Atypical picture of peripheral arterial access in a neonate

Arterial line placement in the pediatric population is a challenging task. Even with the help of ultrasound, multiple attempts may be required for its successful placement. Even in the expert hands, complications such as thrombosis and distal gangrene have been encountered in the past. In recent times, Doppler's ultrasound assistance has reduced the number of attempts required for its successful placement, thereby reducing the unforeseen complications. Sometimes, pediatric arterial line placement can produce a picture like extravasations of injectate into subcutaneous tissue. Hence, one must confirm the position of arterial line with blood pressure tracing and arterial blood gas analysis before removal of the placed cannula in order to avoid unnecessary pricks. We present a case of an atypical picture of a radial artery cannulation in a neonate, which may have led to unnecessary repeated arterial puncture.