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186 Section V ■ Vascular Access

a. Prepare as for percutaneous procedure (Standard

Technique, steps 1 to 3).

b. Scrub and prepare as for major procedure (see

Chapter 5).

c. Infiltrate site of incision (point of maximum pulsation just proximal to proximal wrist crease) with 0.5

to 1 mL of lidocaine.

d. Wait 5 minutes for anesthesia.

e. Make a 0.5-cm transverse skin incision (Fig. 31.7A).

f. Deepen incision into subcutaneous tissue by blunt

longitudinal dissection with curved mosquito hemostat (Fig. 31.7B).

g. Use curved mosquito hemostat to dissect artery free.

Be gentle, to avoid arteriospasm.

h. Elevate artery with hemostat or nerve hook (Fig.

31.7C).

i. Loop ligature (5-0 silk) around artery for traction

purposes (Fig. 31.7D). Do not tie ligature.

j. Advance cannula stylet into artery with bevel down,

until cannula is clearly within vessel lumen (Fig.

31.7E).

Fig. 31.4. A: Anatomic relations of posterior

tibial artery, showing site of incision for cutdown.

B: Cannulation of posterior tibial artery; cannula

is attached to a transducer for continuous blood

pressure monitoring.

A

B

Fig. 31.5. A: Cannulation of artery using Method A (see text).

B: Cannulation of artery using Method B (see text). (Redrawn

from Filston HC, Johnson DG. Percutaneous venous cannulation

in neonates and infants: a method for catheter insertion without

“cutdown.” Pediatrics. 1971;48:896, with permission of the

American Academy of Pediatrics.)

B

A