NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
Heather H. Hager ; Bracken Burns .
Last Update: July 24, 2023 .
Arterial cannulation is a procedure frequently performed in acute and critical care settings. It serves as an invasive means to more accurately measure blood pressure and mean arterial pressure than non-invasive means. Artery cannulation gives precise measurements that allow for immediate recognition of alterations, thus allowing for quicker intervention and potential stabilization of a patient. This activity describes the technique and indications for arterial cannulation and highlights the role of the interprofessional team in ensuring safe arterial access.
Identify the technique of inserting arterial lines. Describe the indications for inserting arterial lines. Recall the complications of arterial lines.Review the importance of improving care coordination among interprofessional team members to improve outcomes for patients needing arterial access.
Arterial cannulation is a procedure frequently performed in acute and critical care settings. It serves as an invasive means to more accurately measure blood pressure and mean arterial pressure than non-invasive means. Artery cannulation gives precise measurements that allow for immediate recognition of alterations, thus allowing for quicker intervention and potential stabilization of a patient. In addition to accurate arterial pressures, arterial cannulation may also serve as a means to collect blood gas samples repetitively without requiring additional punctures and increasing the potential for injury. There are multiple sites for arterial cannulation including but not limited to radial, brachial, and femoral arteries. The radial artery is the most utilized for access in adults and pediatrics. Arterial cannulation is a relatively safe procedure that poses little risk of complication when performed by an appropriately skilled practitioner.[1][2][3][4]
There are several indications for which arterial cannulation may be considered. The most obvious being invasive blood pressure monitoring and accurate mean arterial pressures. Arterial cannulation may also be considered in patients who will require frequent arterial blood samples or in patients which non-invasive blood pressure monitoring is excluded such as those with large surface area burns, severe hypotension, multiple extremity fractures, or extreme obesity.
As in any procedure that has indications, there are also contraindications to arterial cannulation. One of the most common contraindications for arterial cannulation is anticoagulation, especially in those who have recently received thrombolytics for an acute infarct. Other contraindications include coagulopathy, arterial atherosclerosis, insufficient collateral perfusion, partial or full thickness burns over the cannulation site, synthetic arterial or vascular grafts, or infection at the proposed site of cannulation. Caution must be used if one chooses to proceed with arterial cannulation despite the posed contraindications. The procedure has been successfully performed in the presence of contraindications; however, it is not encouraged unless there are extenuating circumstances in which the practitioner feels the procedure is necessary. Absolute contraindications for arterial cannulation are absent pulse, Raynaud Syndrome, full thickness burns over the proposed site of cannulation, inadequate or interrupted circulation. Despite the list of contraindications, there is a less than one percent chance for major complications with arterial cannulation. A risk to benefit analysis should be performed in each patient prior to proceeding with arterial cannulation.
With the radial and femoral arteries being the 2 most cannulated sites, we will explore the anatomical site where the 2 can be located and cannulated in detail.
Radial artery: From the brachial artery, the radial artery originates in the cubital fossa and traverses the lateral aspect of the forearm. It supplies the palmar arches that provide adequate blood circulation to the hand. It is palpable at the wrist, proximal to the radial styloid or radial head and slightly lateral. The cannulation site should be at the very distal portion of the arm. The most frequent location for radial artery cannulation is at the proximal flexor crease of the wrist, 1 cm proximal to the styloid process.
Femoral artery: Originating at the inguinal ligament just off of the external iliac artery, lies the femoral artery. It continues posterior to the inguinal ligament, at the median between the anterior superior iliac spine and pubic tubercle. The femoral artery is situated medial to the nerve thus lateral to the vein. Due to the increased risk of bleeding as a result of increased diameter of the femoral artery in relation to the radial artery, the initial access site should be 2.5 cm distal to the inguinal ligament. This allows for suitable compression of the vessel if necessary. The femoral pulse should be easily identified with slight pressure placed median the distance between the anterior superior iliac spine and the symphysis pubis.
Indications for arterial cannulation include but are not limited to:
