Arterial line is a cannulation of a peripheral artery, which can then be used to monitor continuous blood pressure and allow for frequent blood draws, among other things.
Indications
- Need for constant blood pressure monitoring
- Need for frequent blood draws
- Arterial blood gas to assess ventilation
- Hourly lab draws to assess insulin drips
Contraindications
- Inadequate collateral circulation distal to placement site
- Anatomical variants
- Raynaud phenomenon
- Thromboangiitis obliterans
- Local infection
- Traumatic injury proximal to planned insertion site
- Sites of previous vascular surgery with underlying stents
Equipment
- PPE: cap, mask, sterile gloves, eye protection, sterile drape
- Sterile prep
- 1% lidocaine solution without epinephrine
- Small gauge needle and syringe
- Hollow introducer needle
- Guidewire
- Flexible catheter
- Suture to secure the line
- Transduction system connected to monitor
- Sterile ultrasound probe cover and gel
- Ultrasound machine
- Sterile dressing: Biopatch, Tegaderm
Considerations
- Radial artery is usually first choice, followed by femoral artery
- Other arterial line options: axillary, brachial, dorsalis pedis, ulnar
- Cannulating the radial artery
- Peripheral location
- Dual blood supply
- Ease of compressibility in case of bleeding
- Can be difficult with small size or vasoconstriction
- Cannulating the femoral artery
- Larger, easier to palpate at lower BP
- Can be difficult in location if larger BMI
Relevant Information
- The technique described below uses the modified Seldinger technique
Technique
- Position patient with consideration of target anatomy
- Radial artery: forearm supine with wrist supported in slight extension
- Femoral artery: supine, with abdominal and thigh adipose tissue retracted if needed
- Palpate and find the artery with ultrasound prior to prepping and draping the area. Make sure you have good anatomy and landmarks. It may be that you are expecting to do a radial line, but after investigating the anatomy, decide to go for a femoral line instead.
- Prep and drape the procedure site in the usual sterile fashion. Put on PPE. Have an assistant help with pulling the sterile ultrasound probe cover. Now you can complete the procedure without needing anyone else.
- Prepare your equipment. Get everything you need lined out in the appropriate sequential steps.
- Palpate arterial pulse with nondominant hand. Inject the skin overlying planned puncture site with 1% lidocaine without epinephrine.
- With the nondominant hand holding the ultrasound probe, the dominant hand inserts a cannula-sheathed needle at a 45-degree angle through the skin and toward the artery. The catheter and needle are both advanced until flashback is visualized and then slightly further until pulsatile blood returns from the catheter. The ultrasound probe is dropped and the angle of the needle is then lowered to 10-15 degrees before the catheter alone is advanced over the needle and threaded into the artery.
- Once access is achieved, the catheter is connected to the transducer and an arterial waveform is confirmed. The line is then secured with suture and a sterile dressing.
Complications
- Bleeding
- Hematoma
- Temporary arterial occlusion
- Arterial injury
- Nerve injury
- Thrombosis
- Infection
- Limb ischemia
- Retroperitoneal hematoma
- Iatrogenic anemia