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3.10 RADIAL ARTERY BLOOD GAS SAMPLING IN INFANCY

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3.10 RADIAL ARTERY BLOOD GAS SAMPLING IN INFANCY Powered By Docstoc
					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.

				
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