Administering Bolus Intravenous Norepinephrine to Improve the Peripheral Arterial Line Cannulation: Randomized Controlled Trial
Naruemol Prachanpanich, MD¹
, Sunthiti Morakul, MD¹
, Warit Rojanasiripong, MD¹
, Napanont Kiatmongkolkul, MD²
Affiliation : ¹ Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; ² Chakri Nareubodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
Abstract
Background: The conventional arterial line insertion may pose challenges in some cases. The methods to enhance the success rate of arterial line cannulation require specific equipment and skill, in contrast to the conventional palpation technique.
Objective: To investigate whether administering intravenous norepinephrine as a bolus dose can increase the success rate of arterial line insertion using the conventional technique.
Materials and Methods: The randomized study included adults undergoing elective surgery and requiring the perioperative arterial line insertion. The participants were allocated into two groups: the experimental norepinephrine group (NE group) received five mcg of norepinephrine intravenously, and the control group (NSS group) received an intravenous saline solution before inserting the arterial line. The primary outcome was the difference in the number of puncture attempts. The secondary outcomes included the total time to successful arterial cannulation and complications related to the procedure.
Results: Ninety-two patients were randomized and analyzed, with 46 in the NE group and 46 in the NSS group. There was a significantly lower in the number of arterial puncture attempts in the NE group than the NSS group (p=0.034), demonstrating a notably higher first-attempt success rate [29 (63%) vs. 25 (54.3%)] and fewer patients required more than two attempts [3 (6.5%) vs. 12 (26.1%)]. The time to successful arterial line cannulation was significantly lower in the NE group compared to the NSS group [124 (59-227) seconds vs. 184 (92-480) seconds, p=0.028]. Furthermore, the results also demonstrated a significantly lower incidence of complications in the NE group compared to the NSS group [8 (17.4%) vs. 20 (43.5%), RR 0.400, 95% CI 0.197 to 0.814, p=0.007].
Conclusion: Intravenous norepinephrine administration before the conventional arterial line insertion can reduce the number of attempts required, decrease total time to success, and lower the incidence of complications related to the arterial line insertion.
Received 29 September 2025 | Revised 16 February 2026 | Accepted 17 February 2026
J Med Assoc Thai 2026;109(7):612-7
Keywords : Arterial line; Arterial line insertion; Arterial line cannulation; Norepinephrine
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