Arterial Lines

Clinical Use

Indications

Invasive blood pressure monitoring, frequent arterial blood gas testing
Contraindications

Coagulopathy, inadequate collateral circulation

Equipment & Preparation

Large Dressing Pack

With plenty of gauze
Sterile Gloves
Sterile Gown
Decontaminant

E.g. Chlorhexidine + alcohol swabs
Fenestrated Drape
Local Anaesthetic

1% lignocaine in a 5mL syringe with small needle
Arterial Line Kit

Needle, guide wire, cannula
Suture Kit

Suture material, scissors, forceps
Dressing

Sterile transparent occlusive dressing
Transducer Kit

Line, transducer, pressure bag
Exit strategy

Bin + sharps disposal close by

Identifying an Artery

Potential Sites

Radial, brachial or femoral artery
Choosing the Right Limb

Consider performing Allen's test
Finding an Artery

Place index and middle fingers over the desired artery and feel for the area of maximum impulse

How To Perform

Explain the procedure and ask for patient's consent
Positioning

Raise the bed to waist level, expose the area
Prepare Sterile Field
Scrub, don sterile gloves and gown
Prepare Sterile Equipment

Draw up local, place everything in the order it will be used
Prepare the Site

Decontaminate a wide area e.g. with chlorhexidine + alcohol
Apply the fenestrated drape
Palpate the Pulse

Radial, brachial or femoral
Inject Local Anaesthetic

Adjacent to the pulsation + 2cm distal to insertion site
Insert Needle

Using dominant hand, non-dominant hand on pulse

Pencil grip, bevel up, 45 degrees from skin until pulsating flashback
If the needle or catheter must be removed at any time, place pressure on the insertion site for at least three minutes in order to prevent haematoma formation.
Advance the Guide Wire

Through the needle, soft & flexible end first
Remove the Needle

While holding onto guidewire, apply pressure to site using gauze
Insert the Cannula

Railroad over the guidewire, always with one hand holding the guidewire
Remove the Guidewire

Ensure flashback from the cannula, then stop the flow using a bung
Suture the Cannula

On either site, approximately 2cm from the insertion site
Clean the Area

Normal saline, then with dry gauze
Apply Dressing

Sterile, transparent occlusive dressing
Remove the drape
Connect the cannula to the transducer system and flush the line
Clean Up

Dispose of sharps and other waste

Complications

Blockage

Not transducing, clot in the line, kinking, pain
Distal Ischaemia

Pain, pallor, pulselessness, paralysis, paraesthesia, poikilothermia
Haemorrhage / Haematoma

Bruising, active bleeding from the site
Infection

Erythema, pain, swelling, pus
Nerve Damage

Numbness / paraesthesia

Finding an Artery

On this page:Potential Art Line Sites

Potential Art Line Sites

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

Last updated on January 1st, 2018

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Indications

Contraindications

Large Dressing Pack

Decontaminant

Fenestrated Drape

Local Anaesthetic

Arterial Line Kit

Suture Kit

Dressing

Transducer Kit

Exit strategy

Potential Sites

Choosing the Right Limb

Finding an Artery

Positioning

Prepare Sterile Field

Prepare Sterile Equipment

Prepare the Site

Palpate the Pulse

Inject Local Anaesthetic

Insert Needle

Advance the Guide Wire

Remove the Needle

Insert the Cannula

Remove the Guidewire

Suture the Cannula

Clean the Area

Apply Dressing

Clean Up

Blockage

Distal Ischaemia

Haemorrhage / Haematoma

Infection

Nerve Damage

Finding an Artery

Potential Art Line Sites

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