What is an arterial line?
Also known as an “art-line” or “a-line,” an arterial line is a thin catheter inserted into an artery for the purpose of continuous and accurate blo...
What are the preferred locations for an arterial line?
The most common and recommended site for insertion is the radial artery due to its easy access, collateral circulation provided by the ulnar artery...
Where should the transducer of an arterial line be located?
The transducer of the a-line should be located at the same height as the right atrium. The phlebostatic axis is used to estimate this location. The...
What is the nurse’s responsibility for an arterial line?
The nurse is responsible for assessing the arterial waveform and addressing inaccuracies that can be identified by comparing the a-line blood press...
How do you flush an arterial line?
To flush an arterial line, first ensure that the stop cock is in neutral position to allow flow from saline into the catheter. Next, simply pull on...
How do you zero an arterial line?
When zeroing the arterial line, first ensure that the transducer is at the level of the phlebostatic axis. Next, turn the stopcock off to the patie...
Why is Allen’s test performed before inserting an arterial line into the radial artery?
Prior to insertion of an a-line into the radial artery, the Allen’s test is performed to confirm adequate collateral circulation to the hand provid...
How do you remove an arterial line?
To remove an arterial line, first confirm the order by the physician, as this must be ordered prior to implementation. Next, review labs, specifica...
What is an arterial line?
Also known as an art-line or a-line, an arterial line is a thin catheter that is inserted into an artery. It is most commonly used to monitor blood pressure directly and accurately, as with close and accurate titration of blood pressure medications. It is also used to obtain samples for arterial blood gas analysis (ABG’s), ...
Why is my arterial line underdamped?
The underdamped waveform can be caused by long stiff tubing, too many stopcocks, or a defective transducer. Along with understanding waveforms on the monitor, the nurse is responsible for zeroing (calibrating) the arterial line. Zeroing the system tells the transducer to “ignore” the pressure from the atmosphere.
How to do an Allen's test?
Have the patient elevate their hand and clench their fist for about 30 seconds. Apply pressure to the radial and ulnar arteries in the wrist to stop the blood flow to the hand. Still elevated, the hand is opened and should appear blanched. Release ulnar pressure while maintaining radial pressure to check if there is adequate blood flow back to the hand. If the hand quickly becomes warm and returns to its normal color, this is a positive Allen’s test, meaning that one artery alone will be enough to supply blood to the hand and fingers, therefore the radial artery can be used for the arterial line. If the hand remains pale and cold, it is a negative test, and an arterial line should not be placed in this location.
How often should a saline bag be changed?
The saline bag should be changed daily and the tubing system every 72 hours or according to your hospital guidelines. When drawing blood from an arterial line, always waste the first 10 mL—this blood is hemodiluted and will not give accurate results.
How to stop blood flow to hand?
Apply pressure to the radial and ulnar arteries in the wrist to stop the blood flow to the hand. Still elevated, the hand is opened and should appear blanched. Release ulnar pressure while maintaining radial pressure to check if there is adequate blood flow back to the hand.
What are the disadvantages of the radial artery?
The disadvantages of the radial artery are the small diameter, making it difficult to insert, and possible nerve damage or thrombosis. The advantages of the brachial artery are the large diameter, making it easier to insert, and fairly easy bleeding control. The disadvantages include immobilization of the limb, thrombosis, ...
What are the advantages and disadvantages of femoral artery?
The advantages of the femoral artery include large diameter, making it easy to insert, even when the patient has low volumes. The disadvantages include difficulty visualizing, hard-to-control bleeding, immobilization of the limb, and prone to infection, due to the location.
What is needed to insertion of an arterial catheter?
Additionally, these kits help with adherence to evidence-based essential steps to minimize the risk of catheter-related infection during the insertion. At a minimum, these include the appropriate-sized arterial catheter and the corresponding search needle that usually is available in an arterial catheter package that includes lidocaine, gauze tissue, sterile gloves, mask and gowns, and chlorhexidine solution for aseptic cleansing. The transducer, connecting tubing and monitor cable system must be available before the insertion of the catheter. The waveform obtained after connecting the arterial catheter ensures the successful placement in the lumen of the artery.
Why do we need arterial catheters?
The placement of arterial catheters is often necessary for the management of critically ill patients. Procedures common to the intensive care unit and the operating room rely on the access to the arterial vessels. However, multiple complications including catheter-related infections, loss of distal blood flow, and the availability of other modalities for hemodynamic monitoring have decreased the frequency of arterial catheter placement in the intensive care unit. The placement of arterial catheters should not be considered routine in the management of critically ill pediatric patients.
What are the contraindications for arterial catheter placement?
Contraindications include peripheral or distal arterial vascular insufficiency, peripheral arterial vascular diseases (medium to small vessel arteritis), anatomical variants in which there may be a lack of collateral circulation (absence of the ulnar artery), infection at the site of insertion. Special consideration should be given in cases of coagulation disorders and situations of medical anticoagulation, burns and surgical interventions at the site of insertion.
What is arterial catheterization?
Arterial catheterization is a procedure that is common to the intensive care settings and the operating room. It involves placement of a catheter into the lumen of an artery to provide at least a continuous display blood pressure with access to frequent arterial blood sampling. The discovery of the arterial waveform by insertion of a catheter into an artery dates to 1847 by the German Physiologist Carl Ludwig. More recently, the widely known Seldinger technique has been adopted by guiding catheter into a vessel over a wire previously inserted into the lumen or the artery. With knowledge of anatomy, various sites of insertion are available. However, practitioners must be mindful of indications and contraindications, proper preparation of equipment and personnel as well as the technique of insertion. As all invasive procedures, the placement of arterial catheters may present complications, with an advised operator who must be ready to intervene promptly to prevent unnecessary harm to the patient. [1][2]
Why is the brachial approach to catheter placement problematic?
The brachial approach of placing arterial catheters is traditionally considered problematic and prone to complication because of the paucity of arterial collateral circulation. It should not be accessed for cannulation to avoid the risk of ischemic injury to distal part of the extremity.
How long does it take for a radial arterial catheter to be occluded?
Both radial and ulnar pulses are occluded forcefully by manual palpation for 10 to 15 seconds or until blanching of the palm are noted. The ulnar arterial occlusion is released. If the blanching resolves quickly, the patency of the ulnar artery is enough to perfuse the hand in spite of a complete or partial occlusion of the radial artery.
Which artery is the largest arterial supply of the lower extremity?
The femoral arter y gives the largest arterial supply of the lower extremity. The pulsation of this major vessel is a well-known landmark in juxtaposition to the femoral vein. The location of this pulse divides the inner third of the inguinal ligament to the outer two-thirds. The femoral artery is the single trunk that perfuses the lower extremity as it divides into 4 major branches as it wraps around the structures of the thigh. There are no other major collateral vessels for the arterial supply of the lower extremity. Therefore, complete obstruction of the femoral artery leading to ischemia may have devastating consequences.
Why are positional arterial lines important?
Positional arterial lines are an important potential source for intravascular infection. Catheter movement activates inflammation at the site and movement of the catheter in and out of the tract can introduce pathogens.
Why do I need to disable an arterial line alarm?
Alarms may need to be disabled if an arterial line becomes positional. If an arterial line alarms is disabled, documentation in the AI record is required. This should include the reason for disabling the alarm and should describe troubleshooting strategies. The "positional" code on the graphic can then be used to explain why the arterial line alarm is turned "off".
What monitors are needed for invasive arterial lines?
Invasive arterial lines and right heart catheters must be connected to a monitor that provides a continuous waveform display.
Why should catheters be secured?
Catheters should be secured to prevent movement and positional arterial lines should be removed.
What happens if an arterial line becomes positional?
If an arterial line becomes positional or it can no longer be used for blood sampling, the physician should be notified and line change considered. The plan for line management should be documented in the Plan of Care and communicated to the oncoming nurse.
What is the control of vascular devices?
INFECTION CONTROL. All vascular devices (peripheral, central venous or arterial) can be a source for blood stream infection. Strict aseptic technique should be maintained at all times during insertion, dressing changes, medication administration and when accessing all intravascular devices.
How to prevent thrombus formation?
Flush thoroughly after blood sampling and maintain adequate counter pressure to prevent thrombus formation. Reconfirm waveform after flushing.
When to remove arterial line?
Central venous and arterial lines are indicated if ongoing resuscitation, intracranial pressure monitoring, vasoactive agent infusion or frequent ventilator changes are required. When a patient no longer requires continuous arterial line monitoring or frequent blood gas sampling, the arterial line shoudl be removed.
Why do you need to keep an arterial line alarm on?
Keep arterial line alarms on to promptly detect dislodgement of catheter or hemodynamic instability.
What is unsutured line?
PICC) Lines that are actively oozing or where occlusivity cannot be maintained using a transparent dressing should be dressed with a gauze dressing and tape. All PICC lines are unsutured.
What is the importance of documentation for a patient with established lines?
To identify lines at risk for infection, accurate documentation of a patient with established lines is essential. Documentation should identify where the line was inserted (e.g., in CCTC or another unit/facility), if there is documentation of compliance with the arterial/central line insertion bundle or if there were observed breaks in aseptic technique. Central line infection and blood stream infection risk may be associated with peripheral or central IVs, arterial lines or venipuncture technique.
What is the impact of central line infection?
Central line infections are associated with increased length of stay, morbidity and mortality as well as increased cost of care. The prevention of blood stream infections requires a multi-pronged and multi-team approach to reduce risks during insertion, dressing changes and access of any intravascular device. Click here for our insertion and maintenance bundles and for a copy of the Central Venous and Arterial Line Insertion Checklist and Procedure Record.
When are arterial lines changed?
Lines are changed when evidence of redness or infection is present. The risk for central line infection due to arterial line source increases when arterial lines are in place longer than 5 days or are positional. 3. Assessment and Safety:
Can you flush a clot into a catheter?
Do not flush into the catheter with a syringe if line is blocked. Aspirate any clot first and flush using closed system. Flushing a clot into the system may can result in distal limb ischemia or infarction. Flushing through the stopcock increases the risk of infection.
What equipment is needed for an arterial catheter?
The basic equipment needed for the placement of an arterial catheter includes (1) a flexible catheter, which selection (long vs short) will depend on site selection (femoral vs radial vs axillary); (2) sterile gown and gloves, hair cap, mask, and drape; (3) sterile connector tubing to attach to the monitoring system; (4) a 2.0 silk suture or tape ; (5) a clear biocclusive dressing; and (6) a monitoring system with pressure transduction tubing. A bedside ultrasound device may be used to identify vessels prior and during insertion of the arterial catheter. Ultrasound guidance may be beneficial in technically challenging procedures, or if there is known or suspected anatomic deviation.
How to cannulate deep arteries?
This involves the use of a large, hollow introducer needle that is inserted into the artery. The angle, depth, and technique of insertion vary depending on the specific location. A 3-milliliter syringe is attached to the needle prior to insertion. Once the needle penetrates the skin, the syringe is aspirated while the needle is slowly advanced. The operator will recognize that the needle has entered the artery when brisk, pulsatile flow of bright red blood has been obtained. The syringe is then unscrewed while the needle is stabilized with the nondominant hand, and pulsatile flow is seen from the needle. A guidewire is then inserted through the needle, after which the needle is removed. The catheter is then passed over the guidewire, which is then subsequently removed.
How to monitor blood pressure in hospital?
In the majority of hospitalized patients, non-invasive indirect monitoring of blood pressure by auscultation of Korotkoff sounds is sufficient. However, in critically ill and hemodynamically unstable patients indirect techniques may underestimate blood pressure 1; thus the need for more intensive blood pressure monitoring via arterial catheterization may be beneficial. Historically, the indications for placement of arterial lines included: (1) continuous beat-to-beat monitoring of blood pressure; (2) frequent sampling of blood for laboratory analysis and monitoring of ventilatory impairment; (3) arterial administration of drugs such as thrombolytics; and (4) use of an intra-aortic balloon pump. 1, 3 These remain compelling indications for placement of arterial catheters, however technological advances in contemporary design of catheter and monitoring systems now allow arterial lines to be used for more advanced hemodynamic monitoring, including real-time calculation of cardiac output, stroke volume, and evaluation of fluid responsiveness in suspected hypovolemic states. 1 The modern practitioner requires adequate knowledge of new technologies and data interpretation in order to effectively use these new modalities to enhance patient care and delivery.
What happens when you use a guidewire and catheter?
If using a commercially prepared needle with in-line guidewire and catheter, the guidewire is then advanced into the artery, and the catheter advanced over the wire. The needle–wire device is then removed and the catheter is attached to the tubing and transducer.
How to zero arterial transducer?
Zeroing of the transducer is accomplished by opening a stopcock located proximal to the transducer to ambient air, followed by pressing the “zero” button on the bedside monitor. This provides the transducer with a pressure reference value (atmospheric pressure) against which intravascular pressure can be measured. Once this is done, the pressure tracing should rest on the zero line of the monitor and a pressure value of zero should be demonstrated. Errors in zeroing the transducer will not result in the desired pressure equilibration; this may occur from technical difficulty related to user error or from electronic difficulty due to the phenomenon of “zero drift.” Zero drift is, literally, electronic malfunction of the transducer, transduction cable attached to the monitor, or of the monitor itself, which results in artificial offset of the arterial waveform from the zero line. Sequential manual replacement of each element is indicated to systematically troubleshoot the electronic components.
What angle is the radial pulse inserted?
The needle is then inserted at a 15° to 30° angle and advanced slowly until return of bright red, pulsatile blood is noted.
Which artery is the easiest to cannulate?
Axillary cannulation is comfortable for the patient, but requires the arm to be immobilized in an unnatural position throughout the procedure. The femoral artery site is arguably the easiest to cannulate and provides an easy access in an emergent situation, but carries the highest risk for infection.
