Arterial Line¶

Indications¶

Continuous, accurate hemodynamic monitoring (pts requiring vasopressor titration, pts whose BP accuracy is in question)
Need for frequent ABGs

Abnormal Allen's test, thrombosis of selected site, distorted anatomy at selected site (known prior fistulas, grafts, malformations), severe PAD at selected site, Raynaud's of selected limb

Bruising, pain, damage to adjacent structures, infection, bleeding (possible extension to RP bleed with femoral placement), hematoma formation, vascular complications (dissection, AV fistula, pseudoaneurysm), thrombosis, rarely distal ischemia

Bleeding risk guidelines: no definitive guidelines (some suggest plts > 50K, INR < 3, PTT < 100)
Palpate of artery of interest to best understand anatomy and surrounding structures
Allen Test if placing radial artery access: goal to assess collateral ulnar blood flow to avoid ischemia. Compress both radial and ulnar artery 10-15 sec to allow blanching of palm, then release ulnar artery to assess re-perfusion. If blanching quickly resolves, ulnar artery will allow distal perfusion
If attempting radial access, ensure wrist is adequately extended; use towel roll under wrist and tape hand to bed or table
Discuss with fellow prior to brachial a-line placement
Ask RN to prepare tubing and waveform monitoring prior to time-out

Types of Kits
- Arrow kit: all-in-one device that has arterial catheter over introducer needle
- A-line kit: individual introducer needle, guidewires, and sutures; multiple steps
- Micropuncture kit: atraumatic guidewire, microcatheter and introducer sheath
Reconfirm location with US after lidocaine
Ensure arterial access (pulsatile flow of bright red blood)

Immediately connect pressure tubing to catheter while maintaining sterile technique
Observe monitor for arterial waveform to verify appropriate placement
If persistent bleeding, hold pressure for 15 mins