Anesth Pain Med.  2021 Apr;16(2):119-132. 10.17085/apm.21012.

Ultrasound-guided arterial catheterization

• Cho SA
• Jang YE
• Ji SH
• Kim EH
• Lee JH
• Kim HS
• Kim JT

• KMID: 2515537
• DOI: http://doi.org/10.17085/apm.21012

Abstract

Ultrasonography facilitates arterial catheterization compared to traditional palpation techniques, especially in small arteries. For successful catheterization without complications, practitioners should be familiar with the anatomic characteristics of the artery and ultrasound-guided techniques. There are two approaches for ultrasound-guided arterial catheterization: the short-axis view out-of-plane approach and the long-axis view in-plane approach. There are several modified techniques and tips to facilitate ultrasound-guided arterial catheterization. This review deals with the anatomy relevant to arterial catheterization, several methods to improve success rates, and decrease complications associated with arterial catheterization.

Keyword

Anatomy; Artery; Catheterization; Ultrasonography

Figure

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  Fig. 1. Upper extremity visualized with schematic and sonographic images. The brachial artery is located in the middle of the upper extremity, while the median nerve is located on the medial side of the brachial artery. The radial artery and nerve run on the proximal side of the wrist but run separately in the distal part, while the median nerve is located near the radial artery at the distal wrist. The ulnar artery and nerve run together in the distal wrist. a.: artery, n.: nerve.

• 

  Fig. 2. Lower extremity visualized with schematic and sonographic images. The common femoral artery runs with the vein in the medial and the nerve in the lateral. In the slightly distal part, it divides into superficial femoral artery and deep femoral artery. The dorsalis pedis artery is located with the deep peroneal nerve on the medial side (anatomical variation), while the posterior tibial artery runs with the tibial nerve and veins. CFA: common femoral artery, DFA: deep femoral artery, FN: femoral nerve, FV: femoral vein, n.: nerve, PTV: posterior tibial vein, SFA: superficial femoral artery.

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  Fig. 3. Short axis view of the sonographic images in the vessel using the phantom model. (A) is the point at which the needle enters through the skin before entering the vessel. (B) is the point at which the needle first enters the vessel. When it is confirmed that the needle is in the vessel, like in (C), the ultrasound probe is dynamically moved to check the location of the needle tip as the catheter is advanced (D, E).

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  Fig. 4. Long-axis view of the sonographic images in the vessel using the phantom model. In the long-axis view, real-time visualization is possible before entering the vessel (A), upon entering the vessel (B), and after entering the vessel (C).

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  Fig. 5. Oblique view of the sonographic image in the vessel using the phantom model. In the oblique view, real-time visualization is possible before entering the vessel, which is oval in shape in the ultrasound image (A), upon entering the vessel (B), and after entering the vessel (C).

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  Fig. 6. Possible causes of failure in the advancement of the catheter after flashback of blood and its solutions. (A) The location of the catheter is not optimal because the needle tip spans the vessel wall and the inside the arterial lumen, but the catheter is outside the arterial lumen. (B) The catheter cannot be advanced due to vasospasm or intraluminal obstacles. (C) The catheter cannot be advanced because it gets stuck in the posterior wall of the blood vessel or is bent. (D) Guidewire insertion is helpful when the catheter or needle tip spans the vessel wall and inside the arterial lumen.

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