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1662 S.A. MEDICAL JOURNAL 15 September 1973 • Radial Artery Blood Gas Sampling In Infancy * N. BUCHANA ,1\LB. B.S. LaND., F.e.p. (S.A.), Research Fellow, Nutritional and Metabolic Un-it, Depart- ment of Paediatrics, Uniuersity of the Witwaterswnd and Baragwanath Hospital, Johannesburg SUMMARY immediately obvious when the artery is pierced. After removal of the needle, firm compression over the punc- The results of 100 radial artery punctures for blood gas ture site is required for 1 - 2 min. estimations in infancy, are described. RESULTS S. Air. Med. J., 47, 1662 (1973). Of the 100 punctures performed, 79 were successful on Doubt has been cast upon the validity of sampling arteria- the first attempt, 10 on the second attempt, 4 on the lized capillary blood for gas estimation in infants with third, and 7 were failures. Only 2 haematomas were cardiopulmonary disease.] In this clinical study, the produced, and both occurred in infants after only I majority of infants were malnourished, and often had signs puncture. of kwashiorkor; such patients are known to have a poor As many as 4 punctures of the same vessel were peripheral circulation.' Hence, direct arterial puncture ap- carried out over a 4-day period in many infants and pears to be the most suitable alternative method for no complications were encountered. obtaining samples of blood for gas analysis in these children. Several techniques are used for arterial puncture and DISCUSSION include methods for multiple sampling from the brachial and radial arteries.'" Furman et al: described a method The results of 100 consecutive radial artery punctures of radial artery cannulation in children, and found it are presented. From only 7 infants was it not possible to be highly successful. to obtain suitable specimens; 6 of these 7 were markedly marasmic and, after the needle had been introduced Arterial cannulation, however, holds the hazards of through the skin, there was difficulty due to abnormal infection and embolization" We have used the technique skin mobility in locating the artery. The incidence of of direct arterial puncture, the needle being removed as haematomata was 2% in this series, which compares soon as the sample is obtained. In our experience the favourably with the 10% reported by Furman et al.,' dorsalis pedis artery was found to be unsuitable due to the although their patients had had frank cannulations per- pedal oedema associated with kwashiorkor, the temporal formed. There were no other complications. Hence it would artery to have a very high rate of haematoma formation, appear that direct arterial puncture is a safe method for and the brachial artery to be technically difficult. Radial obtaining arterial blood, as has been recently described artery sampling, however, was comparatively simple, and by Wunderlich and Reynolds.' This provides a suitable we wish to report our results using this technique, in the alternative to capillary sampling in situations where tbe form of an analysis of the first 100 samplings performed. latter may be contra-indicated, namely in some patients with cardiorespiratory disease or poor peripheral circula- tion, or when large amounts of arterial blood are required. METHOD 1 should like to ihank Dr C. H. Kniep, Superintendent of The method ueed was essentially similar to that of Baragwanath Hospital, and Professor S. Wayburne, Chief Shaw.' Paediatrician, for permission to publish these findings, and Professor J. D. L. Hansen for assistance with the manuscript. For the right-handed operator, it is advisable to use the patient's left wrist. The wrist is fully dorsiflexed by REFERE CES an assistant, the thumb of the patient being included 1. Gandy, G., Gar.n, L., Cunningham, N., Adamson, K. and James, L. S. (1964): P.ediatrics, 34, 192. in the assistant's grip. The wrist is cleansed and the 2. Waterlow, J. C. (1971): Advanc. Protein Chem., 25, 117. radial artery palpated. A 25-G intravenous needle (Abbott 3. Reynolds, E. O. R. (1963): Brit. Med. l., 1, 1192. Butterfly) which is preferably as short as 1,5 cm and 4. Shaw. l. C. L. (1968): Lancet, 2, 3 9. which has been heparinized, is inserted horizontally through 5. Furm,n, E. B., Ha-irabet. l. K. and Roman, D. G. (1972).: Brit. l. Anaesth., 44, 531. the skin at the point of maximal arterial pulsation. It is 6. Lowenstein, E., Little, l. and Lo, H. (1971): New Engl. J. Med., 285. 1414. 7. Wunderlich, B. and Reynolds, R. . (1972): Amer. J. Dis. Child., *D~llC receive..l: 4 April 197J. 123, 446.
"3.10 RADIAL ARTERY BLOOD GAS SAMPLING IN INFANCY"