Chapter 31 ■ Peripheral Arterial Cannulation 191

A

C

B

D

Fig. 31.11. A: Muscles supplied by the median nerve in the forearm. B: Muscles supplied by the

median nerve in the hand. C: Muscles supplied by the ulnar nerve in the hand. D: Muscles supplied by

the posterior tibial nerve in the ankle and foot.

192 Section V ■ Vascular Access

(5) Sensation—maximally over volar aspect index

and middle fingers

(6) Vasomotor control in limb

b. Median nerve at wrist (Fig. 31.11B) causes carpal

tunnel syndrome (19).

c. Ulnar nerve at wrist causes (Fig. 31.11C)

(1) Atrophy of small hand muscles

(2) Sensory loss over dorsal and palmar surfaces of

ring and little fingers and ulnar portion of hand

and wrist

d. Peripheral portion of deep peroneal nerve—

anesthesia of the lateral aspect of the dorsum of the

hand, which results in no significant disability

e. Posterior tibial nerve at medial malleolus (Fig.

31.11D) may affect

(1) Flexor hallucis brevis muscle

(2) Flexor of proximal phalanx of big toe

(3) Muscles of foot that spread and close toes and

flex proximal phalanx of toes

(4) Sensation on plantar surface of foot

Lesions of posterior tibial nerve may be difficult to detect on examination but may lead to

significant discomfort in later life owing to loss

of plantar arches on weight bearing.

6. False cortical thumbs (36)

7. Burns from transilluminator (37)

8. Hemorrhage (including accidental dislodgement of

cannula) (32,34)

9. Hypernatremia caused by heparinized saline infusion

through cannula (6)

10. Hypervolemia related to continuous flush device (38)

11. Air embolism (39)

12. Pseudoaneurysm (40)

13. Acquired bone dysplasia (41)

References

1. Greenwald BM, Notterman DA, DeBruin WJ, et al. Percutaneous

axillary artery catheterization in critically ill infants and children.

J Pediatr. 1990;117:442.

2. Piotrowski A, Kawczynski P. Cannulation of the axillary artery in

critically ill newborn infants. Eur J Pediatr. 1995;154:57.

3. Schindler E, Kowald B, Suess H, et al. Catheterization of the

radial or brachial artery in neonates and infants. Paediatr Anaesth.

2005;15:677.

4. Prian GW, Wright GB, Rumack CM, et al. Apparent cerebral

embolization after temporal artery catheterization. J Pediatr. 1978;

93:115.

5. Bull MJ, Schreiner RL, Garg BP, et al. Neurologic complications

following temporal artery catheterization. J Pediatr. 1980;96:

1071.