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To assess the role of a portable ultrasound device in the insertion of radial artery catheters.Prospective, randomized, comparative study.Tertiary university hospital.Elective surgery patients requiring arterial catheter insertion for intraoperative monitoring.A portable ultrasound device was used to visualize the radial artery at the wrist and to direct arterial catheter insertion. This new technique of arterial catheter insertion was compared with the classic palpation technique.A total of 69 patients requiring an arterial catheter were randomized to either the ultrasound (34 patients) or palpation technique (35 patients). The time taken from skin puncture to successful arterial catheter insertion, the time taken per insertion attempt, the number of attempts required, and the number of cannulae used were recorded for each group. The arterial cannula was inserted on the first attempt in 21 (62%) cases using ultrasound vs. 12 (34%) cases by palpation (p = .03). Significantly fewer attempts were required for catheter insertion using ultrasound as compared with palpation (mean ± sd, 1.6 ± 1.0 vs. 3.1 ± 2.4;p = .003); however, the time taken for each successful attempt was longer (26.1 ± 2.0 vs. 17.3 ± 1.6 secs, p = .001). A trend toward shorter overall time required for catheter insertion was found for the ultrasound group (55.5 ± 63.8 vs. 111.5 ± 121.5 secs, p = .17). There were four failures in the ultrasound group and one in the palpation group (not significant).Ultrasound is a useful adjunct to arterial catheter insertion and increases the rate of success at first attempt. The technique is easy to learn and may reduce the time taken to insert the catheter.