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LETTER TO EDITOR
Year : 2018  |  Volume : 34  |  Issue : 3  |  Page : 420-421

Ultrasonography and Seldinger's technique: Using the best of both worlds for difficult radial artery cannulation!


Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication11-Oct-2018

Correspondence Address:
Rashmi Ramachandran
Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacp.JOACP_15_18

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How to cite this article:
Ramachandran R, Bhattacharjee S, Marada S, Rewari V. Ultrasonography and Seldinger's technique: Using the best of both worlds for difficult radial artery cannulation!. J Anaesthesiol Clin Pharmacol 2018;34:420-1

How to cite this URL:
Ramachandran R, Bhattacharjee S, Marada S, Rewari V. Ultrasonography and Seldinger's technique: Using the best of both worlds for difficult radial artery cannulation!. J Anaesthesiol Clin Pharmacol [serial online] 2018 [cited 2018 Dec 19];34:420-1. Available from: http://www.joacp.org/text.asp?2018/34/3/420/243149



Madam,

Invasive blood pressure monitoring is an essential part of perioperative management of patients undergoing pheochromocytoma removal. We performed radial artery cannulation in a 60-year-old female patient undergoing laparoscopic left adrenalectomy for pheochromocytoma. Consent for publication of the report has been obtained from the patient. The patient had had Colles' fracture in bilateral wrist joints and as a result had abduction and flexion deformity of both the wrist joints. The radial artery on both sides had a tortuous course [Figure 1]a. We used real- ultrasonography to localize and guide cannulation in the radial artery by Seldinger technique using a 20-gauge arterial cannula (Leadercath, Vygon, UK). Arterial puncture and guidewire insertion were successfully done followed by insertion of arterial catheter [Figure 1]b.
Figure 1: (a) The tortuous course of radial artery. (b) The guide wire of the arterial catheter in situ

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Use of guidewire for insertion of radial artery catheter significantly improves the success rate of cannulation.[1] This case clearly demonstrates how the guidewire could easily negotiate the bends in the radial artery while a normal polyurethane cannula would have caused intimal tears or possible re-puncture of arterial wall. Use of real-time ultrasound during arterial cannulation has a higher success rate and lesser complication rate when compared with palpation method.[2] The long axis-in plane approach to the cannulation that we used has been shown to have shorter cannulation time and decreased incidence of complications when compared to short axis-out of plane approach.[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pancholy SB, Sanghvi KA, Patel TM. Radial artery access technique evaluation trial: Randomized comparison of Seldinger versus modified Seldinger technique for arterial access for transradial catheterization. Catheter Cardiovasc Interv 2012;80:288-91.  Back to cited text no. 1
    
2.
Seto AH, Roberts JS, Abu-Fadel MS, Czak SJ, Latif F, Jain SP, et al. Real-time ultrasound guidance facilitates transradial access. Cardiovasc Interv 2015;8:283-91.  Back to cited text no. 2
    
3.
Berk D, Gurkan Y, Kus A, Ulugol H, Solak M, Toker K. Ultrasound-guided radial arterial cannulation: Long axis/in-plane versus short axis/out-of-plane approaches? J Clin Monit Comput 2013;27:319-24.  Back to cited text no. 3
    


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