Arterial Line Insertion and Monitoring

Question 1

Most common insertion sites

Answer 1

• Radial

- Femoral

Question 2

Benefits

Answer 2

• Constant and accurate BP and MAP monitoring

- Access for blood sampling

Question 3

What may affect quality of reading?

Answer 3

• Air bubbles
• Kinking of cannula/tubing
• Embolus
• Faulty transducers

Question 4

Define MAP

Answer 4

Average pressure in arterial system during cardiac cycle

Question 5

Normal range for MAP

Answer 5

70-100

Needs to be over 60 for kidney perfuson

Question 6

Formula for MAP

Answer 6

1/3 pulse pressure (SBP-DBP) + DBP

Question 7

Indications for arterial line

Answer 7

• Haemodynamically unstable
• Requiring vasoactive drugs
• Labile BP
• Regular arterial blood sampling

Question 8

Complications of arterial line

Answer 8

• Local haematoma
• Compromised arterial perfusion
• Arterial thrombosis/air emboli
• Infection
• Bleeding
• Accidental intra-arterial drug injection

Question 9

What test is used to test for collateral circulation of hand for arterial line insertion

Answer 9

Allen’s Test

• Have patient clench first and hold it up
• Apply pressure to both arteries then have patient lower their hand and open their first (should appear blanched)
• Remove pressure from ulnar artery
• • Hand flushes in seconds = collateral circulation

Question 10

When are arterial line readings best taken

Answer 10

• Patient is supine to 30-40 degrees elevated head position
• Phlebostatic axis (4th intercostal space and mid axilla
• Use leveller

Question 11

What is zeroing

Answer 11

• Used to establish a reference point and eliminates effects of atmospheric and hydrostatic pressure
• Should be done each shift, when readings are in doubt and when atmospheric pressure changes

Question 12

Draw a normal art line and explain

Answer 12

Pp. 26

• Steep increase during systole (LV contraction)
• Dicrotic notch - closure of aortic valve
• Gradual descent during diastole

Question 13

What is a ROSE device

Answer 13

• Resonance over Shoot Eliminator
• Used to correct arterial waveforms that are underdamped and give high pressures
• Should be placed directly onto arterial line (requires dressing to be taken down and reapplied) or placed anywhere below transducer

Question 14

Draw an overdamped and underdamped arterial line drawing

Answer 14

PP. 28