Alternative arterial catheterization site using the ulnar artery in critically ill pediatric patients

Kahler, Allan C.; Mirza, Farrukh

doi:10.1097/00130478-200210000-00008

Cited by 21 publications

(19 citation statements)

References 13 publications

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“…Kahler and Mirza [3] considered the ulnar artery as a safe alternative for peripheral arterial cannulation in 18 critically ill pediatric patients. In their series, only one patient with ulnar cannulation showed signs of ischemia, and this patient previously had ipsilateral radial artery cannulation for 4 days.…”

Section: Discussionmentioning

confidence: 99%

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Ulnar artery versus radial artery approach for arterial cannulation: a prospective, comparative study

Karacalar

Türe

Barış

et al. 2007

Journal of Clinical Anesthesia

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Section: Discussionmentioning

confidence: 99%

“…Many anesthesiologists consider radial artery cannulation as the standard technique for hemodynamic monitoring among the upper extremity arteries [2]. There is a tendency to choose the ulnar artery if the radial artery is unsuitable for cannulation [3]. The radial artery is the dominant vessel of the hand [4].…”

Section: Introductionmentioning

confidence: 99%

Ulnar artery versus radial artery approach for arterial cannulation: a prospective, comparative study

Karacalar

Türe

Barış

et al. 2007

Journal of Clinical Anesthesia

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“…151 Slogoff et al 16 reported no hand ischemia in 22 patients who had an ulnar artery catheter placed after a failed radial artery cannulation. 149 Although there is a theoretical concern that ulnar artery cannulation could cause neural trauma to the ulnar nerve, the literature lacks evidence of such a complication. 153 Hand ischemia has been reported in pediatric patients with prolonged ulnar artery cannulation in the setting of prior radial artery cannulation.…”

Section: Ulnar Artery Cannulationmentioning

confidence: 99%

Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations

Brzeziński¹,

Luisetti²,

London³

2009

Anesthesia &Amp; Analgesia

295

226

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Consistent anatomic accessibility, ease of cannulation, and a low rate of complications have made the radial artery the preferred site for arterial cannulation. Radial artery catheterization is a relatively safe procedure with an incidence of permanent ischemic complications of 0.09%. Although its anatomy in the forearm and the hand is variable, adequate collateral flow in the event of radial artery thrombosis is present in most patients. Harvesting of the radial artery as a conduit for coronary artery bypass grafting, advances in plastic and reconstructive surgery of the hand, and its use as an entry site for cardiac catheterization has provided new insight into the collateral blood flow to the hand and the impact of radial arterial instrumentation. The Modified Allen's Test has been the most frequently used method to clinically assess adequacy of ulnar artery collateral flow despite the lack of evidence that it can predict ischemic complications in the setting of radial artery occlusion. Doppler ultrasound can be used to evaluate collateral hand perfusion in an effort to stratify risk of potential ischemic injury from cannulation. Limited research has demonstrated a beneficial effect of heparinized flush solutions on arterial catheter patency but only in patients with prolonged monitoring (>24 h). Conservative management may be equally as effective as surgical intervention in treating ischemic complications resulting from radial artery cannulation. Limited clinical experience with the ultrasound-guided arterial cannulation method suggests that this technique is associated with increased success of cannulation with fewer attempts. Whether use of the latter technique is associated with a decrease in complications has not yet been verified in prospective studies. Research is needed to assess the safety of using the ulnar artery as an alternative to radial artery cannulation because the proximity and attachments of the ulnar artery to the ulnar nerve may potentially expose it to a higher risk of injury.

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“…Because of the risk of ischemia to the hand, placement of a catheter in the ulnar artery is contraindicated if the radial artery is thrombosed or after attempts at cannulation have been made. Despite concerns of distal ischemia, a literature report indicates a similar risk for ulnar, radial, and femoral arterial lines [ 104 ].…”

Section: Sites For Invasive Monitoringmentioning

confidence: 99%

Anesthesia for Cardiac Surgery in Neonates

Miller‐Hance

Gottlieb

Motta

2014

Neonatal Anesthesia

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Alternative arterial catheterization site using the ulnar artery in critically ill pediatric patients

Abstract: Based on the ischemic and infectious complication rates, the ulnar artery should be considered as a viable site for peripheral vessel cannulation in cases in which arterial catheterization is necessary and attempts at more common sites of catheterization are unsuccessful.

Cited by 21 publications

References 13 publications

Ulnar artery versus radial artery approach for arterial cannulation: a prospective, comparative study

Ulnar artery versus radial artery approach for arterial cannulation: a prospective, comparative study

Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations

Anesthesia for Cardiac Surgery in Neonates

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