Radial Arterial Cannulation

Direct arterial blood sampling

Continuous arterial blood pressure monitoring

CONTRAINDICATIONS

Absolute: None

Relative Contraindications

Coagulopathy or recent thrombolysis

Overlying infection, burn, or skin damage

Severe peripheral atherosclerosis

RISKS/CONSENT ISSUES

Thrombosis and occlusion of the vessel are common (30%–40%) but almost all resolve spontaneously without requiring intervention, and ischemic complications are rare/case-reportable

Risk of bleeding and infection are low

General Basic Steps

Position patient

Locate radial artery

Anesthetize

Perform procedure

LANDMARKS

Radial artery cannulation site is just medial and proximal to the radial styloid on the volar surface of the wrist

TECHNIQUE

Position the patient’s supinated wrist in 60 degree of extension. Placement of a gauze or towel under the dorsal surface of the wrist and taping the wrist in extension may facilitate positioning.

Prepare and drape the area in a sterile manner

Anesthetize the skin over the radial artery with a small wheal of 1% lidocaine

Open the packaging and remove unit. Remove the protective shield. To ensure proper feeding, advance and retract the spring-wire guide through the needle via the lever. Then retract the wire proximally as far as possible before using.

Palpate the course of the artery with the middle and index fingers of the nondominant hand. Hold the needle at a 45-degree angle to the skin, pointing cephalad, and puncture the skin. Advance the needle until a flash of bright red blood is seen in the clear hub of the needle.

Decrease the angle of the needle to 20 degrees and advance the guidewire (via actuating lever) into the artery. Do not force the wire if resistance is encountered.

Hold the clear transducer needle and advance the catheter forward into the vessel. A rotating motion can be applied to the catheter if resistance is encountered (FIGURES. 27.1 and 27.2).