization is superior compared with the traditional palpation technique: a prospective, randomized, blinded, crossover study. Acta anaesthesiologica scandinavica. 2014;58:446–452.
13. Berk D, Gurkan Y, Kus A, Ulugol H, Solak M, Toker K. Ultrasound-guided radial arterial cannulation: long axis/inplane versus short axis/out-of-plane approaches? Journal of clinical monitoring and computing. 2013; 27:319–324.
14. Levin PD, Sheinin O, Gozal Y. Use of ultrasound guidance in the insertion of radial artery catheters. Critical care medicine. 2003;31:481–484.
15. Hasegawa D, Sato R, Duggal A, et al. Comparison of central and peripheral arterial blood pressure gradients in critically ill patients: a systematic review and meta-analysis. Critical care explorations. 2024;6(6):e1096.
16. Vegas A, Wells B, Braum P, et al. Guidelines for Performing Ultrasound-Guided Vascular Cannulation: Recommendations of the American Society of Echocardiography. Journal of the American society of echocardiography. 2025;38(2):57-91.
17. Brzezinski M, Luisetti T, London MJ. Radial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations. Anesthsia & analgesia. 2009;109(6):1763-1781.
18. Nunes RS, Tamaki CM, Penha HH, Terra JC, Figueiredo GL, Teixeira GC. Dorsal radial artery catheterization for invasive blood pressure monitoring. Revista brasileira de terapia intensiva. 2020;32(1): 153-155.
19. Baththirange MM, Nja SS, Chapman C. A modification to the ultrasound-guided Seldinger technique for arterial catheter insertion. European journal of anaesthesiology. 2025;42(7):665-667.
20. Eley V, Peters N, Woods C, et al. Perioperative arterial catheterization: A prospective evaluation of ultrasound, infection, and patient-focused outcomes. Journal of Vascular Access. 2025;26(3):837-845.
21. Yu Y, Lu X, Fang W, Liu X, Lu Y. Ultrasound-guided artery cannulation technique versus palpation technique in adult patients in pre-anesthesia room: a randomized controlled trial. Medical science monitor. 2019;25:7306-7311.
22. Eda J, Gupta P, Kaushal A. Comparison of ultrasound-guided versus palpatory method of posterior tibial artery cannulation: a prospective randomized controlled study. Cureus. 2023;15(12): e51087.
23. Takeshita J, Yoshida T, Nakajima Y, et al. Dynamic needle tip positioning for ultrasound-guided arterial catheterization in infants and small children with deep arteries: a randomized controlled trial. Journal of cardiothoracic and vascular anesthesia. 2019;33: 1919-1925.
24. Clemmesen L, Knudsen L, Sloth E, Bendtsen T. Dynamic needle tip positioning - ultrasound guidance for peripheral vascular access. A randomized, controlled and blinded study in phantoms performed by ultrasound novices. Ultraschall in der medizin. 2012;33:E321–E325.
25. Mesa B, Sinha M, Kumar M, et al. Radial arterial cannulation by ultrasound-guided dynamic needle-tip positioning using the short-axis out-of-plane approach versus the long-axis in-plane approach: a randomized controlled study. Cureus. 2024;16(2): e54183.
26. Gopalasingam N, Hansen MA, Thorn S, Sloth E, Juhl-Olsen P. Ultrasound-guided radial artery catheterisation increases the success rate among anaesthesiology residents: a randomised study. Journal of the association for vascular access. 2017; 18(6):546-551.
27. Nam K, Jeon Y, Yoon S, et al. Ultrasound-guided radial artery cannulation using dynamic needle tip positioning versus conventional long-axis in-plane techniques in cardiac surgery patients: a randomized, controlled trial. Minerva anestesiologica. 2020;86(1):30-37.
28. Bai B, Tian Y, Zhang Y, Yu C, Huang Y. Dynamic needle tip positioning versus the angle-distance technique for ultrasound-guided radial artery cannulation in adults: a randomized controlled trial. Biomed central anesthesiology. 2020;20(1):231.
29. Siddaramaiah MN, Sharma A, Goyal S, et al. Comparison of ultrasound-guided dynamic needle tip positioning and acoustic shadowing technique with palpation technique for radial arterial cannulation by experienced clinicians: A randomized controlled trial. Journal of the association for vascular access. 2024;25(5):1618-1626.
30. Baidya M, Sinha M, Kumar M, et al. A randomized study comparing ultrasound-guided internal jugular vein cannulation using two techniques: short-axis out-of-plane with dynamic needle tip positioning versus long-axis in-plane. Cureus. 2024;16(6):e63004.