Does Radial Artery Cannulation Affect the Perfusion of the Dominant Hand in Adult Patients with Normal Modified Allen's Test Undergoing Cardiac Surgeries? Data Derived from the Peripheral Perfusion Index

Abstract

Objectives: This study aimed to evaluate the effect of radial artery cannulation on hand perfusion in patients with normal modified Allen's test undergoing cardiac surgeries using cardiopulmonary bypass (CPB).

Design: Prospective follow-up study.

Setting: Single institution, Assiut University Cardiothoracic Hospital.

Participants: Forty-nine patients who underwent cardiac surgeries using cardiopulmonary bypass were enrolled.

Interventions: Cannulation of radial artery in the dominant hand using a 20-gauge catheter.

Measurements and main results: The primary outcomes were the mean peripheral perfusion index (PPI) >60 seconds (mean PPI₆₀) and the thumb temperature, which were measured at different times before and during the surgery. There was a statistically significant difference in the mean PPI₆₀ between both hands (p = 0.033). Before skin incision, the mean PPI₆₀ was significantly higher in the noncannulated hand (p < 0.001). Also, there was a statistically significant difference in the thumb temperature between both hands (p = 0.013). At low core body temperature, the thumb temperature was significantly lower in the noncannulated hand (p = 0.017).

Conclusions: In adult patients undergoing cardiac surgeries using CPB, even with normal modified Allen's test, radial artery cannulation may affect the perfusion of the dominant hand, especially at low arterial blood pressure or low core body temperature. Since the PPI is one of the noninvasive methods used for intraoperative assessment of the peripheral perfusion, the authors recommend the use of the noncannulated hand for this purpose to not misguide this assessment.

Keywords: body temperature; cardiac; cardiopulmonary bypass; hand; perfusion index; radial artery; thumb.