CHAPTER 182 Pediatric Arterial Puncture and Venous Minicutdown
Arterial Puncture
Arterial blood may be needed for blood gas analysis or for routine laboratory analysis. In the infant or child, the radial artery is the most appropriate and most commonly selected site for arterial puncture. The posterior tibial and dorsalis pedis arteries are optional sites, but each has its own risk of complications. Because of the risk of thrombosis, use of the femoral artery for arterial puncture in the infant or child should be reserved for emergencies. Likewise, because of the risk of median nerve damage and the fact that the brachial artery has minimal collateral circulation, the brachial artery should be reserved as a last resort in emergencies. The temporal artery should probably not be used because of the high risk of neurologic complications.
The radial artery is located just medial to the styloid process of the radius. It is palpable between the radius and the tendon of the flexor carpi radialis (see Chapter 208, Arterial Puncture and Percutaneous Arterial Line Placement).
Indications
NOTE: The last indication is controversial. The benefit must outweigh the higher risk of obtaining an arterial sample.
Contraindications
Infection, burns, local skin damage, trauma, or severely disturbed anatomy at the site of the intended puncture are all contraindications. They are considered relative contraindications in a life-threatening situation.
Equipment and Supplies

Precautions
The modified Allen test is performed to ensure patency of the ulnar artery before an arterial puncture or the placement of an indwelling arterial catheter. Verifying adequate collateral circulation may reduce the risk of ischemic complications if thrombosis of the radial artery occurs. (See Chapter 208, Arterial Puncture and Percutaneous Arterial Line Placement, for a description of the modified Allen test as well as other techniques available to test for collateral circulation.)
Technique

Figure 182-1 Pediatric arterial puncture. A, Anatomic location of the radial artery with immobilization of the wrist in hyperextension. B, The artery is entered with the bevel up and the needle at 30 to 45 degrees from horizontal.
NOTE: The total blood volume in a neonate is usually about 80 mL/kg, and the volume of blood withdrawn should not exceed 3% to 5% of this total blood volume. As an example, 8 mL is 5% of the total blood volume in a 2-kg infant.

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