Updated: Jun 10
Inserting an arterial line
24 March 2022
Author : Dr Jadumani Singh
Disclaimer: The information contained does not serve as a standard of medical care, this is from the author's personal clinical experience.
Trolley set up
Arterial Cannula, both a closed system with a built-in guidewire or an open system (Seldinger technique) with a separate guidewire and needle Preferably 5 cm for the radial artery, about 8-10 cm for the brachial and femoral artery A clean towel or a litre of saline/water bag to use as an anchor elevation at the wrist. Perfect for arterial line without too much stretching or bending the wrist. Clean blue towel to lay over the sheet or water/NS bag Sterile clean "Hole" disposable towel or use 2 sterile towels to cover the area. Preferably covering half of the patient side where you plan to cannulate. Two 2 ml syringes and a 26 insulin needle - need only 1-2 ml of local anaesthesia Stitches ( 2-O cotton to stitch, needle holder, scissors or thread cutter and Tegaderm-like sticking breathable bandage) or any other available dressing or per individual ICU protocol.
Position, position, and position - Position the arm well so that you can comfortably perform the procedure. Take your time to feel the pulse, during which you may examine the hand for signs of low flow or conduct an Allen test if you choose to. DO NOT stretch the artery by arching back the hand too much, about 30-45 degrees will suffice. Use a soft roll of cloth or a towel as an anchor point. Arteries may collapse due to excessive stretching, thereby making it difficult to cannulate. Since arteries are composed of smooth muscles, any wrong prick around the arterial wall will cause the artery to go into spasm, making it difficult to feel the pulse. And my advice is not to try more than three times in one go. Use ultrasound if you are comfortable using it or if you feel it might be a complicated procedure, especially if a patient is coagulopathic, in shock or an extended-stay patient with previous multiple pricks and oedematous patients. If it's the first time, make sure you have practised it in a simulation session first to make yourself comfortable with the procedure, and to have a feel of the types of cannulas used.
Once blood flows back, insert the cannula gradually and with a slow rotation, which will help ease the cannula to slide in smoothly. Pushing too hard will create a kink at the base of the cannula, and the arterial line will not last long. Always stitch or stick securely to prevent any kink at the base. Flush them properly with heparin saline once the dressing is complete. Check the waveform and calibrate it yourself. Calibrate the arterial line set-up with the help of the nurse. Clean the area before dressing
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