THE INCIDENCE OF ARTERY PUNCTURE WITH CENTRAL VENOUS CANNULATION USING A MODIFIED TECHNIQUE FOR DETECTION AND PREVENTION OF ARTERIAL CANNULATION

Background: Cannulation of the central circulation is essential for ma nagement of patients who require major surgery, and for patients who a re critically ill. Arterial puncture is the most frequent complication associated with central venous cannulation, and is potentially fatal. Detection of arterial puncture can be problematic, especially in pati ents with cyanotic congenital heart disease. Methods: One thousand ele ven consecutive cardiothoracic and vascular surgical patients who requ ired central venous cannulation were studied using a new technique for detection of arterial puncture and prevention of arterial cannulation . This technique involves continuous pressure transduction of the stee l introducer needle. Central venous cannulation was attempted in all p atients. The sites of attempted catheterizations, number of arterial p unctures and cannulations, and the number of successful catheterizatio ns were noted. All patients were treated in accordance with standard a nesthetic and surgical techniques in the institution. Results: One tho usand one hundred seventy-two central venous catheters were placed. Th e overall success rate was 99.6%. The incidence of arterial puncture w as 9.3% for central venous cannulation attempts of the internal jugula r, subclavian, and femoral veins. No arterial cannulation occurred, an d none of the patients had significant complications. Congenital heart disease patients had a higher incidence of arterial puncture (14.1%) and a lower rate (96.8%) of successful cannulation. Conclusion: Pressu re transduction of the steel needle is a useful technique for detectin g arterial puncture and preventing arterial cannulation during attempt s to achieve central venous cannulation. Copyright (C) 1997 by W.B. Sa unders Company.