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LETTERS TO EDITOR
Year : 2020  |  Volume : 21  |  Issue : 2  |  Page : 159-160
 

A modified technique of conventional arterial catheterization to increase success rate while reducing the complications


Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, Rajasthan, India

Date of Submission05-May-2020
Date of Acceptance27-May-2020
Date of Web Publication19-Sep-2020

Correspondence Address:
Dr. Manoj Kamal
Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TheIAForum.TheIAForum_53_20

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How to cite this article:
Hariprasad R, Choudhary G, Kamal M, Bhatia P. A modified technique of conventional arterial catheterization to increase success rate while reducing the complications. Indian Anaesth Forum 2020;21:159-60

How to cite this URL:
Hariprasad R, Choudhary G, Kamal M, Bhatia P. A modified technique of conventional arterial catheterization to increase success rate while reducing the complications. Indian Anaesth Forum [serial online] 2020 [cited 2020 Oct 30];21:159-60. Available from: http://www.theiaforum.org/text.asp?2020/21/2/159/295385




Sir,

Arterial catheterization is a commonly performed procedure for beat-to-beat blood pressure monitoring and for repeated arterial blood gas sampling. The radial artery is the most common site for catheterization. Radial artery catheterization is performed using Seldinger technique or catheter-over-needle technique.[1] In the catheter-over-needle technique, the artery is often transfixed by puncturing the posterior wall, and then the needle is withdrawn partially followed by the catheter, till a gush of blood is seen into the catheter hub and then the catheter is pushed into the artery. The intentional puncture of the posterior wall of the artery may lead to more chance of hematoma formation and passage of catheter into a false track. The average diameter of radial artery in an adult is approximately 2.5 mm, while the bevel length at the distal end of needle is 1.1 mm, with the needle tip cut obliquely at the acute angle. The sharp tip may be more likely to transfix the artery in bevel-up approach. In the bevel-up approach, the needle tip might remain inside the artery, while the catheter will be outside the artery [Figure 1] and [Figure 2]. Even when blood flows in the hub, it may be difficult to thread the catheter because either the needle tip has punctured the posterior wall or the catheter tip is outside the artery. This might damage the endothelium of the artery, which might lead to thrombus formation.
Figure 1: Puncture of the posterior wall of the artery by the needle in bevel-up approach, while the angle and length of needle insertion are same as of bevel-down approach

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Figure 2: In the bevel-down approach, both the catheter tip and the needle tip are present in the lumen of artery, while only the needle tip is present in the lumen in bevel-up approach

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We suggest that the cannula should be inserted with the bevel facing downside instead of the bevel facing upward. Once the blood flows into the hub of the cannula, the needle is withdrawn slightly and the catheter is threaded into the artery. This reduces the risk of puncture of the posterior wall of the artery and subsequent hematoma formation or passage of the catheter into a false track. The proposed modification of arterial catheterization can increase the success rate of arterial catheterization, thereby decreasing complications. Min et al. studied the effect of bevel direction on ultrasound-guided arterial cannulation and concluded that bevel-down approach exhibited a higher success rate with fewer complications compared to the bevel-up approach.[2] However, large trials are required to confirm the same.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflict of interest.



 
  References Top

1.
Mangar D, Thrush DN, Connell GR, Downs JB. Direct or modified Seldinger guide wire-directed technique for arterial catheter insertion. Anesth Analg 1993;76:714-7.  Back to cited text no. 1
    
2.
Min SW, Cho HR, Jeon YT, Oh AY, Park HP, Yang CW, et al. Effect of bevel direction on the success rate of ultrasound-guided radial arterial catheterization. BMC Anesthesiol 2016;16:34.  Back to cited text no. 2
    


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