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Arterial Lines

Identifying an Artery for Art Line Insertion

February 15th, 2021


When identifying an artery for insertion of an arterial line, place the index and middle fingers over the desired artery and palpate for the area of maximal impulse.
  • Potential Sites for Arterial Line Insertion

  • Radial artery -laterally on the anterior aspect of the forearmThe most commonly used site
  • Brachial artery - medially within the antecubital fossa
  • Femoral artery - centrally within the femoral triangle, between the inguinal ligament, adductor longus and sartorius

Tips for Identifying an Artery

  • Do

  • Try to use the radial artery if possible
  • Perform Allen's test prior to inserting the needle
  • Don't

  • Absolutely do not use the same arm as an AV fistula
  • Don't use the radial artery on a limb with a fractured wrist
  • Avoid areas with inadequate collateral circulation (e.g. peripheral vascular disease)
  • Avoid inserting a needle through cellulitis, burns or oedema

Allen's Test

A clinical test used to determine the patency of the radial and ulnar arteries, used as a predictor of distal ischaemia risk post radial arterial cannulation or catheterisation.
  • How to Perform

  • Ask the patient to clench their fist, and apply pressure to both the radial and ulnar arteries. Ask the patient to relax their hand, looking for blanching - if the hand does not blanch then both vessels are not occluded. Release pressure on the ulnar nerve, and look for flushing as the hand is reperfused.
  • Interpretation

  • If the hand does not flush in 10-15 seconds then the ulcer circulation is inadequate, a contraindication to radial puncture on the limb in question.
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