Arterial cannulation: a critical review

Area of Science:

• Cardiovascular Medicine
• Critical Care Medicine
• Medical Device Technology

Background:

• Arterial catheterization is a cornerstone of hemodynamic monitoring in clinical practice.
• Complications associated with arterial cannulation have been documented since the technique's inception.
• Understanding the risks and benefits of different cannulation sites is crucial for patient safety.

Purpose of the Study:

• To systematically review and compare the complications and data accuracy of various arterial catheterization sites.
• To evaluate radial, brachial, axillary, and femoral cannulation for hemodynamic monitoring.
• To inform clinical decision-making regarding the optimal site for arterial catheterization.

Main Methods:

• Comprehensive literature search of CINAHL and MEDLINE databases (January 1997 - February 2002).
• Inclusion of English-language randomized controlled trials, reviews, practice guidelines, and meta-analyses.
• Analysis of waveform distortion, adjacent structure injury, and thrombus incidence for each site.

Main Results:

• Radial cannulation: prone to inaccuracy and thrombus, but offers dual circulation.
• Brachial cannulation: inaccurate, lacks collateral circulation, associated with median nerve injury.
• Axillary cannulation: approximates aortic pressure, low thrombotic risk, but risks brachial plexus compression.
• Femoral cannulation: approximates aortic pulse contour, minimal thrombotic risk, low infection incidence.

Conclusions:

• No single arterial catheterization site is without risk.
• Axillary and femoral sites provide accurate hemodynamic data with lower thrombotic risks compared to radial and brachial sites.
• Clinical choice of cannulation site should balance data accuracy, potential complications, and patient-specific factors.