Session 26: Arterial Line Flashcards
arterial line indications
repetitive blood sampling
real time BP monitoring
inability to measure w/NIBP
arterial blood gases
most accurate PO2 values
most venous draws are within _____% of ABG
95%
types of repetitive blood sampling
Hb
Na+
Ca2+
PTH
reasons for real-time BP monitoring
sympathomimetic infusions
strict BP control
- aneurysm
- vessel surgery
resuscitative end points
what can resuscitative end points help determine
volume status
what could make it difficult to measure NIBP
fistula
burns
morbid obesity
LVAD
arterial lines absolute CI
inadequate circulation
- cold limb
raynaud’s
buerger’d
full-thickness burns
arterial lines relative CI
previous sx
- distorted anatomy
anticoag/coagulopathy
- DIC
active skin infection
atherosclerosis
inadequate collateral flow
partial-thickness burn
arterial lines complications
hematoma
infection
bleeding
ischemia
thrombosis/embolism
AV fistula formation
pseudoaneurysm formation
arterial spasm
radial > femoral
arterial occlusion
radial > femoral
ischemia
femoral > radial
internal bleeding
femoral > radial
infection
femoral > radial
radial artery location
thumb side of wrist
superficial
collateral flow for radial artery
ulnary artery
allen’s test: positive
hand does not flush within 7 seconds
positive result is bad
2nd most common art line site
femoral artery
femoral artery catheter
longer and larger
requires seldinger wire
femoral hematoma
compress against femoral head to relieve
brachial artery
lack of collateral flow
brachial artery location
medial aspect of bicep head in antecubital fossa
dorsalis pedis art line
used in peds
art line equipment
chloraprep
4x4 gauze
catheter
arm board/wrist roll
pressure bag w/flushed transducer and cable
tegaderm
continued antiseptic
tape
art line needle length
1.75”
radial catheter size
20g
femoral catheter size
18g
16g (10cm)
brachial catheter size
20g (10cm)
arrow catheter size
20g
art line kit: femoral/brachial
35 cm J tip seldinger
3” fenestrated drape
3mL syringe
18g injection needle
20g introducer needle
25g injection needle
gauze
1% lido
1.75” 20g catheter
#11 scalpel
5” 20g catheter
3-0 suture w/straight needle
iodine prep
pressure tubing capacitance
low capacitance
- stiff
- limits stretching
- higher freq
factors that increase artifact
incr length
stopcocks
in-line syringes
how do you keep art line patent?
flushing
intermittent art line flush
every 15-30 mins
continuous art line flush
2-3 mL/hr
(built in to new systems)
fluid compressibility
minimally compressible
overdampened
narrow PP
falsely low BP
overdampening causes
air bubbles
kinking
clot
underdampened
wider PP
falsely high BP
underdampened causes
tachycardia
hypothermia
MAP in under and overdampened systems
minimally unchanged
potential art line resonance issues
flexed wrist
kinked catheter
loose connections
closed stopcocks
needs to be zeroed
needs to be flushed
peak of art line waveform
ESV
underdampened post-flush
> 2 oscillations
underdampened BP
overestimates systolic
underestimates diastolic
optimal post-flush
1-2 oscillations
overdampened post-flush
no oscillations
no dicrotic notch
overdampened
underestimates systolic
overestimates diastolic
pulsus paradoxus
systolic pressure drop of 10mmHg during inspiration
decr end-diastolic preload
decr SV
pulsus alternans
frank-starling mechanics
- changes ESV
papillary muscle contractility decreased
- ischemic event
pulsus bisferiens
2 systolic peaks
- regurgitant aortic valve
- back fill into relaxing ventricle
- venturi effect/arterial muscular collapse
aortic insufficeincy
aortic stenosis
pulsus parvus et tardus
slow systolic rise
due to aortic stenosis
the radial artery is tethered to
the tensor retinaculum
what angle do you insert the arterial line
45 degrees until flash
arterial line verification
monitor
ability to withdraw blood
sustained brisk blood return
zero transducer
off to pt
open to air
“zero” on monitor
turn off to air
