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Background Continuous invasive arterial monitoring is necessary in sick neonates needing hemodynamic and ventilatory support. The primary objective of our study was to describe clinical experience with percutaneous peripheral arterial cannulation (PAC) in sick neonates. Methods Neonates needing PAC were prospectively enrolled in the study. Inclusion criteria were: neonates needing respiratory support (invasive or non-invasive), neonates requiring vasoactive medications or neonate likely to need more than 5 sampling pricks in 24 h. Results One hundred eight neonates (93.1%) needed cannulation of one arterial site while 8 (6.9%) needed cannulation of 2 arterial sites, thus giving a total of 124 cannulations. Out of the 124 cannulations, 102 (82%) were performed in first attempt, while 22 (18%) cannulations needed 2 or more attempts. Serious complications like discolouration of digits, blanching of skin or bleeding were seen in 6 (4.9%) cannulations. These resolved after removal of arterial line and no long term consequences were noted. On comparing neonates having radial arterial cannulation(n = 108) with posterior tibial arterial cannulation (n = 16) there was no difference in duration of arterial line between radial artery group (mean, SD 53.30 ± 22.56) and posterior tibial artery group (mean, SD 48.25 ± 27.39). However, more attempts were needed to cannulate post tibial artery (mean, SD 2.25 ± 1.32) as compared to radial artery (mean 1.22 ± 0.789) and this difference was statistically significant (MD -1.02, 95% CI − 1.75 to − 0.30). There was no difference in incidence of serious complications between the radial artery group (3.7%, n = 4) as compared to posterior tibial group (5.5%, n = 1, OR 0.57, 95% CI 0.06–5.51, p = 0.63). Conclusions Peripheral arterial cannulation is a safe method for hemodynamic monitoring and blood sampling in sick neonates. Complications can be minimized by diligent monitoring and proactive removal of line if there is damping of tracing.

Background: the aim of our study was to evaluate the impact of different cannulation strategies, retrograde and antegrade, on outcome of type A aortic dissection (TAAD) surgery and to identify the predictors of perioperative transient & permanent neurologic dysfunction. Methods: Between March 2014 and September 2017, 50 patients with TAAD who underwent surgical repair of aortic dissection at Kasr Alainy Hospital, Cardiothoracic Surgery Department were divided into two equal groups: The first group had retrograde (femoral) cannulation, while the second group had antegrade cannulation (central, right axillary, and innominate artery). Results: the mean age was 52.6 years in the retrograde group and 46.5 years in the antegrade group. There were 3 deaths in the retrograde group (12%) and 2 deaths in the antegrade group (8%). Transient neurologic dysfunction was observed in 4 patients (16%) in the first group and 0 patients (0%) in the second group. A total of 3 patients (12%) in the first group suffered from a permanent neurologic dysfunction to 2 patients (8%) in the second group. Conclusions: The cannulation site in an aortic dissection should be carefully chosen on a case-by-case basis and larger study is recommended to better evaluate optimal cannulation technique. Keywords: Axillary artery, Femoral artery, Cardiopulmonary bypass, Cannulation, Aortic dissection

The current available literature is not unanimous in reporting the utility of short-axis and long-axis techniques for radial artery cannulation in both adults and children. This study was designed to compare short-axis out-of-plane (SA-OOP) and long-axis in-plane (LA-IP) techniques in ultrasound-guided radial artery cannulation in adults. In this prospective randomized controlled trial, 150 adult patients of American Society of Anesthesiologists physical status I–III aged between 18 and 70 years were included. All patients were randomized into two groups (group SA-OOP) and (group LA-IP) of 75 each undergoing ultrasound-guided radial artery cannulation. The primary outcome was successful cannulation in the first attempt. Secondary outcomes included antero-posterior arterial diameter, skin-to-artery distance, ultrasonic localization time, cannulation time, no of attempts to cannulate artery, cannula insertion failure, and vascular complications. First-attempt arterial cannulation was successful in 80 % of patients in the SA-OOP group as opposed to 82.6 % patients in the LA-IP group (p = 0.67). The time to cannulate the artery was similar between the two groups, but the time to localize artery was significantly higher in the long-axis technique (p

Inadvertent arterial cannulation at a noncompressible site is a highly risky complication of central venous line placement.We present a case of inadvertent placement of a 6-French venous sheath into the right subclavian artery (SCA) at the origin of the vertebral artery (VA), which was treated successfully using endovascular therapy.Due to the complex site of cannulation, and the patient being fully anticoagulated, the use of a percutaneous closure device was not attempted. Open vascular surgery was not a treatment option due to high surgical risk. After determining left VA dominance, the right VA was occluded distal to the catheter entry point with platinum coils. Subsequently, a covered stent was placed into the SCA across the origin of the VA. The sheath was then removed safely without complications. A minor leak was initially present, which was stopped by repeating balloon inflation within the stent above nominal pressure.

We report a case of compartment syndrome caused by femoral arterial cannulation during cardiopulmonary bypass. A 62-year-old man who had been diagnosed as acute aortic dissection (type I) received a operation of partial arch replacement with reconstruction of brachiocephalic and left carotid arteries. Compartment syndrome was noticed just after the operation, which was caused by long-term ischemia during femoral arterial cannulation combined with poor collateral circulation by the dissection of iliac arteries. The emergency fascitomy was performed, therefore, he could be discharged without any complications. It is concluded that in case of acute aorte aortic dissection, the back-flow of blood should be checked at the time of femoral arterial cannulation, and whenever the back-flow is poor, some procedures should be added to increase distal blood flow.

To the Editor, We read with interest the article by Aoyama et al. regarding a novel technique to confirm the location of guidewires, and we have a few suggestions to supplement correct internal jugular venous (IJV) cannulation and catheter placement. We agree with the authors’ observation that the guidewire may not always be visible during ultrasoundguided IJV cannulation and commend them for the novel technique they devised to identify guidewire location. We practice several maneuvers at our own institution to assist with identification of the guidewire during central venous cannulation. We perform these maneuvers either alone or in sequence, especially if the guidewire is difficult to visualize. One of the maneuvers involves placing the ultrasound probe either in plane or obliquely over the guidewire to assist with guidewire identification. It is advantageous to hold the ultrasound probe in line because a significant length of the guidewire can be visualized in the vein, the guidewire’s location in the internal jugular vein can be confirmed, and distal arterial cannulation by the guidewire, if any, can be detected. A second maneuver we use to assist with identification of the guidewire in the internal jugular vein involves wiggling the guidewire while it is held close to the entry point in the skin with the ultrasound probe in a transverse position. Our third maneuver involves gradually increasing the pressure exerted by the ultrasound probe over the vein until the vein collapses. When this is followed by the sudden release of the probe, it leads to changes in the intraluminal pressure and movement of the guidewire within the lumen of the vein, thus assisting in its identification. We suggest using multiple techniques to confirm guidewire location in the internal jugular vein, especially in cases of difficult visualization. This will minimize complications and improve patient safety.

leading nationalorganizations (National Institute for Clinical Excellence[UK], Agency for Healthcare Research and Quality [USA])to recommend US guided internal jugular CVC insertion.We describe an intraoperative carotid artery punctureduring attempted internal jugular venous cannulation,which occurred despite the use of US.A 34-year-old male with chronic renal failure had aCVC placed for perioperative monitoring during renaltransplantation. The right jugular approach was used withUS guidance oriented in the transverse view. A puncture ofthe carotid artery by the 18G needle was identified by colorand pulsatility. The needle was withdrawn and pressureapplied. The next attempt, also with US, resulted in apuncture of a vessel that was identified as a vein because ofthe dark non-pulsatile blood aspirated through the needle.Next, a multi-lumen 7 Fr catheter was inserted, and arterialcannulation was identified by connecting the catheter to apressure transducer. The catheter was withdrawn andpressure applied. A non-pulsatile hematoma developed,and further attempts at CVC were abandoned. Due to thehematoma, the patient required brief postoperative venti-lation. A postoperative Doppler exam of the carotid arterywas normal.The use of an US technique does not remove all riskinherent with CVC insertion. Methods are not standardized,and we believe many practitioners use the US techniqueonly to locate and puncture the internal jugular vein, andthen they discontinue using the method.

The following case report describes an expanding aneurysmal dilatation of the radial artery which developed 17 days following cannulation. Possible causes of this complication are: abnormal state of the vessel wall, multiple attempts at cannulation, and haematoma or infection at cannulation site. Other major and minor sequelae following arterial cannulation are reviewed.

BACKGROUND: We compared six kinetic models with and without the requirement of arterial cannulation for estimating the binding potential of [N-methyl-11C]mirtazapine in the living human brain. METHODS: Distribution volumes of [N-methyl-11C]mirtazapine in brain regions were estimated using single- and two-tissue compartment models as well as a graphical plasma input model. The two-tissue compartment model provided a direct estimate of the binding potentials of [N-methyl-11C]mirtazapine in brain regions, while binding potentials of the single-tissue compartment model and the graphical plasma input model were estimated indirectly from ratios of distribution volumes in brain regions. We obtained also direct estimates of binding potentials using a graphical reference tissue model and two nonlinear reference tissue models. RESULTS: The two-tissue compartment model required several fits with different initial guesses for avoiding negative values of parameters. Despite the extra fits, estimates of distribution volumes and binding potentials of [N-methyl-11C]mirtazapine obtained by the two-tissue compartment model were far more variable than those produced by the other methods. The graphical plasma input method and the graphical reference tissue method provided estimates of the binding potential that correlated closely, but differed in magnitude. The single-tissue compartment model provided relatively low estimates of binding potentials with curves that failed to fit the data as well as the three other methods that used the entire series of positron emission tomography data. The reference tissue method and the simplified reference tissue method provided similar, consistent estimates of binding potentials. However, certain assumptions of the simplified reference tissue method may not be fulfilled by the radioligand. CONCLUSION: The reference tissue method is appropriate for estimating the binding potential of [N-methyl-11C]mirtazapine in regions of the human brain so that the binding potential of [N-methyl-11C]mirtazapine can be estimated without arterial cannulation. KEYWORDS: [11C]mirtazapine; antidepressant; PET; kinetic models; distribution volume; binding potential; human brain.

Arterial cannulation is a very useful tool in the management of patients in mechanical ventilation or hemodynamic instability. However, local complications are always a concern.

The radioisotope technique for cardiac output measurement has the advantage over the dye dilution method of not requiring arterial cannulation. Repeated determination and repeated calibration are easily achieved. Because of a systematic error in the calibration procedure, the usual isotope technique of recording from the praecordium gives higher values than those obtained from dye dilution curves. The reasons for this are discussed. It is suggested that recording from the head has certain advantages in terms of calibration. Radioisotope curves from the praecordium, the lung and the head and arterial dye dilution curves have been simultaneously recorded in 21 subjects. The results suggest that recording from the head gives values for cardiac output most closely related to those obtained by the dye dilution technique.

We encountered eight rare cases of myonephropathic metabolic syndrome (MNMS) which developed as a complication of the femoral arterial cannulation (FAC) during cardiopulmonary bypass (CPB). Seven were boys ranging in age from 4-17 years, and all had undergone open heart surgery using CPB with a hemodilution technique. These eight corresponded to 1.9 per cent of the 420 patients treated with CPB before June, 1974. The pump priming fluid used was either Ringer's lactate solution alone or that containing a small amount of colloidal solution. Duration of CPB ranged from 52 min to 2 hrs and 42 min, but the FAC period was more than 3 hrs in each case. Acute renal failure occurred in 3 and 2 required peritoneal dialysis. Severe respiratory insufficiency occurred in 2 and one died 3 months after the operation. The most effective means to prevent the development of MNMS seems to be the local cooling of the cannulated limb during FAC. MNMS did not occur in 444 cases of CPB with FAC after July 1974, and here local cooling was applied in all cases.