31 Peripheral Arterial Cannulation
Therefore, peripheral arterial cannulation may be required.
As a general rule, the most peripheral available artery
should be used, to reduce the potential sequelae from any
associated vascular compromise or thromboembolic event.
The artery chosen should be large enough to measure blood
that can be easily monitored and cared for by nursing staff.
Common sites for peripheral arterial cannulation include
the radial, ulnar, dorsalis pedis, and posterior tibial arteries.
Although cannulation of the axillary (1,2) and brachial (3)
high potential for ischemic complications. Cannulation of
the temporal artery should likewise be avoided due to
potential adverse neurologic sequelae (4,5).
1. Monitoring of arterial blood pressure
2. Frequent monitoring of blood gases or laboratory tests
(e.g., sick ventilated neonates or extremely lowbirthweight premature infants)
3. When preductal measurement is required (e.g., with
persistent pulmonary hypertension) (right upper
1. Bleeding disorder that cannot be corrected
2. Pre-existing evidence of circulatory insufficiency in
limb being used for cannulation
3. Evidence of inadequate collateral flow (i.e., occlusion
of the vessel to be catheterized may compromise perfusion of extremity)
5. Malformation of the extremity being used for cannulation
6. Previous surgery in the area (especially cutdown)
2. Antiseptic solution (e.g., iodophor, chlorhexidine)
4. 0.5 to 0.95 normal saline (NS) with 1 to 2 U/mL heparin
Although hypernatremia has been reported in very
small premature infants who received excess sodium in
flush solution (6), in our experience 0.5 NS has been
used without complications at infusion rates of 0.5 to
1 mL/h. Using heparinized saline has been shown to
maintain line patency longer than hypotonic solutions
such as heparinized 5% dextrose water (7) or unheparinized NS (8).
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