Artline Insertion Manual

Question 1

What are the 3 general indications for artline insertion?

Answer 1

1. continuous arterial blood pressure monitoring
2. repeated arterial blood sampling
3. monitoring or continuous infusion of vasoactive medications or antihypertensive agents

Question 2

what are the 4 contraindications for artline insertion?

Answer 2

1. marked bleeding disorders (e.g. hemophilia)
2. severe peripheral vascular disease (may be indicated by skin changes, scars, sores, discolouration or swelling)
3. Poor or absent circulation
4. thrombolytic/anticoagulant therapy - relative contraindication (eg. heparin or warfarin)

Question 3

Normal INR, PTT and platelet count (for PHC)

Answer 3

INR > 1.1
PTT > 37 seconds
Platelet count < 20 000

Question 4

Cautions to artline insertion (exercise caution and avoid insertion sites which ….) (x6)

Answer 4

1. arterial circulation may be compromised (MAT should be performed)
2. skin is effected or weepy
3. previous vascular surgery has occurred (may result in unexpected vessel anatomy)
4. synthetic graft material present (damage to the graft will compromise it’s integrity)
5. Peripherally Inserted Central Catheter (PICC) lines are in the immediate vicinity (may punter or damage the PICC
6. Arterial-Venous fistula has been created (in patients who need long term hemodialysis. NOTE: mixing of blood from the AV fistula will not accurately reflect arterial gas samples, and may not indicate true systemic BP)

Question 5

Hazards and complications of artline insertion (x10)

Answer 5

1. Hemorrhage (most common complication; estimated 300-500 ml/min of blood loss can occur through an 18-gauge catheter in a pt with normal CO; more common in elderly, obese and those on anticoagulants)
2. Vascular occlusion or insufficiency
3. local infection or septicaemia - most respond to catheter removal and antibiotics
4. Pseudoaneurysm - infrequent; requires surgical repair; almost always occur after catheter removal and may not be apparent for days
5. Arterio-Venous Fistula formation - infrequent; requires surgical repair: almost always occur after catheter removal and may not be apparent for days
6. arterial spasm - due to cannulation attempts or prolonged flushing (> 3 seconds)
7. Hematoma (most likely to occur, like hemorrhage) - occur during failed cannulation attempts, most likely to occur after catheter removal, generally a result of inadequate compression. Most are minor and resolve spontaneously, large hematoma can lead to compartment syndrome
8. Arterial thrombosis - the longer the catheter is in place, the larger the size of the catheter relative to the artery, the greater the incidence of hematoma. Thrombosis may be noted a by loss of pulse or weakened pulse below the cannulation site, and by a loss of warmth, sensation and mobility
9. Air embolism - may occur due to loose connections or improper flushing of artlines; suspected when waveforms are dampened, change in vital signs or cyanosis
10. Radial nerve injury - result of improper technique