Temporal artery catheterization for arterial access in the high risk newborn

The hazards of umbilical artery catheterization necessitate the adoption of an alternate arterial cannulation site for monitoring arterial pressure and oxygen tension in the critically ill newborn. A newly developed method of catheter placement in the temporal artery not only provided arterial access for substantially longer than that reported for radial artery cannulation, but more than 50% of the infants in which it was performed weighted less than 1500 grams. Close adherence to the technique of arterial cannulation and catheter fixation is essential for prolonged arterial access. The method involves (1) Doppler location of the temporal artery, (2) a 3 mm transverse incision directly over the vessel, (3) bevel-down insertion of a winged hub teflon catheter with inner needle stylet, (4) securing the catheter with suture and collodion, and (5) maintenance of catheter patency with a constant infusion of heparinized solution. Temporal artery cannulation using this technique has been performed thus far 115 times in 100 infants with severe respiratory distress. The patients weighed between 540 and 3900 grams. Catheters remained operational for an average of 6.5 days (8 hours to 23 days), with 62% of all catheters providing arterial samples for more than 5 days. The cannulas worked well for arterial pressure monitoring, and pulse contour matched that of the umbilical artery in infants with catheters in both vessels.