Arterial catheter (insertion)
Clinical Procedure
 
Aliases:
Arterial line
Intraarterial catheter
Intra-arterial catheter
Arterial lines
Intraartial blood pressure
Intra arterial blood pressure

Topic aliases are alternate phrasings for a particular topic.


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Indications include beat to beat measurement of intra-aterial blood pressure and when frequent arterial blood-gas measurements are required to avoid repeated arterial stabs.

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Sep 20, 2012
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At my current institution (paediatric) the artline flush is 1unit/ml of heparin since all the lines are 22g. This seems to help prevent clots.

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May 18, 2011
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Small arterial cannulae (22g/24g) clot easily. Flush cannula as you close the 3-way tap to stop any retrograde flow of blood which can clot

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May 18, 2011
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"Radial artery pressure underestimates central pressure in hypotensive septic patients receiving high-dose vasopressor therapy. Clinical management, based on radial pressures, may lead to excessive vasopressor administration. Awareness of this phenomena may help minimize adverse effects of these potent agents by enabling dosage reduction." refl.in/j6

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Oct 02, 2011
2009 study confirming this refl.in/k6. 2008 study suggesting only a ~4mmHg systematic bias. refl.in/k7
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A persistent white hand or foot should be heparinised
75 iu/kg load, then 25 iu/kg/hr targeting an APTT of 80 – 100 #ref

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Sep 15, 2012
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If the distal limb turns white, observe for a few minutes as it may resolve if it is a temporary aterial vasospasm. If it doesn’t resolve, then remove the cannula.

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Sep 15, 2012
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When inserting a femoral arterial line using a seldinger technique, use the needle without the syringe. Use this to find a good pulsatile arterial flow before inserting the guidewire. If flow is not pulsatile, it is possible that the needle tip is not entirely in the lumen which increases the risk of dissection.

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Nov 03, 2011
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Arterial line insertion - needle set up with 'reservoir' using the optiva iv-catheter-jelco Attaching the plastic casing to the proximal end of the cannula after removing the filter tip will create a larger reseviour than is present with the filter tip.

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Mar 13, 2012
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If inserting a radial arterial line for a prolonged procedure, consider using at least a 22g cannula (you may need to exchange a 24g with a 22g over a wire).
A 24g is quite likely to pack up in the middle of the case.

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Aug 15, 2012
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When exchanging an arterial line over a wire, try to avoid pressing down over the artery as you pull the wire out.
This may result in a shearing force being applied to the arterial endothelium which may result in arterial spasm.

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Aug 15, 2012
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If the available arterial catheters aren't long enough (eg for a deep femoral artery in an obese patient), a central venous catheter is an acceptable substitute. You must remember to label the line very clearly to avoid administering vasopressors which may lead to limb ischemia.

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Dec 23, 2011
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If the radial artery is deep and the catheter is an insufficient distance into lumen, a longer 8cm 20g arterial catheter (eg arrow) can be railroaded over its own wire.

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Mar 12, 2012
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