critical care medicine
How To Do Radial Artery Cannulation
Contraindications to Radial Artery Cannulation
Absolute contraindications An artery that is neither palpable nor detectable by ultrasonography (never try to cannulate a site simply because the artery is expected to be there) Unsuitable artery (eg, dialysis fistula at same limb, thrombosed or inaccessible artery, generalized limb ischemia) Inadequate collateral blood flow from ulnar artery circulation Full-thickness burns Local infection at the insertion site Relative contraindications Coagulopathy (including therapeutic anticoagulation*) or recent/pending thrombolysis: The radial artery is the preferred arterial cannulation site in these situations; prolonged pressure (eg, 10 minutes or more) may be needed to stop bleeding/hematoma at the site. Local anatomic distortion (traumatic or congenital), or gross obesity History of prior surgery in the area Distal extremity ischemia/gangrene * Therapeutic anticoagulation (eg, for atrial fibrillation) increases the risk of bleeding with radial artery cannulation, but this must be balanced against the increased risk of thrombosis (eg, stroke) if anticoagulation is reversed. Discuss any contemplated reversal with the clinician managing the patient's anticoagulation and then with the patient. 