Novel Use of the Raulerson Syringe and Y-Shaped Introducer Needle for Femoral Artery Cannulation

Dear Editor, Femoral artery cannulation is not an uncommon procedure performed in both the operating room and intensive care unit. It is commonly indicated for continuous blood pressure monitoring, repeated blood gas analysis, continuous cardiac function assessment, cardiopulmonary bypass initiation, cardiac catheterization (for both diagnostic and therapeutic purposes), and endovascular coiling for intracranial aneurysms.[1] The classical Seldinger technique involves inserting a hollow needle into the blood vessel, advancing a round-tipped guidewire through the needle, and then withdrawing the needle. This allows for the safe introduction of a catheter over the guidewire into the vessel.[2] However, during the initial puncture of the femoral artery, before guidewire insertion there is often a sudden gush of blood, leading to spillage around the procedure site [Figure 1a]. This not only creates a mess but also increases the risk of contamination. Additionally, one drawback of using a conventional needle is the potential for malpositioning of the tip if the needle is not properly stabilized after arterial puncture. This can occur during syringe disconnection for guidewire insertion, increasing the risk of complications and procedural difficulty.Figure 1: (a) Blood spillage with a conventional syringe, while trying to insert guidewire with an advancer (b) Arrow Raulerson syringe with a central hollow channel and guide wire in situ (c) Cleaner procedure using the Raulerson syringe (d) Y-shaped introducer needle with guide wire in situ (e) Dual-port syringe design allowing blood aspiration for vessel entry confirmation (f) Guidewire insertion through the second portTo address this issue, we propose using a Raulerson syringe instead of a conventional syringe. The Arrow Raulerson syringe is specifically designed for guidewire insertion. It features a centrally placed hollow channel running through the plunger, equipped with a hemostatic valve [Figure 1b]. This valve effectively prevents blood spillage and air entry during femoral artery puncture, maintaining a cleaner and more sterile field [Figure 1c]. Alternatively, a Y-shaped introducer needle (Newtech Medical Devices, India) [Figure 1d] can be used to reduce blood spillage during femoral artery cannulation. It features a dual-port design where one port allows for blood aspiration to confirm vessel entry [Figure 1e], while the other facilitates the smooth insertion of the guidewire [Figure 1f]. We propose that replacing the conventional syringe with a Raulerson syringe or a Y-shaped introducer needle can be seamlessly integrated into clinical practice, providing a cleaner, more efficient approach to femoral artery cannulation. Authorship contribution statement Ashutosh Kaushal: Conceptualization, Writing – original draft, Writing – review and Editing, Final approval Harish Kumar: Writing – original draft, Writing – review and editing, Final approval Sri Rama Ananta Nagabhushanam Padala: Writing – original draft, Writing – review and editing, Final approval L Pfokreni: Writing – original draft, Writing – review and editing, Final approval. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.