Overview
Arterial Line Insertion is a procedure used to establish continuous arterial access for hemodynamic monitoring and frequent blood sampling. It is essential for critically ill patients and major surgeries.
Arterial line insertion is crucial for continuous blood pressure monitoring, frequent arterial blood gas sampling, and hemodynamic assessment in critically ill patients.
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Indications
Continuous blood pressure monitoring
Arterial blood gas analysis
Intraoperative monitoring
Hemodynamic assessment
Monitoring during pressor therapy
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes patient consent, sterile technique setup, ultrasound guidance, monitoring equipment, and emergency backup. All team members should understand their roles.Step-by-Step Procedure
Step 1: Patient Preparation
Explain procedure, obtain consent, position patient, prepare sterile field.
⚠️ Common Mistakes to Avoid:
- Inadequate consent
- Poor positioning
- Incomplete sterile prep
💡 Pro Tip:
Ensure patient is comfortable and cooperative.
Step 2: Site Selection
Choose insertion site, mark with ultrasound guidance.
⚠️ Common Mistakes to Avoid:
- Wrong site selection
- Poor ultrasound visualization
💡 Pro Tip:
Use ultrasound to identify optimal artery and assess collateral flow.
Step 3: Local Anesthesia
Infiltrate local anesthetic at insertion site.
⚠️ Common Mistakes to Avoid:
- Inadequate anesthesia
- Wrong technique
💡 Pro Tip:
Use adequate local anesthetic for patient comfort.
Step 4: Artery Puncture
Puncture artery under ultrasound guidance, confirm arterial blood.
⚠️ Common Mistakes to Avoid:
- Venous puncture
- Multiple attempts
💡 Pro Tip:
Always confirm arterial blood return before proceeding.
Step 5: Guidewire Insertion
Insert guidewire through needle, confirm position.
⚠️ Common Mistakes to Avoid:
- Wrong guidewire placement
- Guidewire loss
💡 Pro Tip:
Maintain control of guidewire at all times.
Step 6: Catheter Insertion
Insert catheter over guidewire, remove guidewire.
⚠️ Common Mistakes to Avoid:
- Catheter malposition
- Guidewire entrapment
💡 Pro Tip:
Ensure guidewire is completely removed.
Step 7: Confirmation
Confirm placement with waveform, secure catheter.
⚠️ Common Mistakes to Avoid:
- Poor confirmation
- Inadequate securing
💡 Pro Tip:
Always confirm arterial waveform before use.
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Post-procedure Care
Post-procedure care involves confirming placement, monitoring for complications, daily line care, and timely removal when no longer needed.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Bleeding | 2-5% | Hematoma, hypotension | Pressure, exploration if needed | Proper technique, ultrasound guidance |
| Thrombosis | 5-10% | Loss of pulse, cold extremity | Line removal, anticoagulation | Proper positioning, timely removal |
| Infection | 3-8% | Fever, erythema, purulent discharge | Antibiotics, line removal | Sterile technique, proper care |
| Distal ischemia | 1-3% | Cold, pale, pulseless extremity | Line removal, vascular consultation | Assess collateral flow, proper technique |
Clinical Pearls
Always use ultrasound guidance for safer insertion.
Assess collateral circulation before insertion.
Maintain control of guidewire at all times.
Always confirm arterial waveform before use.
Use sterile technique throughout the procedure.
Secure catheter properly to prevent dislodgement.
Monitor for complications post-procedure.