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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


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" 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 critically ill patients for whom multiple arterial measurements or continuous arterial blood pressure monitoring will be required. (See 'Indications, contraindications, and precautions' below.)

Site selection and equipment — We suggest that children have arterial puncture performed at the distal radial arterial site (figure 1). The radial artery can be tested for collateral circulation using the modified Allen test (figure 2 and picture 1) and is easily accessed in most children [1,2]. Positioning and restraint of the upper extremity is also more easily accomplished in the uncooperative child. Finally, the risk of complications following arterial puncture at the radial site is low, especially compared with the femoral or brachial sites [2].

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Literature review current through: Nov 2017. | This topic last updated: Nov 28, 2017.
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