- Continuous direct arterial blood pressure monitoring (i.e. refractory shock on pressors, hypertensive emergency, high risk surgery)
- Frequent arterial blood draws (example: ARDS protocol, severe hypoxia)
- Failure of indirect blood pressure monitoring (unreliable cuff pressure)
- Absolute: absent pulse, Buerger’s disease (thromboangiitis obliterans), full-thickness burn over site, inadequate circulation to extremity (ischemic PVD), Raynaud syndrome
- Relative: anticoagulation/coagulopathy, atherosclerosis, inadequate collateral flow, partial-thickness burn at cannulation site, previous surgery in area, synthetic vascular graft, infection at/near site
(Crit Care Review 2002: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC137445/)
- Common: temporary occlusion of radial artery (up to 35%), hematoma (~15%)
- Uncommon (<1%): permanent thrombosis/ischemia, AV fistula, pseudoaneurysm, nerve injury, air embolus, compartment syndrome
- Radial arterial line kit (should include arterial needle, catheter, wire, lidocaine and syringe)
- Chlorhexadine, small drape, sterile gown and gloves, mask with splash guard, extra sponges, sterile saline flush, tegaderm.
- Informed consent
- Perform Allen test
- Identify radial artery site
- Dorsiflex patient wrist and secure to wrist board or rolled up towel with tape
- Clean and drape sterile field
Insertion of radial arterial catheter
- Anesthetize the insertion site with 1% lidocaine, make a small wheal
- While gently palpating radial artery, insert radial artery needle in the skin just distal to the palpated artery, advance until pulsatile blood returns
- Over the wire (Seldinger)
- Advance the wire through the needle into the artery
- Remove the needle while keeping the wire in the artery
- Advance the catheter over the wire
- Remove guide wire
- Over the needle
- Once you see the flash, advance the needle slightly further, then lower the angle to 10-15 degrees and advance the catheter over needle
- Apply proximal pressure and remove the needle while keeping the catheter in place
- Connect the catheter to the transducer system
- Secure the catheter in place with suture and apply dressing over catheter
- Check distal perfusion
- Document procedure note
- Log your procedure in Med Hub
- If you have difficulty locating the artery, use a doppler probe covered in a sterile glove to locate the artery.
- If you think you’ve entered the artery but are not getting pulsatile flow, your needle may be clogged and needs to be flushed with sterile saline.
- Use the sonosite or ultrasound to guide line placement.
- Switch from the Arrow to Cook kit.
- Switch locations.
- Call your fellow!