Arterial Line

Leonie Dupuis

NEJM Guide: https://www.youtube.com/watch?v=HE7dJxFMBPE

Kits

  • Arrow kit: all-in-one device that has arterial catheter over an 18g introducer needle 
  • A-line kit: individual introducer needle, guidewires, and sutures; multiple steps; Is compatible with micropuncture kit (21g micropuncture needle with atraumatic guide wire)

Supplies 

  • Ultrasound with linear probe 
  • Ultrasound probe cover and sterile gel 
  • Kit of Choice 
  • Sterile towels 
  • Sterile gloves 
  • Table for supplies 
  • Small towel to position patient wrist (see diagram) 
  • Tape 
  • Sterile dressing 
  • Pressure tubing (ask nurse to obtain and set up) 
  • 1% lidocaine, 25G needle, 5mL syringe (if not in kit)

Procedure 

  • Clean site with chlorhexidine 
  • Give local lidocaine subcutaneously 
  • Reconfirm location with US after lidocaine 
  • Advance needle at 45-degree ankle with ultrasound guidance until in the target vessel 
  • Depending on kit used, advance catheter over needle (Arrow kit) or insert wire then advance catheter over wire after removing needle (Micropuncture kit) 
  • Hold pressure over/proximal to the catheter 
  • Attach pressure tubing with nursing and ensure good waveform 
  • Suture into place 
  • Apply sterile dressing

Post-procedural considerations 

  • Immediately connect pressure tubing to catheter while maintaining sterile technique 
  • Observe monitor for arterial waveform to verify appropriate placement 
  • If persistent bleeding, hold pressure for 15 mins
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