Efficacy of real time ultrasonography in arterial puncture of paediatric patients: a systematic review

Background: Traditionally, peripheral arterial access is achieved using the palpation technique with catheter insertion guided by the perception of the arterial pulse. In small children, this access is more difficult than in adults due to the smaller size of the arteries, making the procedure more challenging for those performing it. Real-time ultrasound has shown good results in guiding arterial access in paediatric patients. Objectives: This study evaluates the efficacy of ultrasound-guided arterial puncture at different sites and identifies the profiles of patients who benefit from this technique through the outcomes of first-attempt success, total success and complications. Methods: a systematic review was conducted with data collected from PubMed, Embase, Cochrane CENTRAL and Scopus using the search terms “Infant, Newborn”, “Infant”, “Child, Preschool”, “Child”, “Adolescent”, “Catheterization, Peripheral”, “Ultrasonography” and their equivalents. Randomised clinical trials comparing ultrasound-guided arterial puncture with palpation technique were searched for first-attempt success (primary outcome), total success and complications. Results: Seven trials met the inclusion criteria and showed different risks of bias. The trials analysed the radial, femoral, posterior tibial and dorsalis pedis arteries. The selected trials included 675 patients among newborns, infants, preschoolers, children, and adolescents. In the radial artery, ultrasound increased first-attempt and total success, in addition to decreasing the incidence of haematomas. In the femoral artery, ultrasound increased first-attempt success. Ultrasound also increased first-attempt and total success in the posterior tibial and dorsalis pedis arteries. Conclusion: In consonance with past reviews, ultrasonography is an effective tool for improving arterial puncture outcomes in a variety of sites and patients, particularly in the radial artery. To provide better care, training in ultrasound-guided arterial puncture is a strategy that can be adopted by universities and health services.