Arterial Line

  • James Bardes
  • Lydia Lam


  • Arterial lines are indicated for continuous invasive blood pressure monitoring or in patients that require frequent arterial blood sampling. The invasive blood pressure measurement is more accurate than the noninvasive sphygmomanometric measurement, especially in the critically ill.

  • Consent should be obtained, if possible.

  • Complications include catheter dislodgement and bleeding, hematoma, thrombosis, false aneurysm, peripheral tissue ischemia and necrosis, and infection.
    • Although rare, the most serious complication is the development of ischemia and necrosis of the extremity, usually the fingers or toes. Extremity ischemia can occur due to embolization by a dislodged clot, or atheromatous debris, or due to fragmentation of the catheter.

    • Routine monitoring of perfusion to the distal extremity should be performed.

  • The radial artery is the most commonly accessed vessel followed by the femoral artery, in both adults and children.
    • Alternative sites of insertion include the ulnar, brachial, and the dorsalis pedis.

    • Caution should be used when accessing the ulnar artery, because this is the dominant artery to the hand in 95% of patients. In the presence of poor collateral flow, or an occlusion of the radial artery, the hand can become ischemic. The adequacy of the collateral circulation can easily be assessed by performing the Allen’s test (see radial artery catheter).

  • Arterial catheterization is contraindicated by lack of arterial pulse, inadequate collateral flow or circulation to an extremity, infection at the catheter site, and the presence of a synthetic vascular graft.

  • Use of ultrasound guidance improves cannulation rates, especially in patients with not easily palpable pulses.
    • A straight linear array probe is preferred for vascular imaging.

    • These probes produce higher frequencies (5–13 MHz), which provide better resolution for blood vessels.

    • Color Doppler can be used to confirm flow within the artery.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Trauma, Emergency Surgery and Surgical Critical CareUniversity of Southern CaliforniaLos AngelesUSA

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