Cannulation of the axillary artery in critically ill newborn infants

The axillary artery has been successfully cannulated in critically ill adult and paediatric patients. There is little information about experience with this technique in neonates. We report the use of axillary cannulation in 62 mechanically ventilated neonates with birth weight from 750 to 3800 g (mean 1950 g). The axillary artery was catheterized with 24 or 22 gauge teflon catheters by means of the catheter-over-a-needle technique. Arterial access was used for blood pressure monitoring, blood sampling and in seven cases for blood removal during exchange transfusions. Cannulae were removed when the fraction of inspired oxygen (FIO2) was less than 0.3. During cannulation capillary refill, radial artery pulse and neurological status of the arm were checked daily. The mean period of cannulation was 4.1 days (1-10 days). During cannulation and after catheter removal there were no complications related to the chosen vessel e.g. no change in the skin colour, skin warmth, capillary refill and the quality of the radial pulse. No changes in the motor activity of the limb on the cannulated side were observed.

Axillary artery cannulation is a useful alternative for establishing an arterial access in ventilated neonates. Further studies are needed to evaluate the long-term consequences of this technique.