Axillary Artery Cannulation in Pediatric Cardiac Bypass Cases

Advantages and Technical Considerations

Axillary artery cannulation permits antegrade flow in the arch vessels and is usually free from atherosclerosis with rich collateral vessels to the distal arm, as recommended by the British Journal of Anaesthesia guidelines 1, 2

Special attention must be paid to the brachial plexus during cannulation, particularly in small children and neonates, by visualizing it and avoiding a too lateral approach, according to the Intensive Care Medicine guidelines 3
The external diameter of the catheter should not exceed 1/3 of the internal diameter of the vessel to avoid the risk of venous thrombosis, as suggested by the Intensive Care Medicine guidelines 3
Ultrasound equipment should remain easily accessible at the patient's bedside after central venous catheter placement to detect early life-threatening catheter-related complications, as recommended by the Intensive Care Medicine guidelines 3
Pre-procedural ultrasound evaluation of all possible vascular options allows for rational choice of the most appropriate vessels to cannulate, according to the Intensive Care Medicine guidelines 3

There is no ideal site for cannulation in children; the best site should be determined after ultrasound examination, as suggested by the Intensive Care Medicine guidelines 3
Ultrasound-guided arterial catheterization improves first-pass success and should be used routinely in children and neonates, according to the Intensive Care Medicine guidelines 3
Ultrasound guidance is strongly recommended for arterial cannulation in pediatric patients to improve success rates and reduce complications, as recommended by the Intensive Care Medicine guidelines 3, 4