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E. Technique

Standard Technique for Percutaneous

Arterial Cannulation

1. Choose a site for cannulation and secure the appropriate limb.

a. Radial artery: This is the most routine site for cannulation (15,21). The infant’s forearm and hand can

be transilluminated with the wrist in extension 45 to

60 degrees (Fig. 31.1), making sure that fingers are

visible to monitor distal perfusion. The artery can

be palpated proximal to the transverse crease on the

palmar surface of the wrist, medial to the styloid process of the radius, and lateral to the flexor carpi radialis (Fig. 31.2).

b. Ulnar artery: In a small number of infants, the ulnar

artery may be easier to locate than the radial artery

(22). If an Allen test indicates that the collateral blood

supply is adequate, the ulnar artery may be cannulated using the same method as for a radial artery.

The ulnar artery runs along the palmar margin of the

flexor carpi ulnaris, radial to the pisiform bone.

Fig. 31.1. Transillumination of the radial artery.

184 Section V ■ Vascular Access

Caution is necessary when cannulating the ulnar

artery because it runs next to the ulnar nerve and is

smaller in caliber than the radial artery (Fig. 31.2).

c. Dorsalis pedis artery: The dorsalis pedis artery can

be found in the dorsal midfoot between the first and

second toes with the foot held in plantar flexion

(Fig. 31.3). It should be noted that the vascular anatomy of the foot is variable and the dorsalis pedis

artery may be absent in some patients (23), whereas

it may provide the main blood supply to the toes in

others (24).

d. Posterior tibial artery: The posterior tibial artery runs

posterior to the medial malleolus with the foot held

in dorsiflexion (Fig. 31.4).

2. Identify artery by

a. Palpation (see anatomic landmarks as described

above or individual arterial sites)

b. Transillumination (see Fig. 13.1 and Chapter 13) (25)

c. Doppler ultrasound (9–11)

3. Scrub and put on gloves.

4. Prepare skin over site with antiseptic (e.g., an iodophor).

5. Make small skin puncture with venipuncture needle over

site (optional; to ease passage of cannula through skin

and reduce chances of penetrating the posterior wall of

the vessel, especially when using a larger-gauge cannula).