Arterial line

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

• 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