LASER guidance with smart glasses may improve success of ultrasound-guided radial artery catheterization

Operators can now improve their success of ultrasound-guided radial artery catheterization using LASER guidance with smart glasses. This can be used by users who are inexperienced in the long-axis in-plane approach as per a study that was published in the Canadian Journal of Anesthesia. 

Radial artery cannulization is one of the challenging procedures with high failure rates. Despite the clinical experience of the anesthesiologist, there are multiple reasons for failure like inappropriate puncture site, insufficient hand-eye coordination, the collapse of the arterial lumen, needle angulation, and deviation, etc. Using smart glasses for ultrasound-guided needle procedures reduces the operators’ head movements. But despite this, procedural performance has not been increased. Recent literature showed that LASER guidance can reduce the time required for ultrasound-guided procedures in phantom models. As it has not been researched thoroughly, researchers from the Seoul National University Hospital have conducted a trial using LASER guidance to smart glasses for ultrasound-guided radial artery catheterization using the long axis approach. 

An unblinded controlled trial was carried out on 52 patients requiring radial artery catheterization under anesthesia. They were randomized to two groups of smart glasses only (SO) as the control group with 26 participants and the smart glasses with laser guidance group (SL) having 26 participants. Catheterization time was assessed as the primary outcome others included the number of needle redirections, first-pass success rate, and operator satisfaction (100 = most satisfactory; 0 = unsatisfactory) were also assessed.  

Findings:

• Comparing the SL with the SO group, the catheterization time was shorter (13 sec vs 24 sec).
• The number of needle redirections was lower (0 vs 3). 
• The first-pass success rate (50% vs 12%) and operator satisfaction score (85 vs 52) were higher.  

Thus, users unfamiliar with the long-axis in-plane approach performed ultrasound-guided radial artery catheterization yielding better results when using laser guidance. But further studies on a large scale are needed.  

Further reading: Kim, Y.J., Jung, CW., Choi, S. et al. Laser guidance for ultrasound-guided radial artery catheterization using smart glasses: a randomized trial. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02532-0