PAL Procedure Flashcards
What is the primary objective of the module on Neonatal Peripheral Arterial Line Placement?
To provide a didactic review of the indications, contraindications, complications, and technical approach to the placement of a peripheral arterial line (PAL) in the neonate.
What is the first site usually selected for arterial access in critically ill neonates?
The umbilical artery.
What are the indications for peripheral arterial cannulation in neonates?
- Need for continuous monitoring of arterial blood pressure
- Need for frequent blood sampling
- Need for pre-ductal blood pressure or arterial blood gases from right radial artery.
What are some contraindications for peripheral arterial line placement?
- Uncorrected bleeding disorder
- Evidence of circulatory insufficiency in the limb
- Localized skin infection at desired insertion site
- Malformation of the extremity
- Previous surgery in the area, especially at a cut-down site.
Name some potential complications of peripheral arterial line placement.
- Thromboembolism
- Vasospasm
- Thrombosis
- Blanching of hand/foot
- Loss of digits
- Gangrene of fingertips
- Hemiplegia
- Peripheral nerve damage
- Necrosis of extremity
- Skin ulcers
- Cerebral emboli
- Infection
- Hematoma.
True or False: It is safe to ligate the artery during peripheral arterial line placement.
False.
What should be displayed on a monitor at all times when a peripheral arterial line is in place?
Continuous pressure waveform tracing.
Fill in the blank: When performing radial artery cannulation, always check _______ collateral circulation using the Allen test or Doppler ultrasound.
ulnar.
What equipment is considered sterile for peripheral arterial line placement?
- Gloves
- Antiseptic solution
- 4 x 4 gauze squares
- Normal saline solution with heparin
- Syringes
- Needles
- Arterial pressure transducer
- T connector primed with heparinized flush solution
- Transparent, semipermeable dressing.
What is the preferred site for peripheral arterial line placement?
Radial artery.
What is the technique for performing the Allen Test?
Raise the foot, occlude the dorsalis pedis and posterior tibial arteries, release pressure over one and monitor for tissue perfusion within 10 seconds.
Technique A for PAL placement is preferred for which type of infant?
Small premature infants.
What angle should the artery be punctured during Technique A?
10 to 15 degrees to the skin.
What should be done if a hematoma forms during cannulation?
A slight adjustment in the needle position may be necessary, or attempt cannulation of a different artery.
What should be done after the cannula is inserted into the artery?
Securely attach the cannula end to the T connector and gently flush with heparinized solution.
What should be monitored for after inserting the cannula?
Evidence of blanching or cyanosis.
