Chapter 10 Arterial Catheterization
INTRODUCTION
Continuous arterial pressure monitoring and direct arterial blood samplings are the two most common indications for arterial catheterization, which is typically used for perioperative monitoring during major surgical procedures and in critically ill patients. Common sites of cannulation include radial, femoral, and axillary arteries, and the most frequently reported complications include vascular insufficiency, bleeding, and infection. Despite reported complications, numerous studies have demonstrated the safety of arterial cannulas for monitoring in both the surgical and the medical intensive care settings.1 In an extensive review of the literature from 1978 to 2001, Scheer and coworkers1 reported a major complication rate of less than 1% in over 25,505 attempts at cannulation of the radial, femoral, and axillary arteries.
OPERATIVE PROCEDURE
Radial Artery Cannulation
Scheer and coworkers1 found temporary occlusion of the radial artery to be the most common complication, with an incidence rate from 1.5% to 35%. Complications after radial cannulation have also been reported: hematoma formation (14% incidence rate), local infection (0.7%), bleeding (0.5%), pseudoaneurysm (0.09%), and permanent ischemic damage (0.09%).1
Thrombosis
• Consequence
• Prevention
Infection
• Consequence
• Prevention
Pseudoaneurysm (Fig. 10-1)
Pseudoaneurysm after radial cannulation has a mean incidence of 0.09% in the literature and is typically managed with ligation of the radial artery after an Allen test demonstrates collateral flow.11
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