The Massachusetts General Hospital Handbook of Neurology

Authors: Flaherty, Alice W.; Rost, Natalia S.

Title: Massachusetts General Hospital Handbook of Neurology, The, 2nd Edition

Copyright 2007 Lippincott Williams & Wilkins

> Table of Contents > Procedures > Arterial Line

Arterial Line

A. Consent

Bleeding, infection, thrombosis, nerve damage.

B. Need

Mask, Xylocaine and TB needle, 20-gauge 1 ; inch angiocatheters, heparinized saline hookup or flush and plug, wire, sterile towels or small sheet, wrist board with gauze roll wrapped in chuck, thick adhesive tape, iodine, sterile 4 4 gauze 10-pack, sterile gloves, 3-0 suture.

C. Check for ulnar-radial anastomosis

First check ulnar pulse. Have pt. make a fist; press on radial artery, open hand. Whole hand should turn pink, not just ulnar side.

D. Setup

Tape wrist, slightly hyperextended, to board, perhaps to bed too. Prep arm, sterile drape, flush catheter tip with heparinized saline, put on gloves, anesthetize wrist, unwrap wire.

E. Stick

Impale artery bevel up, at 45 degrees, flatten angiocath somewhat. When blood spurts out, thread wire, remove needle, and advance catheter.

F. Secure

If flow looks good, remove wire, connect catheter to transducer; suture catheter, cover with clear plastic dressing.

G. Removal

Hard hand pressure for 5 min; check for continued bleeding.