Transcript Arterial Lines

Arterial Lines
Set Up & Monitoring
Union Hospital
Emergency Department
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Objectives
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Introduction and review of anatomy
Indications for arterial lines
Sites for arterial pressure monitoring
Allen’s Test
Overview of arterial line set up
Patient monitoring
The arterial waveform
Arterial Line blood draws
Care and maintenance
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Introduction
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What is it? A Teflon catheter inserted into an
artery that is connected to a pressure
transducer system.
Advantages-Continual beat –to-beat
monitoring of blood pressure, and continual
vascular access for blood sampling.
Risks-Hemorrhage, Emboli-Air or Thrombus,
Tissue ischemia, Bacterial contamination.
NOT for use as an infusion port for ANY
medications!
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Indications for Arterial Lines
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Intra arterial blood pressure monitoring
is indicated for any major medical or
surgical condition that compromises
cardiac output, tissue perfusion, or fluid
volume status.
Examples-DKA, Fluid shifts after
surgical bowel resection, respiratory
failure.
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Sites for Arterial Lines
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Radial Artery(most frequently used)
Brachial Artery
Femoral Artery
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Allen’s Test
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Used to establish the presence of
collateral arterial blood flow through the
PALMAR ARCH via the ULNAR artery.
Used and documented “positive” or
“negative” when considering RADIAL
artery puncture or annulations by
physician or RT.
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Overview of Arterial Line Set
Up
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Equipment needed: Pressure bag, 500cc bag
0.9% NS, Transducer tubing, #20 angiocath,
dressing supplies, dead end caps.
Ensure ALL air removed from system to
include flush bag and stopcocks.
Inflate pressure bag to 300mm.
Purpose of pressure bag is to provide a
continuous saline flush at 3-6cc/hr that will
overcome the patient’s systolic blood
pressure.
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Patient Monitoring
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Place transducer in holder at mid-chest/aorta
level and secure.
ZERO the system by having transducer at
(phlebostatic axis) right atrium, open
stopcock to atmospheric pressure, Zero
monitor.
Once zeroed, turn stopcock back to patient
monitoring and replace cap.
A cuff pressure on extremity not used for Art.
Line should be obtained.
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Patient Monitoring Cont’d.
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A 5-20 mmHg difference between cuff
and arterial pressure is normal, with the
arterial pressure being the higher of the
two.
Arterial pressure should be documented
every 5 minutes until stable.
Obtain a strip of waveform.
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The Arterial Waveform
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Represents the ejection phase of the left
ventricular systole.
As the aortic valve opens, blood is ejected
and recorded as an increase in pressure in
the arterial system.
Highest point is systolic measurement.
Dicrotic notch represents aortic valve closure
and signifies the start of diastole.
Lowest point is the diastolic measurement.
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Arterial Waveform
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Arterial Line Blood Draws
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Remove cap from proximal stopcock and
attach 5cc syringe.
Open stopcock to patient.
Draw 5cc blood for waste.
Attach appropriate size syringe for labs
ordered and draw blood.
Close stopcock and remove syringe.
Flush system and replace sterile dead end
cap.
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Care and Maintenance
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Assess color, movement, pulse,
temperature, and sensitivity of
extremity where line is in place.
Zero transducer with position changes.
Ensure transducer at phlebostatic axis.
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