The ulnar artery: A site suitable for arterial cannulation in pediatric patients

Abstract

Background: Historically, the ulnar artery has rarely been considered for arterial cannulation as it is less easily palpated than the radial artery. With the current routine use of ultrasound in pediatric patients, the ulnar is as accessible as the radial and could be viewed as an equivalent site for cannulation. Aims:The purpose of this study was to compare ulnar and radial artery suitability for arterial cannulation in pediatric patients using 2-dimensional ultrasound. Methods:We examined the ulnar and radial arteries of pediatric patients aged birth to 6 years who were scheduled to undergo general anesthesia. Following anesthesia induction, the investigators positioned the patient's wrist to 30-45 degrees of extension and obtained images of the ulnar and radial arteries in the transverse and longitudinal planes. Assessments of the arteries' anterior-posterior diameter, cross-sectional area and depth were made by visual inspection at the time of image acquisition and by electronic caliper measurement of recorded images. Results:In 108 patients, mean anterior-posterior diameter of the ulnar artery was larger than the radial artery in the transverse view, longitudinal view, and crosssectional area in 63.6%, 59.4%, and 60.4% of patients (p = .002, .004, and .006, respectively). Mean ulnar artery size was, on average, larger than the radial artery by 7.7%, 8.1%, and 12.9% in the transverse AP diameter, longitudinal AP diameter, and cross-sectional area (95% CI 3.1-12.4%; 3.2-13.0%; 4.4-21.5%). The investigator's visual evaluation of vessel size at the bedside showed substantial agreement with the measured cross-sectional area (linear-weighted kappa of 0.73). In a subset of 13 patients age <24 months, the mean depth of the ulnar artery was 2.13 mm compared to 1.65 mm for the radial artery (difference −0.48 mm 95% CI 1.08-0.12). Conclusions:The ulnar artery was larger than the radial artery in 60% of pediatric patients thus may offer an arterial cannulation site advantage due to its larger size. The use of 2-dimensional ultrasound examination allows accurate assessment of upper extremity distal arteries in order to optimize site selection for arterial cannulation in pediatric patients.

Analysis of the radial and ulnar arteries using ultrasound and a vascular visualization device in children

“…Comparing the UA and RA in children, the previous reports of Latham et al indicated a larger RA diameter, 5 while Roux et al reported a larger UA diameter 6 . However, in this study, there were no statistically significant differences between the diameters of the UA and RA in all age groups (Figure 3).…”

“…[1][2][3][4] However, there are few clinical studies on the UA approach in children and comparing the diameter of UA and RA. [5][6][7][8] It has also been reported that a depth of 2-4 mm from the skin surface increases the success rate of arterial cannulation. 9 Recently, a new transcutaneous vascular visualization device, the Mill Suss™ Vascular Visualization Device (Nippon Covidien Ltd.), has been introduced.…”

“…In adults, the UA diameter is often reported to be either equal to or smaller than the RA diameter 1–4 . However, there are few clinical studies on the UA approach in children and comparing the diameter of UA and RA 5–8 . It has also been reported that a depth of 2–4 mm from the skin surface increases the success rate of arterial cannulation 9 …”

Ipsilateral double arterial puncture in children

“…This patient population often requires specialized pain management strategies secondary to increased muscle tone and spasticity, which can be worsened by inadequate pain control. 1 While there have been many surgery-specific guidelines published in the adult population, there is far less available literature for the pediatric population. [2][3][4][5][6] Prior to development of our ERAS protocol, we noticed that patients that were not eligible to have an epidural placed (eg, posterior spinal fusion, baclofen pump) and who had single-shot peripheral nerve blocks placed appeared to have similar pain management outcomes and were leaving the hospital earlier compared to our patients who had an epidural placed.…”

Can the ulnar artery serve as an alternative option for arterial cannulation in neonates?

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We read with great interest the article by Roux et al 1 comparing the size and depth of radial and ulnar arteries in pediatric patients from birth to 6 years of age. The authors reported that the ulnar artery was larger than the radial artery in 60% of the patients, which might be advantageous for ultrasound-guided peripheral arterial cannulation.

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