Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Arterial puncture and cannulation in children

Lalit Bajaj, MD, MPH
Section Editors
Anne M Stack, MD
Adrienne G Randolph, MD, MSc
Deputy Editor
James F Wiley, II, MD, MPH


Arterial punctures permits measurement of blood gases and provides information essential for the care of patients with critical illness and respiratory disease and is also performed when blood cannot be obtained by venipuncture. Arterial cannulation is helpful when multiple arterial blood gas measurements are necessary over time and in patients for whom continuous blood pressure or cardiac output monitoring is desirable.

The procedures for obtaining and handling arterial blood gas specimens in children are reviewed here. The technique for arterial blood sampling in adults and the interpretation of blood gas results and pulse oximetry are discussed separately. (See "Arterial blood gases", section on 'Arterial sampling' and "Oxygenation and mechanisms of hypoxemia" and "Pulse oximetry in adults" and "Simple and mixed acid-base disorders".)


Indications, contraindications, and precautions — In children, arterial puncture is frequently performed to assess acid-base status and oxygenation, to correlate arterial with less invasive measurements (eg, venous blood gas or pulse oximetry), or to obtain a blood sample when venipuncture is unsuccessful.

Arterial puncture should not be performed at arterial sites with overlying skin infection.

Arterial cannulation instead of puncture is advisable in patients for whom multiple arterial measurements or continuous arterial blood pressure monitoring will be required. (See 'Indications, contraindications, and precautions' below.)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Jan 12, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Torrey SB, Saladino RA. Arterial puncture and catheterization. In: Textbook of Pediatric Emergency Procedures, 2nd edition, King C, Henretig FM. (Eds), Lippincott, Williams & Wilkins, Philadelphia 2008. p.715.
  2. Brzezinski M, Luisetti T, London MJ. Radial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations. Anesth Analg 2009; 109:1763.
  3. Brotschi B, Hug MI, Latal B, et al. Incidence and predictors of indwelling arterial catheter-related thrombosis in children. J Thromb Haemost 2011; 9:1157.
  4. Schindler E, Kowald B, Suess H, et al. Catheterization of the radial or brachial artery in neonates and infants. Paediatr Anaesth 2005; 15:677.
  5. King C, Henretig FM. Pocket Atlas of Pediatric Emergency Procedures, Lippincott Williams & Wilkins, Philadelphia 2000.
  6. Gao YB, Yan JH, Gao FQ, et al. Effects of ultrasound-guided radial artery catheterization: an updated meta-analysis. Am J Emerg Med 2015; 33:50.
  7. Schwemmer U, Arzet HA, Trautner H, et al. Ultrasound-guided arterial cannulation in infants improves success rate. Eur J Anaesthesiol 2006; 23:476.
  8. Ganesh A, Kaye R, Cahill AM, et al. Evaluation of ultrasound-guided radial artery cannulation in children. Pediatr Crit Care Med 2009; 10:45.
  9. Yildirim V, Ozal E, Cosar A, et al. Direct versus guidewire-assisted pediatric radial artery cannulation technique. J Cardiothorac Vasc Anesth 2006; 20:48.
  10. Tegtmeyer, K, Brady, G, Lai, S, et al. Placement of an arterial line. http://content.nejm.org/cgi/video/354/15/e13 (Accessed on April 17, 2007).
  11. Barker WJ. Clinical Procedures in Emergency Medicine, 3rd, Roberts. (Ed), WB Saunders, Philadelphia 1998.
  12. Miyasaka K, Edmonds JF, Conn AW. Complications of radial artery lines in the paediatric patient. Can Anaesth Soc J 1976; 23:9.
  13. Macnicol MF, Anagnostopoulos J. Arrest of the growth plate after arterial cannulation in infancy. J Bone Joint Surg Br 2000; 82:172.
  14. Dumond AA, da Cruz E, Almodovar MC, Friesen RH. Femoral artery catheterization in neonates and infants. Pediatr Crit Care Med 2012; 13:39.
  15. Wong AF, McCulloch LM, Sola A. Treatment of peripheral tissue ischemia with topical nitroglycerin ointment in neonates. J Pediatr 1992; 121:980.
  16. Vasquez P, Burd A, Mehta R, et al. Resolution of peripheral artery catheter-induced ischemic injury following prolonged treatment with topical nitroglycerin ointment in a newborn: a case report. J Perinatol 2003; 23:348.
  17. Baserga MC, Puri A, Sola A. The use of topical nitroglycerin ointment to treat peripheral tissue ischemia secondary to arterial line complications in neonates. J Perinatol 2002; 22:416.
  18. Venkataraman ST, Thompson AE, Orr RA. Femoral vascular catheterization in critically ill infants and children. Clin Pediatr (Phila) 1997; 36:311.
  19. King MA, Garrison MM, Vavilala MS, et al. Complications associated with arterial catheterization in children. Pediatr Crit Care Med 2008; 9:367.
  20. Sheridan, RL, Weber, JM, Tompkins, RG. Burns 1994; 20:451.
  21. Mourot JM, Oliveira HM, Woodson LC, et al. Complications of femoral artery catheterization in pediatric burn patients. J Burn Care Res 2009; 30:432.
  22. Borrego R, López-Herce J, Mencía S, et al. Severe ischemia of the lower limb and of the intestine associated with systemic vasoconstrictor therapy and femoral arterial catheterization. Pediatr Crit Care Med 2006; 7:267.
  23. Randolph AG, Cook DJ, Gonzales CA, Andrew M. Benefit of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomised controlled trials. BMJ 1998; 316:969.
  24. Page C, Retter A, Wyncoll D. Blood conservation devices in critical care: a narrative review. Ann Intensive Care 2013; 3:14.
  25. Haller M, Kilger E, Briegel J, et al. Continuous intra-arterial blood gas and pH monitoring in critically ill patients with severe respiratory failure: a prospective, criterion standard study. Crit Care Med 1994; 22:580.
  26. Weiss IK, Fink S, Harrison R, et al. Clinical use of continuous arterial blood gas monitoring in the pediatric intensive care unit. Pediatrics 1999; 103:440.
  27. Coule LW, Truemper EJ, Steinhart CM, Lutin WA. Accuracy and utility of a continuous intra-arterial blood gas monitoring system in pediatric patients. Crit Care Med 2001; 29:420.
  28. Hatherill M, Tibby SM, Durward A, et al. Continuous intra-arterial blood-gas monitoring in infants and children with cyanotic heart disease. Br J Anaesth 1997; 79:665.
  29. Shapiro BA, Mahutte CK, Cane RD, Gilmour IJ. Clinical performance of a blood gas monitor: a prospective, multicenter trial. Crit Care Med 1993; 21:487.