Outlines:
Definition
Indication
Arterial Line Sites
Insertion Procedure
Waveforms Produced by Arterial pressures
Obtaining blood sample from A. line
Removal of An Arterial line
Contraindication
complications
Nursing care
Definition:
It is an arterial catheter over a needle( cannula)
inserted in to an artery and through its connection
with specific monitoring tubing, can continuously
monitor blood pressure.
A catheter inserted into an artery and connected to
pressure tubing, a transducer, and a monitor. The
device permits continuous direct blood pressure
readings
Indications:
A. Continuous monitoring of arterial blood
pressure
Indications,cont:
B. Allows direct access for blood draws for
ABG’s
Indications,cont:
C. To evaluate of hemodynamic response to pharmacologic
agents
D. If venous access is limited and multiple lab draws are
needed
CONDITIONS THAT INDICATED FOR THE USE OF
ARTERIAL PRESSURE MONITORING:
❖ Acute hypotension or hypertension (hypertensive crisis)
❖ Hemodynamic instability or circulatory collapse
❖ Hemorrhage
❖ Shock from any cause
Sepsis
Cardiac arrest
❖ Continuous infusion of vasoactive medications
❖ Major surgical procedures
Multiple trauma
❖ Respiratory failure
❖ Failure of indirect BP monitoring i.e. morbid obesity,
burned extremity
Intra aortic balloon pump therapy
WHAT CREATES BLOOD PRESSURE?
Blood pressure (usually refers to the arterial pressure) is the volume of
blood in the arteries (Normal pressures need to be maintained to perfuse
vital organs)
Normal Values: MAP: 70 – 100mmHg, Systolic: 100 – 140 mmHg and
Diastolic: 60 – 90mmHg
MAP = DP+1/3(SP-DP)
PP= (SP-DP)
Arterial Line Sites
Radial
Radial artery is the first choice.
Ease of placement
Relative accuracy
presence of collateral flow.
Allen’s test
To Assess Adequacy of Collateral Blood Flow
Arterial Line Sites,cont
Brachial( forbidden)
Less access, sole supply for forearm and hand
It was the second choice, except in the presence of
poor pulsation caused by shock, obesity, or a sclerotic
vessel (because of previous cardiac catheterization).
Arterial Line Sites,cont
Femoral
Easier but anatomy not consistent, poorer access
Use the femoral artery in the case of cardiopulmonary
arrest or altered perfusion to the upper extremities
Dorsalis Pedi's
Smaller vessel, less access
Insertion procedure:
Equipment needed to insert arterial catheters
Arterial cannula of choice
Sterile gloves
Clean dressing trolley
Alcohol for skin disinfection
A pre prepared, fully primed transducer set
Examination gloves
Lidocaine 1%
2ml syringe with needle
Transparent semi-permeable dressing
Gauze swabs
Arterial Cannula
Arterial line insertion is done by
physician but the nurse is charge for
preparation equipment's, observation,
monitoring and care of it
Arterial line connection:
Zeroing of arterial line
To ensure accuracy of readings
Flush the device & turn it off to patient but open to
atmosphere
Hold zero button on the monitor for 2-3 seconds
Then turn the stopcock off to atmosphere and open to
patient
Zero once per shift or if values are questionable
Ensure flush bag is pumped up
Transducer - A couple of things to
remember
The transducer has to be leveled correctly-to make
sure that it’s at the fourth intercostal space, at
the mid- axillary line (Phlebostatic axis)
Zero the line to atmospheric pressure properly
Waveforms Produced by Arterial pressures
A normal waveform on the monitor will have a sharp
upstroke, a dicrotic notch and a clear end diastole
Abnormal Waveforms
Dampened: wide, flattened
tracing
Dampened trace
This type of trace Under estimate SBP, over estimate
DBP
Dampened: wide, flattened tracing
Dampening occurs due to:
air bubbles
catheter kinks
clots
low flush bag pressure or no fluid in the flush
bag
Improper scaling
Severe hypotension if everything else is
ruled out
Resonant: ‘spiked’ tracing
Resonant trace
Resonant: ‘spiked’ tracing
Resonance occurs due to:
long tubing
non-fully opened stopcock valve
This type of trace
Over estimate SBP, under estimate DBP
complications :
Infection
Haemorrhage
Ischemia
arterial damage
coldness and loss of pulse to the limb, can be as a
result of thrombosis forming in the cannula
complications , cont
Arterial spasm
Accidental Intra-Arterial Injection of Drugs
Thrombosis
Embolism
Skin necrosis
Abscess Inflammation
Contr aindications
Deficiencies in collateral circulation( in radial site)
Raynaud’s phenomenon .
Infection and traumatic injury proximal to the proposed
insertion site.
Burn over the intended insertion site.
Coagulopathy
NURSING INTERVENTIONS:
PATIENT ASSESSMENT
Obtain the patient’s medical history
Diseases
Patient’s allergy history
Patient’s current anticoagulation therapy
NURSING INTERVENTIONS:
Procedure
Prepare full Equipment, Maintain sterile procedure
Never inject anything into an arterial line
Ensure that the insertion site is visible at all times
If not sutured, you may need two nurses when
cleaning to prevent it being dislodged
When cleaning observe for any signs of infection
The transducer set must be changed every three
days. When changing ensure once again that the set
is fully primed
Cont.,
Monitor color& temperature of limb distal to arterial
line
On removal of arterial cannula maintain pressure
over puncture site for at least 5 minutes until
bleeding has stopped
Maintain the pressure within the Heparin pressure
bag at 300mmHg to ensure constant patency of the
line
Do not apply blood pressure cuffs to that arm
If a line does not flush, do not force the flush
Never inject anything into an
arterial cannula or arterial line
–Concentration of a drug into
the tissues served by the
cannulated artery can result in
cell death
–Skin necrosis, severe gangrene,
limb ischemia, amputation &
permanent disabilities
How to draw blood samples from
a-lines
some stopcocks point to where they’re open, and some
point to where they’re closed – it just takes some time to
learn which is which.
The trick is remembering which way to turn the stopcock,
and avoiding a mess.
Draw the required blood sample
Don’t forget to clear the stopcock, recap, and then flush
the line.
Keep things nice and sterile.
REMOVAL OF AN ARTERIAL LINE!
Use of an aseptic technique
Once dressing is withdrawn, cut the suture if in place and
withdraw slowly from the patient
Apply direct pressure with sterile gauze for approx. five
minutes
Dress Site With Gauze and MicroPore
ASSESS The Peripheral Circulation as thrombosis can
occur after Removal
