11/13/24, 7\:18 PM Guide | Arterial line insertion
Arterial line insertion
Table of contents
Introduction
Arterial cannulation is a procedure that is commonly performed in emergency and critical care. It allows invasive blood
pressure monitoring and accessible blood sampling. Common sites which can be used include the radial, brachial and
femoral arteries.
Indications and contra-indications
Indications for inserting an arterial line include\:
1
Beat-to-beat blood pressure monitoring
Arterial blood gas sampling
Haemodynamic instability or rapid changes in blood pressure
Inaccurate non-invasive blood pressure monitoring (e.g. morbid obesity, arrhythmias)
Titration of vasoactive drugs
Frequent blood sampling
Absolute contraindications to inserting an arterial line include\:
Absent pulse
Raynaud's syndrome
Buerger's disease
Poor perfusion
Gather equipment
Gather the appropriate equipment to insert an arterial line\:
Arterial catheter*
Drape*
Swabs*
Dressing*
5ml syringe*
Hypodermic needle 25G*
Chlorhexidine 2% stick*
Local anaesthetic (e.g lidocaine 1% 2ml ampule)
Filter needle (for local anaesthetic)
Sterile gloves
Tape (to secure the hand in position)
Trolley
Arterial line
*These items of equipment may be found in an arterial line pack.
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An arterial line catheter [2]
Ultrasound (if required)
Some patients may have poorly palpable arteries or have had di
ultrasound will aid with the procedure. A sterile ultrasound probe cover should be used.
Introduction
Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.
Don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain what the procedure will involve using patient-friendly language\:
" T h i s p r o c e d u r e i s t o p l a c e a n a r t e r i a l l i n e . T h i s i s a
s m a l l p l a s t i c t u b e w h i c h i s i n s e r t e d i n t o a b l o o d v e s s e l i n y o u r w r i s t t h a t l e t s u s m e a s u r e y o u r b l o o d p r e s s u r e a n d t a k e b l o o d
s a m p l e s . I w i l l u s e a l o c a l a n a e s t h e t i c t o n u m b t h e a r e a s o t h a t i t w i l l b e l e s s p a i n f u l f o r y o u . T h e m a i n r i s k s t o y o u i n c l u d e
b l e e d i n g a n d r a r e l y i n f e c t i o n o r b r u i s i n g ( h a e m a t o m a ) , w h i c h i s a l u m p b e l o w t h e i n s e r t i o n s i t e .
"
Gain consent to proceed with the insertion of an arterial line.
Check if the patient has an allergy to local anaesthetic (if requested) or to the skin preparation agent.
Check for any contraindications.
Initial palpation
One of the most important parts of the procedure is the set-up and ensuring you palpate both radial arteries.
Traditional teaching suggests performing Allen’s test, but in practice this is rare. It is important to check and follow local
guidelines for arterial line insertion.
To perform a modi
1. Ask the patient to clench their
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2. Apply pressure over the radial and ulnar arteries to occlude both vessels.
3. Ask the patient to open their hand, which should now appear blanched. If the hand does not appear blanched, it suggests
you are not completely occluding the arteries with your
4. Remove the pressure from the ulnar artery whilst maintaining pressure over the radial artery.
5. If there is adequate blood supply from the ulnar artery, the normal colour should return to the entire hand within 5-15
seconds. If the return of colour takes longer, this suggests poor collateral circulation.
Position patient and set up equipment
Position the patient’s arm in an appropriate position. Place a pillow and absorbable pad below their wrist and raise the bed to a
comfortable height.
Use tape to aid the patient in keeping their wrist steady during the procedure.
Place the arterial line pack (or individual pieces of equipment) on a clean trolley.
Wash your hands using a surgical scrubbing method.
Open the arterial line pack and don sterile gloves.
Prepare the insertion site
Clean the site and the surrounding area thoroughly using chlorhexidine solution and allow it to dry.
Place the sterile drape over the insertion site.
Local anaesthetic
Check the expiry date of the local anaesthetic.
Prepare and administer lidocaine subcutaneously using an orange needle (25G) over the planned puncture site (create a
bleb). Aspirate to ensure you are not in a blood vessel.
Insert the arterial line
1. Insert the needle at a 30-45 degree angle where you palpated the radial artery. You will see a
successful.
2. Thread the guidewire through the introducer needle. If there is any resistance, remove the guidewire and inspect for
3. Keeping one hand on the guidewire at all times, remove the introducer needle and thread the arterial cannula over the
guidewire.
4. Hold the top of the guidewire and using a twist and push technique, advance the cannula until
guidewire and observe for
5. Attach the
6. Connect the transducer and observe for an arterial trace (Figure 2).
7. Secure with cannulation dressing, or stitch in place and cover with a dressing.
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An arterial waveform [3]
To complete the procedure...
Explain to the patient that the procedure is now complete.
Thank the patient for their time.
Dispose of PPE and other clinical waste into an appropriate clinical waste bin.
Wash your hands.
Document the details of the procedure including\:
Whether local anaesthetic was used
Any immediate post-procedure concerns or complications
Reviewer
Dr Claire Mitchell
ST7 ICM/Anaesthesia
References
1 Heather H Hager; Bracken Burns A r t e r yC a n n u l a t i o n 2022 Available from\: [LINK]
Source\: geekymedics.com
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