Arterial catheterization for hemodynamic monitoring is
used widely in clinical management. Complications of can-
nulation have been recognized since introduction of the
technique.
This review examines radial, brachial, axillary, and
femoral cannulation sites. Waveform distortion, adjacent
structure injury, and the incidence of thrombus are described.
Computerized subject heading searches were executed
using CINAHL and MEDLINE databases. Searches encom-
passed English-language, randomized, controlled trials,
reviews, practice guidelines, and meta-analyses published
from January 1997 to February 2002. Additional studies
were identified via review of retrieved literature.
Radial cannulation is subject to inaccuracy and thrombus
formation, although a benefit is dual circulation. The
brachial site is subject to inaccuracy, lacks collateral circula-
tion, and is associated with median nerve injury. Axillary
cannulation provides data closely approximating aortic
pressure and poses minimal thrombotic risk but is associ-
ated with brachial plexus compression. Femoral cannulation
provides a pulse contour approximating aortic with minimal
thrombotic risk. There is little evidence to show increased
incidence of catheter-related systemic infection at this site