Direct versus guidewire-assisted pediatric radial artery cannulation technique

Radial artery cannulation is a more difficult procedure in pediatric patients. Direct technique commonly fails in these patients, and several techniques have been developed for successful arterial cannulation. The purpose of this study was to compare direct radial artery cannulation with guidewire-assisted cannulation in children undergoing cardiac or aortic surgery. The hypothesis was that the guidewire-assisted technique would lead to fewer attempts and provide better long-term blood pressure monitoring and blood sampling.

One hundred pediatric patients with congenital heart defects undergoing major cardiovascular surgery, who required a radial artery catheter, were included in the study. Patients were divided into 2 groups: group 1 included 50 patients who had radial artery cannulation with the direct technique, and group 2 included 50 patients who had a guidewire-assisted radial artery cannulation.

A radial artery was successfully cannulated in 48 patients in group 2 but only 38 patients in group 1. Mean elapsed time for radial artery cannulation was 22 +/- 4.6 minutes in group 1 and 7 +/- 4.2 minutes in group 2 (p = 0.001). The average number of attempts for cannulation was 4.5 in group 1 and 2.1 in group 2 (p = 0.022). The opposite radial or an alternative artery was used more commonly in the direct technique group. Satisfactory blood pressure monitoring and sampling of blood were obtained in 28 patients in group 1 and 46 patients in group 2 (p < 0.001).

The authors recommend the use of a guidewire-assisted radial artery cannulation technique rather than a direct technique. The guidewire-assisted technique provided easy, safe, and quick cannulation and allowed for long-term satisfactory blood pressure monitoring and blood sampling because of the longer length of the Teflon catheter advanced into the artery over the guidewire, and a low rate of dissection of the radial artery.