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Arterial Line Access and Monitoring

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Interventional Critical Care

Abstract

Percutaneous arterial cannulation is a common procedure which can allow for the measurement of beat-to-beat blood pressure. Assessment of hemodynamic stability in critically ill patients can be accomplished through arterial monitoring. An intra-arterial catheter can be inserted via a number of superficial and deep arteries. Complications of arterial cannulation can include bleeding, infection, ischemia, thrombosis, embolization, and damage to adjacent structures. Many organizations credential advanced practice providers for arterial line placement. In order for proper placement to occur, it is imperative to have a basic technical understanding of the procedure as well as a deep knowledge of indications and complications of the procedure. This chapter outlines the steps needed for arterial line placement and monitoring.

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Author information

Authors and Affiliations

  1. NP/PA Critical Care Residency Program, Emory Critical Care Center, Emory Healthcare, Atlanta, GA, USA

    Aimee M. Abide & Heather H. Meissen

Authors
  1. Aimee M. Abide
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  2. Heather H. Meissen
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Corresponding author

Correspondence to Aimee M. Abide .

Editor information

Editors and Affiliations

  1. Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Dennis A. Taylor

  2. Department of Surgery, Oregon Health & Science University, Portland, OR, USA

    Scott P. Sherry

  3. Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA

    Ronald F. Sing

Appendix 11.1

Appendix 11.1

[Reprinted with Permission from the Emory Critical Care Center Office of Quality]

Arterial Catheterization Competency Checklist

For Critical Care Medicine Advanced Practice Providers

Provider Name:

Date:

Checked by:

PT MRN:

Arterial Catheterization Checklist

 

Yes

Yes (w reminder)

No/comments

Patient/family consent

   

Time out

   

Identify appropriate site; use ultrasound to assess size and patency of vessel

   

Patient appropriately positioned

   

Skin prep performed with alcoholic chlorhexidine 2% (must be dry before needle insertion)

   

Clean hands

   

Wear mask, sterile gloves, and eye protection if in contact with or crossing the sterile field at any time during the procedure. If femoral/axillary site, full sterile gown required

   

Drape the area with sterile towels or sterile drape

   

Ultrasound is recommended for all sites with utilization of sterile placement of probe cover

   

Anesthetize skin with lidocaine

   

Slowly advance needle tip with bevel up under ultrasound visualization until the needle tip is in the vessel and a flash of pulsatile blood is seen

   

For radial artery kit:

Advance the guidewire and then advance the angiocatheter into the artery

   

Remove needle and wire apparatus

   

For all other sites:

Remove syringe and advance the guidewire through the needle

   
 

Yes

Yes (w reminder)

No/comments

Remove needle while holding control of wire

   

Place angiocatheter over the wire while controlling wire at all times and advance catheter into artery

   

While holding pressure, remove wire

   

Attach pressure transducer tubing

   

Secure line with suture if needed

   

Use transparent sterile dressing

   

Confirm arterial placement by waveform tracing

   

Checklist reproduced with permission from Emory Center of Critical Care.

Arterial Catheterization Checklist

  • Patient/family consent.

  • Time out.

  • Identify appropriate site; use ultrasound to assess size and patency of vessel.

  • Patient appropriately position.

  • Skin prep performed with alcoholic chlorhexidine 2%. Scrub back and forth with chlorhexidine with friction for 30 seconds; allow to air dry completely before puncturing site. Do not wipe, fan, or blot. Groin prep with scrub for 2 minutes and allow to dry for 2 minutes to prevent infection.

  • Clean hands.

  • Wear mask, sterile gloves, and eye protection if in contact with or crossing the sterile filed at any time during the procedure. If femoral/axillary site, full sterile gown required.

  • Drape the area with sterile towels or sterile drape.

  • Ultrasound is recommended for all sites with utilization of sterile placement of probe cover.

  • Anesthetize skin with lidocaine.

  • Slowly advance needle tip with bevel up under ultrasound visualization until the needle tip is in the vessel and a flash of pulsatile blood is seen.

  • For the radial artery kit: Advance the guidewire and then advance the angiocatheter into the artery.

  • Removed needle and wire apparatus.

  • For all other sites: Remove syringe and advance the guidewire through the needle.

  • Removed needle while holding control of wire.

  • Place angiocatheter over the wire while controlling wire at all times and advance catheter into artery.

  • While holding pressure, remove wire.

  • Attach pressure transducer tubing.

  • Secure line with suture if needed.

  • Use transparent sterile dressing.

  • Confirm arterial placement by wave form tracing.

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Abide, A.M., Meissen, H.H. (2021). Arterial Line Access and Monitoring. In: Taylor, D.A., Sherry, S.P., Sing, R.F. (eds) Interventional Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-64661-5_11

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  • DOI: https://doi.org/10.1007/978-3-030-64661-5_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-64660-8

  • Online ISBN: 978-3-030-64661-5

  • eBook Packages: MedicineMedicine (R0)

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