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Radial artery cannulation in edematous patients

Lucknow India

To the Editor:

Cannulation of peripheral arteries is a useful procedure for monitoring of arterial pressure and analysis of blood gases. In edematous patients cannulation of peripheral arteries and veins becomes difficult, owing to the presence of excessive perivascular interstitial fluid. Thus, arterial pulsations become feeble and at times impalpable. This leads to repeated attempts at cannulation and even failure.

A 26-yr-male patient with myeloid leukemia in accelerated phase with massive splenomegaly and anasarca was admitted for splenectomy. Following intubation, right radial artery cannulation was attempted with a 22 G cannula. It was difficult to palpate the radial artery, which was punctured on the third attempt but could not be cannulated. Thereafter, pressure was applied over the puncture site for two minutes to prevent hematoma formation. Once the pressure was released, there was a depression at the site due to redistribution of edema fluid and the radial artery was easily palpated. Subsequently, the artery could be punctured and cannulated easily on the second attempt.

In patients with pitting edema there is exudation of fluid in the interstitial space. Neonates and more so preterms have relatively more total body fluid (interstitial fluid).¹ Displacement of perivascular interstitial fluid by pressure over the peripheral artery makes the course of the artery visible, rendering cannulation under direct vision easy in pediatric patients.² Although the radial artery lies deep to the deep fascia, the overlying interstitial fluid can be displaced by applying pressure, making arterial palpation easy and facilitating cannulation.

References

1 Stoelting RK, Dierdorf SF, McCammon RL. Water and Electrolyte disturbances. In: Stoelting RK, Dierdorf SF, McCammon RL (Eds.). Anesthesia and Co-existing Disease, 2^nd ed. New York: Churchill Livingstone Inc., 1988: 445–71.

2 Raichur DV. Radial artery cannulation in Neonates: a new method. Indian Journal of Pediatrics 2000; 67: 843.[Medline]

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