Arterial line: Difference between revisions
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==Indications== | ==Indications== | ||
*Hemodynamic instability | |||
*Titration of pressors or other cardioactive drugs | |||
*Need for recurrent or serial ABG analysis | |||
==Contraindications== | ==Contraindications== | ||
*Infection overlying insertion site | |||
*Known arterial insufficiency or occlusion distal to placement site | |||
*Traumatic or vascular injury proximal to placement site | |||
==Equipment Needed== | ==Equipment Needed== | ||
*Sterile gloves, gown, cap, mask | |||
*Sterile drape | |||
*Iodine or chlorhexidine prep | |||
*Local anesthetic | |||
*27-30ga needle and syringe for local anesthetic administration | |||
*Appropriately sized needle and catheter for chosen site | |||
*Guidewire (may be integrated into needle/catheter) | |||
*Nonabsorbable suture | |||
*Armboard to hold wrist in extension (radial site only) | |||
*500cc IV NS with pressure bag | |||
*Transducer kit with tubing | |||
*Transducer cable | |||
*Bioderm patch | |||
*Tegaderm dressing | |||
*Ultrasound (if using ultrasound-guided technique) | |||
==Procedure<ref>Tegtmeyer K, Brady G, Lai S, Hodo R, Braner D. Videos in Clinical Medicine. Placement of an arterial line. N Engl J Med. 2006 Apr 13;354(15):e13.</ref>== | |||
==Procedure== | *Identify landmarks and palpate pulse | ||
**Radial - 1-2 cm proximal to wrist | |||
**Femoral - anteromedial thigh distal to inguinal ligament | |||
*Cleanse skin with iodine or chlorhexidine | |||
*Anesthetize skin and subcutaneous tissue over site with local anesthetic | |||
*"Over-the-needle" technique | |||
**Gently palpate pulse with nondominant hand to guide needle placement | |||
**Insert needle at 30-45 degrees to the skin | |||
**Advance until pulsatile blood is seen in flash chamber or catheter | |||
**Lower angle of catheter to 10-15 degrees to the skin | |||
**Advance over needle into artery | |||
*"Over-the-wire" technique (Seldinger or modified Seldinger) | |||
**Gently palpate pulse with nondominant hand to guide needle placement | |||
**Insert needle at 30-45 degrees to the skin | |||
**Advance until pulsatile blood is seen in flash chamber or catheter | |||
**Insert wire through needle into artery | |||
**Remove needle and advance catheter over wire into artery | |||
***Some arterial line needles have the wire integrated into flash chamber, allowing the wire to be advanced into artery and the catheter over the needle/wire system without removing the needle | |||
==Complications== | ==Complications== | ||
Revision as of 09:46, 29 June 2015
Indications
- Hemodynamic instability
- Titration of pressors or other cardioactive drugs
- Need for recurrent or serial ABG analysis
Contraindications
- Infection overlying insertion site
- Known arterial insufficiency or occlusion distal to placement site
- Traumatic or vascular injury proximal to placement site
Equipment Needed
- Sterile gloves, gown, cap, mask
- Sterile drape
- Iodine or chlorhexidine prep
- Local anesthetic
- 27-30ga needle and syringe for local anesthetic administration
- Appropriately sized needle and catheter for chosen site
- Guidewire (may be integrated into needle/catheter)
- Nonabsorbable suture
- Armboard to hold wrist in extension (radial site only)
- 500cc IV NS with pressure bag
- Transducer kit with tubing
- Transducer cable
- Bioderm patch
- Tegaderm dressing
- Ultrasound (if using ultrasound-guided technique)
Procedure[1]
- Identify landmarks and palpate pulse
- Radial - 1-2 cm proximal to wrist
- Femoral - anteromedial thigh distal to inguinal ligament
- Cleanse skin with iodine or chlorhexidine
- Anesthetize skin and subcutaneous tissue over site with local anesthetic
- "Over-the-needle" technique
- Gently palpate pulse with nondominant hand to guide needle placement
- Insert needle at 30-45 degrees to the skin
- Advance until pulsatile blood is seen in flash chamber or catheter
- Lower angle of catheter to 10-15 degrees to the skin
- Advance over needle into artery
- "Over-the-wire" technique (Seldinger or modified Seldinger)
- Gently palpate pulse with nondominant hand to guide needle placement
- Insert needle at 30-45 degrees to the skin
- Advance until pulsatile blood is seen in flash chamber or catheter
- Insert wire through needle into artery
- Remove needle and advance catheter over wire into artery
- Some arterial line needles have the wire integrated into flash chamber, allowing the wire to be advanced into artery and the catheter over the needle/wire system without removing the needle
Complications
See Also
References
- ↑ Tegtmeyer K, Brady G, Lai S, Hodo R, Braner D. Videos in Clinical Medicine. Placement of an arterial line. N Engl J Med. 2006 Apr 13;354(15):e13.