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Arterial cannulation: a critical review.

Teresa R Cousins¹, John M O'Donnell

¹University of Pittsburgh School of Nursing Nurse Anesthesia Program, PA, USA.

|September 10, 2004

Summary

This review compares arterial catheterization sites for hemodynamic monitoring. Femoral and axillary sites offer accurate readings with low thrombotic risk, but axillary sites may cause brachial plexus compression.

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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.

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