Chapter 31 ■ Peripheral Arterial Cannulation 187

medially by the extensor pollicis longus and extensor pollicis brevis muscles (Fig. 31.8A).

e. The artery becomes superficial immediately after

passing the extensor pollicis longus and before passing beneath the first dorsal interosseous muscle.

f. The point for cannulation is located at the junction of

a line drawn along the medial aspect of the extended

thumb and another line drawn along the lateral

aspect of the extended index finger (Fig. 31.8B).

Posterior tibial Artery Cannulation by a

Cutdown Procedure

1. Prepare as for percutaneous method.

2. Put on mask.

3. Tape foot to footboard in equinovarus position (see

Chapter 4).

4. Scrub and prepare as for major procedure (see Chapter

5).

5. Infiltrate incision site with 0.5 to 1 mL of 0.5% lidocaine (Fig. 31.4).

k. Remove stylet and advance cannula to hub (Fig.

31.7F).

l. Remove ligature.

m.See percutaneous method under E (Standard

Technique, steps 7 to 11) for fixation and care of

cannula.

The incision can usually be kept small enough so

that the hub of the cannula fills it and no closing

suture is needed.

2. Technique II: Cannulation at anatomic snuffbox

a. Described by Amato et al. (26)

b. May be used in infants who have undergone previous arterial cutdown at wrist

c. Should not be a primary approach to radial artery

(particularly if cannulation is achieved by cutdown)

(1) Site is not easy to expose.

(2) Scar tends to be more disfiguring than at wrist.

d. The radial artery passes dorsally at the wrist and traverses the anatomic snuffbox, which is bounded

A B

C D

Fig. 31.6. A: Puncture artery directly at angle of 10 to 15 degrees to skin, with needle bevel down.

B: Advance slowly. C: Withdraw needle stylet, allow for blood return, and advance cannula into artery.

D: Attach cannula firmly to T connector.