INVASIVE LINE MONITORING Flashcards
Arterial line indications
Elective hypotensive techniques Anticipated wide BP swings End organ disease Beat BP control Multiple labs and ABG analysis
Most used artery for arterial line
Radial Artery
For CABG, surgeon
Will determine A-line location
Arterial line Gauge
20ga, 45 degrees, longer needle, ARROW needle
Position
Arm supinated on arm board
Preparation
Sterile towel 4 ways leaving site exposed
Leaving
No AIR BUBBLES after priming A-line
Anatomy of radial site
Tendons under injection site
Nerve runs along blood vessels
Carpel tunnel
Approach
Proximal to the
Before you use guidewire
test guidewire,
Black line on the tubing, once there, exiting needle tip, meaning wire going into the vessel
Radial artery collateral
Ulnar
5% of the population have
incomplete palmar arches
Lacks adequate collateral flow
Allen test is
A simple BUT NOT ALWAYS reliable method for determining adequacy of ulnar collateral circulation in the even of radial artery thrombosis
Before placement of arterial line
Allen’s test for assessment of collateral flow
2nd most helfpul site
Axillary
Femoral
Most highly infectious site and does not last long
Femoral
The primary source of good blood flow
Ulnar
If a radial artery stick has been performed
ULNAR cannulation should NOT be attempted
Radial vs ulnar
Most larger
Femoral artery
prone to pseudoaneurysm
Problem with femoral
Increase incidence of infection and thrombosis.
Femoral be careful to be
below inguinal ligament
Axillary advantages
patient comofrt, access to a central arterial pressure waveform
Axillary site is
near axillary pressure, nerve damage possible.
Risk of cerebral embolization is increased when more centrally located arterial catheters are used
Axillary
Be able to identify
arterial waveform
which artery and which waveform
Determine course of artery with
LIGHT FINGERTIP PRESSURE
Do not push too hard
