- Arterial line placement.

Arterial line placement.

An intra-arterial catheter (A-line) is a very small plastic tube (called catheter) placed in one of your blood vessels (an artery) by highly trained personnel. This is usually done during or before certain types of surgery or in the Intensive Care Unit.

To see how to undergo Arterial line see the following video from New Engeland Journal of Medicine.

you can see the video online on NEJM here or

Download it directly from here 

  or watch it now :D

- The Allen Test:-

Should be performed prior to cannulating either the radial or ulnarartery.
Evaluates the ability of the opposing artery to adequately perfuse the hand.

Steps of Allen test:

1. Occlude the radial and ulnar arteries with thumb and index finger
2. If able to do so, instruct patient to raise wrist above head and make a fist repeatedly
3. Release ulnar artery and determine amount of time needed for normal color to return to the hand.

Results of Allen test::-

• Normal time is less than or equal to 7 seconds
• A positive Allen test is a delay of equal to or greater than 14 seconds in normal color return.
• A positive test is a general contraindication for radial artery cannulation.

- Indications of Arterial line placement.:-

1. To watch your blood pressure very closely.
2. To draw frequent blood samples for lab tests e.g for ABG.

- CONTRAINDICATIONS of Arterial line placement.:-

Absolute contraindications:-

• Infection at the site of insertion
• Traumatic injury proximal to the site of insertion

Relative contraindications:-

• Failure to demonstrate collateral flow in small vessels (e.g., by Doppler ultrasonography)
• Presence of arteriovenous (AV) shunt in the limb in question
• History of surgery disrupting lymphatics of the upper extremity, such as a mastectomy with lymph node dissection.
• Arterial insufficiency in the distribution of the artery to be cannulated.

- Complication of Arterial line placement.:-

• Partial or complete obstruction of flow with distal ischemia.
• Emboli.
• Massive hemorrhage.
• Temporary loss of pulse.
• Local infection.

Ref:-

1. "A-Line" or "Intra-Arterial Catheters" The Internet Journal of Health
2. Arterial Line Insertion Honore S. Becker, RN, ACNP-S andWm. Dan Roberts, MS, ACNP-CS,Columbia University School of Nursing.
3. NEJM

Dr Ibrahim