Doppler-Assisted Radial Artery Cannulation in Infants and Children

Abstract

Percutaneous radial artery cannulation allows beat-to-beat blood pressure monitoring and frequent blood-gas analysis in critically ill patients. It has been employed in adults for many years with a high rate of success and low rate of complication (1–3). More recently, the technique has been applied to sick neo-nates, and has produced fewer serious vascular and infectious complications than are associated with umbilical artery catheterization (4–6). Refinements in technique have improved the success rate of percutaneous cannulation and have diminished the need for the cutdown procedure. In neonates, although not in older children or adults, it is possible to identify the radial artery with transillumination of the wrist (7). Doppler localization of the radial artery has improved the rate of successful cannulation in adults in whom the traditional percutaneous technique has failed (8). As a further refinement of this technique, the Doppler probe can be held over the artery throughout cannula insertion; the exact position of the artery is identified by a change or loss of Doppler tones as the cannula contacts and compresses the artery. Results of a prospective series of infants and children with congenital heart disease in whom this technique was used are presented and are compared to a series performed before the introduction of the Doppler technique.