Arterial cannulation is used to enable continuous arterial pressure monitoring and blood gas analysis. It is usually performed by either a palpatory or landmark technique, or under ultrasonographic guidance. We wish to report a novel approach which demonstrates the insertion of the arterial cannula under real‐time direct waveform assistance. In this method, the arterial cannula with stylet in situ is attached with a pressure transducer and a pressure monitoring line as a single assembly (Fig. 1a). The assembly is then flushed with heparinised saline and the pressure transducer is attached to the monitor. The arterial puncture site is determined by palpation. With strict aseptic technique, the cannula is inserted at the arterial puncture site. An arterial pressure waveform appears on the monitor once the stylet has entered the artery. The stylet is then slightly withdrawn and the persistence of the waveform confirms the intra‐arterial position of the cannula (Fig. 1b). Following the removal of the stylet, the pressure monitoring line is disconnected from the stylet to be attached to the arterial cannula. The procedure is summarised in the online video included with this article (see online Supporting Information Video S1). This technique adds real‐time guidance to an otherwise purely palpatory technique, analogous to the use of a nerve stimulator needle for regional blocks. It is well known that ultrasound‐guided arterial cannulation has a high success rate compared to the blind or palpatory approach [1, 2]. Combining ultrasound guidance and waveform assistance could potentially further augment the first pass success rate. The standalone use of our technique may also minimise the need for an ultrasound and its associated costs in resource‐limited settings.
Figure 1.
(a) The assembly of the arterial cannula, with its stylet, attached to the transducer set up (DiWA assembly); (b) Photograph showing confirmation of the intra‐arterial placement (characteristic waveform on the monitor).
Supporting information
Video S1.
Acknowledgements
Published with the written consent of the patient. No external funding or competing interests declared.
References
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Supplementary Materials
Video S1.