Arterial Lines Set Up & Monitoring Union Hospital Emergency Department
Objectives • 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
Introduction • 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!
Indications for Arterial Lines • 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.
Sites for Arterial Lines • Radial Artery(most frequently used) • Brachial Artery • Femoral Artery
Allen’s Test • 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.
Overview of Arterial Line Set Up • 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.
Patient Monitoring • 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.
Patient Monitoring Cont’d. • 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.
The Arterial Waveform • 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.
Arterial Line Blood Draws • 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.
Care and Maintenance • Assess color, movement, pulse, temperature, and sensitivity of extremity where line is in place. • Zero transducer with position changes. • Ensure transducer at phlebostatic axis.