Abstract:

Objective To explore the application of ultrasound-guided distal radial artery approach compared to the conventional radial artery approach for peripheral arterial catheterization in critically ill patients with invasive arterial blood pressure monitoring，and to provide evidence for selecting the appropriate arterial puncture approach in critical care nursing. Methods Convenience sampling was used to select 156 patients requiring invasive arterial blood pressure monitoring in the Cardiac Intensive Care Unit of a tertiary hospital in Henan Province from October 2023 to October 2024. Random sampling was performed to assign the patients to an experimental group（n=78） and a control group（n=78）. The experimental group received arterial catheterization via the distal radial artery，while the control group received catheterization via the conventional radial artery. The puncture success rate，the incidence of catheter-related complications（including puncture site bleeding，catheter blockage，puncture site ecchymosis，local hematoma，and catheter dislodgement），catheter dwell time，and puncture pain were compared between the 2 groups. Results A total of 145 patients completed the study，with 72 patients in the experimental group and 73 in the control group. No significant difference in the puncture success rate was found between the 2 groups（P>0.05）. The incidence of puncture site bleeding was 6.94% in the experimental group，lower than 21.92% in the control group，and the incidence of catheter blockage was 9.72%，lower than 23.29% in the control group；these differences were statistically significant（P<0.05）. No significant differences were found in the incidence of subcutaneous hematoma，local blood accumulation，and catheter displacement between the 2 groups（P>0.05）. The catheter dwell time was （116.00±25.03） hours in the experimental group，longer than（102.15±22.35） hours in the control group，with a statistically significant difference（P<0.05）. The experimental group reported lower levels of pain compared to the control group（P<0.001）. Conclusion Ultrasound-guided distal radial artery catheterization is safe and feasible in critically ill patients. It shows comparable first-attempt success rates to the conventional radial artery approach，but offers advantages in terms of lower incidence of catheter-related complications，longer catheter dwell time，and reduced puncture pain. It can be considered as an alternative approach for invasive arterial blood pressure monitoring in critically ill patients.

Key words: Distal Radial Artery, Radial Artery, Invasive Arterial Blood Pressure Monitoring, Nursing Care, Intensive Care Unit

摘要：

目的 探讨超声引导下远端桡动脉入路与常规桡动脉入路外周动脉导管置入在重症患者有创动脉血压监测中的应用效果，为重症护理中的动脉穿刺入路选择提供依据。 方法 采用便利抽样法，选择2023年10月至2024年10月在河南省某三级甲等综合医院心脏重症监护病房住院需行有创动脉血压监测的156例患者作为研究对象，采用随机数字表法将其分为试验组和对照组，每组78例。试验组采用远端桡动脉入路置入动脉导管，对照组采用常规桡动脉入路置入动脉导管。比较两组穿刺成功率、置管后并发症（穿刺点渗血、导管堵塞、穿刺点皮下瘀斑、局部血肿、导管脱出）发生率、动脉导管留置时间及穿刺疼痛程度的差异。 结果 共145例患者完成研究，其中试验组72例，对照组73例。两组穿刺成功率比较，差异无统计学意义（P>0.05）。试验组穿刺点渗血发生率为6.94%，低于对照组的21.92%；试验组导管堵塞发生率为9.72%，低于对照组的23.29%，差异均有统计学意义（P<0.05）。两组穿刺点皮下瘀斑、局部血肿及导管脱出发生率比较，差异均无统计学意义（P>0.05）；试验组动脉导管留置时间为（116.00±25.03）h，长于对照组的（102.15±22.35）h，差异有统计学意义（P<0.05）；试验组疼痛程度较对照组低，差异有统计学意义（P<0.001）。 结论 超声引导下远端桡动脉入路在重症患者中应用安全、可行，其穿刺成功率与常规桡动脉入路相当，导管相关并发症发生率较低，动脉导管留置时间相对较长，穿刺疼痛程度较轻，可作为有创动脉血压监测的替代入路之一。

关键词: 远端桡动脉, 桡动脉, 有创动脉血压监测, 护理, 重症监护病房