1 Arterial Lines Set Up & Monitoring Union Hospital Emergency Department

2 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

3 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!

4 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.

5 Sites for Arterial Lines Radial Artery(most frequently used) Brachial Artery Femoral Artery

6 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.

7 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.

8 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.

9 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.

10 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.

11 Arterial Waveform

12 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.

13 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.