Procedure - Arterial Line Flashcards
The guide wire leaves the tip of the needle when __________.
you advance the wire past the black indicator line
When doing an arterial line without US, always pay attention to the ___________.
catheter right above the skin
Noticing when the pulsatile blood begins to enter the catheter is crucial to knowing when you should stop advancing.
If you see blood in the catheter but it is not rising, then __________________.
retract the catheter slowly and drop the angle
It’s likely that if you got blood and it stopped that you advanced past the vessel.
Straight needles (like the kind you might suture a line down with) are called ______________.
Keith needle
Why should you always use a rolled-up cloth under the wrist for radial arterial lines?
Extending the wrist moves the hand out of the way and brings the artery closer to the surface.
The femoral artery is _________ to the femoral vein.
lateral
Classically, the femoral artery is _________ finger-widths lateral to the pubic tubercle.
3
The transducer needs to be at the ___________ axis.
phlebostatic
This is the level of the heart. Placing the transducer here allows you to cancel out atmospheric pressure.
The radial artery is most superficial at a location given by what landmarks?
Medial and proximal to the radial styloid
Lateral to the tendon of the palmaris longus
How do you perform the Allen test?
Have the patient clench their fist to blanch the skin of their palm. Occlude the ulnar and radial arteries. Remove the occlusion of the ulnar artery and record the time it takes for the palm to turn red. Less than 7 seconds is normal.
The femoral artery is given by which landmarks?
Midway between the ASIS and pubic tubercle and interior to the inguinal ligament
How do you confirm the axis of the vessel if you are not using US?
Use three fingers of your non-dominant hand to find the axis. Insert just under your fingers.
What materials do you need for an A-line?
US
Positioning:
- Tape
- Towel
- Table
Cleaning:
- Chuck
- 4x4s
- Chlorapreps
- Sterile gloves
- US cover
Procedure:
- Dart (radial or femoral) x2
- Suture (2-0 silk)
- Needle driver
- Scissors
- Sterile dressing
Review the steps of arterial line insertion.
- Gather supplies (see card for that)
- Scan for which arm is better
- Position patient (bed, railings, arm, patient)
- Position table and US
- Place roll under wrist and tape arm down
- Place chuck on table
- Sterilize arm
- Open dart, gloves, suture, needle driver, scissors, and dressing, 4x4’s
- Prepare US for grabbing
- Get on sterile gloves
- Put probe in cover
- Insert the art line
- Occlude the pulse when removing the wire
- Place the gauze beneath the catheter
- Connect the tubing
- Clean the blood and gel off
- Tape the tubing
- Suture line down
- Place dressing
What is the risk of infection in arterial lines?
A meta-analysis showed an incidence of 3 infections per 1000 catheters. This is about half the rate of central lines.
Femoral has a RR of 2 compared to radial.
