Vascular Cannulation

  • Shawn E. Banks
  • Albert J. Varon


Vascular cannulation is an essential tool for fluid and drug administration, accurate monitoring of hemodynamic parameters, and blood sampling in critically ill patients. Preparation, indications, contraindications, clinical utility, and techniques for vascular cannulation are reviewed in this chapter. The sites of catheterization and complications of arterial, central venous, and pulmonary artery catheterization are also presented.


Pulmonary Artery Central Venous Catheter Central Venous Pressure Radial Artery Internal Jugular Vein 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Venus B, Mallory D. Vascular cannulation: preparation of the patient for vascular cannulation. Probl Crit Care. 1988;2(2):211–216.Google Scholar
  2. 2.
    Seldinger SL. Catheter replacement of the needle in percutaneous arteriography. Acta Radiol. 1953;39:368–376.PubMedCrossRefGoogle Scholar
  3. 3.
    Gilbert TB, Seneff MG, Becker RB. Facilitation of internal jugular venous cannulation using an audio-guided Doppler ultrasound vascular access device: results from a prospective, dual-center, randomized, crossover clinical study. Crit Care Med. 1995;23(1):60–65.PubMedCrossRefGoogle Scholar
  4. 4.
    Lin BS, Huang TP, Tang GJ, Tarng DC, Kong CW. Ultrasound-guided cannulation of the internal jugular vein for dialysis vascular access in uremic patients. Nephron. 1998;78(4):423–428.PubMedCrossRefGoogle Scholar
  5. 5.
    Mimoz O, Pierone L, Lawrence C, et al. Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients. Crit Care Med. 1996;24(11):818–823.CrossRefGoogle Scholar
  6. 6.
    Maki DG, Ringer M, Alvarado CJ. Prospective randomized trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet. 1991;338(8763):339–343.PubMedCrossRefGoogle Scholar
  7. 7.
    Hla KM, Vokaty KA, Feussner JR, Hla KM, Vokaty KA, Feussner JR. Overestimation of diastolic blood pressure in the elderly. Magnitude of the problem and a potential solution. J Am Geriatr Soc. 1985;33(10):659–663.PubMedGoogle Scholar
  8. 8.
    Bruner JMR, Krenis LJ, Kunsman JM, Sherman AP. Comparison of direct and indirect methods of measuring arterial blood pressure: III. Med Instrum. 1981;14(3):182–188.Google Scholar
  9. 9.
    Bedford RF, Shah NK. Blood pressure monitoring: invasive and noninvasive. In: Blitt CD, Hines RL, editors. Monitoring in anesthesia and critical care medicine. 3rd ed. New York: Churchill Livingstone; 1995.Google Scholar
  10. 10.
    Venus B, Mathru M, Smith RA, Pham CG. Direct versus indirect blood pressure measurements in critically ill patients. Heart Lung. 1985;14(3):228–231.PubMedGoogle Scholar
  11. 11.
    Varon AJ, Kirton OC, Civetta JM. Physiologic monitoring of the surgical patient. In: Schwartz SI, editor. Principles of surgery. 7th ed. New York: McGraw-Hill; 1999. p. 485–509.Google Scholar
  12. 12.
    Tavernier B, Makhotine O, Lebuffe G, Dupont J, Scherpereel P. Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology. 1998;89(6):1313–1321.PubMedCrossRefGoogle Scholar
  13. 13.
    Franklin C. The technique of radial artery cannulation. Tips for maximizing results while minimizing the risk of complications. J Crit Illn. 1995;10(6):424–432.PubMedGoogle Scholar
  14. 14.
    Weiss BM, Gattiker RI. Complications during and following radial artery cannulation: a prospective study. Intensive Care Med. 1986;12:424–428.PubMedCrossRefGoogle Scholar
  15. 15.
    Ejrup B, Fischer B, Wright IS. Clinical evaluation of blood flow to the hand. Circulation. 1966;33:778–780.PubMedCrossRefGoogle Scholar
  16. 16.
    Bryan-Brown CW, Kwun KB, Lumb PD, Pia RLG, Azer S. The axillary artery catheter. Heart Lung. 1983;12:492–497.PubMedGoogle Scholar
  17. 17.
    Franklin CM. The technique of dorsalis pedis cannulation. An overlooked option when the radial artery cannot be used. J Crit Illn. 1995;10(7):493–498.PubMedGoogle Scholar
  18. 18.
    McKay R, Johansson B, de Leval MRl, Stark J. Superficial temporal artery cannulation in infants. Thorac Cardiovasc Surg. 1981;29(3):174–177.PubMedCrossRefGoogle Scholar
  19. 19.
    Horlocker TT, Bishop AT. Compartment syndrome of the forearm and hand after brachial artery cannulation. Anesth Analg. 1995;81(5):1092–1094.PubMedGoogle Scholar
  20. 20.
    Venus B, Mallory D. Vascular cannulation: arterial cannulation. Probl Crit Care. 1988;2(2):286–295.Google Scholar
  21. 21.
    Norwood SH, Cormier B, McMahon NG, Moss A, Moore V. Prospective study of catheter-related infection during prolonged arterial catheterization. Crit Care Med. 1988;16(9):836–839.PubMedCrossRefGoogle Scholar
  22. 22.
    Andrews RT, Bova DA, Venbrux AC. How much guidewire is too much? Direct measurement of the distance from subclavian and internal jugular vein access sites to the superior vena cava-atrial junction during central venous catheter placement. Crit Care Med. 2000;28:138–142.PubMedCrossRefGoogle Scholar
  23. 23.
    Merrer J, De Jonghe B, Golliot F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients. JAMA. 2001;286(6):700–707.PubMedCrossRefGoogle Scholar
  24. 24.
    Mansfield PF, Hohn DC, Fornage BD, Gregurich MA, Ota DM. Complications and failures of subclavian-vein catheterization. N Engl J Med. 1994;331(26):1735–1738.PubMedCrossRefGoogle Scholar
  25. 25.
    Bold RJ, Winchester DJ, Madary AR, Gregurich MA, Mansfield PF. Prospective, randomized trial of Doppler-assisted subclavian vein catheterization. Arch Surg. 1998;133(10):1089–1093.PubMedCrossRefGoogle Scholar
  26. 26.
    Lefrant JY, Cuvillon P, Benezet JF, et al. Pulsed Doppler ultrasonography guidance for catheterization of the subcla­vian vein: a randomized study. Anesthesiology. 1998;88(5):1195–1201.PubMedCrossRefGoogle Scholar
  27. 27.
    O’Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. MMWR Morb Mortal Wkly Rep. 2002;55(RR-10):1–26.Google Scholar
  28. 28.
    Venus B, Mallory D. Vascular cannulation: clavicular appro­aches for central vein cannulation. Probl Crit Care. 1988;2(2):242–265.Google Scholar
  29. 29.
    Tan BK, Hong SW, Huang MH, Lee ST. Anatomic basis of safe percutaneous subclavian venous catheterization. J Trauma. 2000;48(1):82–86.PubMedCrossRefGoogle Scholar
  30. 30.
    Sparks CJ, McSkimming I, George L. Shoulder manipulation to facilitate central vein catheterization from the external jugular vein. Anaesth Intensive Care. 1991;19(4):567–568.PubMedGoogle Scholar
  31. 31.
    Durbec O, Viviand X, Potie F, Vialet R, Albanese J, Martin C. A prospective evaluation of the use of femoral venous catheters in critically ill adults. Crit Care Med. 1997;25(12):1986–1989.PubMedCrossRefGoogle Scholar
  32. 32.
    Smyrnios NA, Irwin RS. The jury on femoral vein catheterization is still out. Crit Care Med. 1997;25(12):1943–1946.PubMedCrossRefGoogle Scholar
  33. 33.
    Trottier SJ, Veremakis C, O’Brien J, Auer AI. Femoral deep vein thrombosis associated with central venous catheterization: results from a prospective, randomized trial. Crit Care Med. 1995;23(1):52–59.PubMedCrossRefGoogle Scholar
  34. 34.
    Raad I, Darouiche R, Dupuis J, et al. Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infections. Ann Int Med. 1997;127(4):267–274.PubMedCrossRefGoogle Scholar
  35. 35.
    Ullman JI, Stoelting RK. Internal jugular vein location with the ultrasound Doppler blood flow detector. Anesth Analg. 1978;57:118.PubMedCrossRefGoogle Scholar
  36. 36.
    Milling TJ, Rose J, Briggs WM, et al. Randomized, controlled clinical trial of point-of-care limited ultrasonography assistance of central venous cannulation: The Third Sonography Outcomes Assessment Program (SOAP-3) Trial. Crit Care Med. 2005;33(8):1764–1769.PubMedCrossRefGoogle Scholar
  37. 37.
    Making Health Care Safer. A critical analysis of patient safety practices. Rockville, MD: Agency for Healthcare Research and Quality; 2001.Google Scholar
  38. 38.
    Veenstra DL, Saint S, Saha S, Lumley T, Sullivan S. Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection. JAMA. 1999;281(3):261–267.PubMedCrossRefGoogle Scholar
  39. 39.
    Darouche RO, Raad II, Heard SO, et al. A comparison of two antimicrobial-impregnated central venous catheters. N Engl J Med. 1999;340(1):1–8.CrossRefGoogle Scholar
  40. 40.
    Connors AF, Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA. 1996;276:889–897.PubMedCrossRefGoogle Scholar
  41. 41.
    Dalen JE, Bone RC. Is it time to pull the pulmonary artery catheter? JAMA. 1996;276:916–918.PubMedCrossRefGoogle Scholar
  42. 42.
    The ESCAPE Investigators and ESCAPE Study Coordinators. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA. 2005;294:1625–1633.CrossRefGoogle Scholar
  43. 43.
    Shah M, Hasselblad V, Stevenson L, et al. Impact of the pulmonary arterty catheter in critically Ill patients: meta-analysis of randomized clinical trials. JAMA. 2005;294:1664–1670.PubMedCrossRefGoogle Scholar
  44. 44.
    Eidelman LA, Sprung CL. Direct measurements and derived calculations using the pulmonary artery catheter. In: Sprung CL, editor. The pulmonary artery catheter: methodology and clinical applications. 2nd ed. Closter, NJ: Critical Care Research Assocites; 1993.Google Scholar
  45. 45.
    Mermel LA, Maki DG. Infectious complications of Swan-Ganz pulmonary artery catheters. Am J Respir Crit Care Med. 1994;149:1020–1036.PubMedCrossRefGoogle Scholar
  46. 46.
    Kearney TJ, Shabot M. Pulmonary artery rupture associated with the Swan-Ganz catheter. Chest. 1995;108:1349–1352.PubMedCrossRefGoogle Scholar
  47. 47.
    Kirton OC, Varon AJ, Henry RP, Civetta JM. Flow-directed, pulmonary artery catheter-induced pseudoaneurysm: urgent diagnosis and endovascular obliteration. Crit Care Med. 1992;20:1178–1180.PubMedCrossRefGoogle Scholar
  48. 48.
    Tuman KJ, Carroll GC, Ivankovich AD. Pitfalls in interpretation of pulmonary artery catheter data. J Cardiothor Anesth. 1989;3:625–641.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Shawn E. Banks
    • 1
  • Albert J. Varon
    • 2
  1. 1.Department of AnesthesiologyJackson Memorial Hospital, University of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of AnesthesiologyUniversity of Miami Miller School of Medicine, Jackson Memorial HospitalMiamiUSA

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