Title: Review of Practice and Complications of Intra Arterial Cannulation in a Tertiary Care Centre-An Observational Study

Authors: Dr Girijanandan D Menon, Mr Basil Paul, Dr Manjit George, Dr Shaloo Ipe

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i7.87

Abstract

Introduction: Intra arterial cannulation is a common procedure performed in operating rooms and intensive care units. It aids in continuous monitoring of blood pressure and blood sampling for blood gas analysis. The present study was conducted to evaluate the practice of percutaneous arterial cannulation in our hospital, which is a rural tertiary care centre. Twenty five consecutive cases done over three months were evaluated for the study purpose. The indication for insertion and removal of intra arterial cannulation was noted. Associated complications, if any, during or after arterial line insertion and/or removal were noted.

Background: Arterial line placement is a common procedure in various critical care settings. Intra-arterial blood pressure (IABP) measurement is more accurate than measurement of blood pressure by noninvasive means, especially in the critically ill. Intra-arterial blood pressure monitoring permits the rapid detection of blood pressure changes that is vital for patients on continuous infusions of vasoactive drugs. Arterial cannulation also allows repeated arterial blood gas samples to be drawn without injury to the patient.

Aim of the study: To assess the practice and complications associated with intra arterial cannulation in a tertiary care centre

Study Design: Observational study over a period of  three  months

Methods: 25 consecutive cases of intra arterial cannulation were assessed regarding the indications and associated complications if any.

Results: Beat to beat observation of blood pressure, use of ionotropes and arterial blood sampling together constituted 48 % of all the indications for intra arterial cannulation. Kinking and or displacement of cannula  together formed 48% of the complications, resulting in intra arterial line removal. Haematoma was noted in 16 % cases, while pain and swelling was reported by 4-8% patients.

Conclusion: Intra arterial blood pressure monitoring, for all its accuracy and reliability, is associated with minimal complications.

Keywords: arterial cannulation, indications, techniques, complications

References

  1. Hales S. Statical Essays: Haemastatics. Innys; 1740. 422 p.
  2. Tiru B, Bloomstone JA. Radial Artery Cannulation: A Review Article. J Anesth Clin Res [Internet]. 2012 [cited 2018 Jun 1];03(05). Available from: https://www.omicsonline.org/radial-artery-cannulation-a-review-article-2155-6148.1000209.php?aid=6615
  3. Adsumelli RSN, Steinberg ES, Schabel JE, Saunders TA, Poppers PJ. Sequential compression device with thigh-high sleeves supports mean arterial pressure during Caesarean section under spinal anaesthesia. Br J Anaesth. 2003 Nov;91(5):695–8.
  4. Arterial Line Placement Technique: Approach Considerations, Allen Test, Catheter-Over-Needle Technique [Internet] [cited 2018 Jun 1]. Available from: https://emedicine.medscape.com/article/1999586-technique
  5. Arterial Line Placement: Background, Indications, Contraindications. 2018 Mar 26 [cited 2018 Jun 3]; Available from: https://emedicine.medscape.com/article/1999586-overview
  6. Scheer BV, Perel A, Pfeiffer UJ. Clinical review: Complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care. 2002;6(3):199–204.
  7. Cousins TR, O’Donnell JM. Arterial cannulation: A critical review. :5.
  8. Mandel MA, Dauchot PJ. Radial artery cannulation and complications in 1,000 patients: Precautions. J Hand Surg. 1977 Nov 1;2(6):482–5.
  9. Nuttall G, Burckhardt J, Hadley A, Kane S, Kor D, Marienau MS, et al. Surgical and Patient Risk Factors for Severe Arterial Line Complications in Adults. Anesthesiol J Am Soc Anesthesiol. 2016 Mar 1;124(3):590–7.
  10. Slogoff S, Keats AS, Arlund C. On the safety of radial artery cannulation. Anesthesiology. 1983 Jul;59(1):42–7.

Corresponding Author

Dr Manjit George

Associate Professor, Department of Anaesthesiology

MOSC Medical College, Kolenchery 682311

Tel- 9447411536, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.