Quick Facts

• Arterial lines provide continuous blood pressure monitoring and allow for frequent arterial blood sampling.
• Common insertion sites include the radial, femoral, and brachial arteries, with the radial artery being the most commonly used due to its accessibility and collateral circulation.
• Proper technique and aseptic conditions are crucial to minimize complications such as infection, thrombosis, or ischemia.

Procedure

Preparation

• Verify the indication for arterial line placement (e.g., hemodynamic monitoring, frequent blood sampling).
• Obtain informed consent when appropriate.
• Perform an Allen’s test to assess collateral circulation if using the radial artery.
• Gather necessary equipment: arterial catheter kit, sterile gloves, antiseptic solution, local anesthetic, pressure transducer setup, flush solution, and dressings.

Insertion Technique

1. Position the patient’s wrist in slight extension using an arm board or rolled towel.
2. Don sterile gloves and prepare the insertion site with antiseptic solution; drape the area.
3. Infiltrate the skin and subcutaneous tissue with local anesthetic.
4. Palpate the artery and insert the catheter-over-needle assembly at a 30-45° angle until a flash of arterial blood is seen.
5. Advance the catheter into the artery while withdrawing the needle.
6. Connect the catheter to the pressure transducer system and secure it with sutures or adhesive devices.
7. Apply a sterile transparent dressing over the insertion site.

Confirmation Steps

• Observe a characteristic arterial waveform on the monitor to confirm placement.
• Zero the transducer at the level of the heart (phlebostatic axis).
• Ensure the system is free of air bubbles and that the flush system is functioning properly.

Documentation Requirements

• Record the indication for arterial line placement.
• Note the insertion site, technique used, and any complications encountered.
• Document the results of the Allen’s test if performed.
• Include details about the catheter size and type, as well as the date and time of insertion.

Scope Guide

References

1. EMRA. Arterial Line Placement: Basics for Medical Students. https://www.emra.org/emresident/article/arterial-line-placement
2. Geeky Medics. Arterial Line Insertion (Arterial Cannulation) – OSCE Guide. https://geekymedics.com/arterial-line-insertion-arterial-cannulation-osce-guide/
3. Medscape. Arterial Line Placement Technique. https://emedicine.medscape.com/article/1999586-technique