Arterial line
Ahmed Zinhom
Lecturer at ZMK training center
PHD in nursing administration
AHA BLS instructor
Indications
A- Continuous monitoring of arterial blood pressure
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Indications
B- Allows direct access for blood draws for ABG’s
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Arterial Line Sites
❑ Radial artery :
➢ Is the first choice.
➢ Ease of placement.
➢ Relative accuracy.
➢ Presence of collateral flow.
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Arterial Line Sites
❑ Femoral
➢ Easier but anatomy not consistent, poorer access
➢ Use the femoral artery in the of cardiopulmonary
arrest or altered perfusion to the upper extremities
❑ Brachial( forbidden)
➢ Less access, sole supply for forearm and hand
➢ It was the last choice, except in the presence of poor pulsation caused by shock,
obesity, or a sclerotic vessel (because of previous cardiac catheterization).
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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
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Transducer - A couple of things to
remember
➢ The transducer has to be leveled correctly-to make sure that it’s at the 4th
intercostal space, at the mid- axillary line (Phlebostatic axis)
➢ Zero the line to atmospheric pressure properly
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Waveforms Produced by Arterial
pressures
➢ Normal waveform on monitor will have sharp
upstroke, dicrotic notch & clear end diastole.
➢ Abnormal Waveforms
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Dampened: wide, flattened tracing
❖ Dampened trace
❑ Dampening occurs due to:
➢ low flush bag pressure or no fluid in the flush bag
➢ Severe hypotension if everything else is ruled out
➢ air bubbles
➢ catheter kinks
➢ clots
➢ Improper scaling
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Resonant: ‘spiked’ tracing
➢ Resonance occurs due to:
✓ long tubing
✓ non-fully opened stopcock valve
➢ This type of trace
➢ Over estimate SBP, under estimate DBP
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Complications
➢ Infection.
➢ Hemorrhage.
➢ Ischemia.
➢ Arterial spasm.
➢ arterial damage.
➢ coldness and loss of pulse to the limb, can be as
a result of thrombosis forming in the cannula.
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Complications
➢ Accidental Intra-Arterial Injection of Drugs.
➢ Thrombosis.
➢ Embolism.
➢ Skin necrosis.
➢ Abscess Inflammation.
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Contraindications
➢ Deficiencies in collateral circulation (radial site)
➢ Infection and traumatic injury proximal to the
proposed insertion site.
➢ Burn over the intended insertion site.
➢ Coagulopathy
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Nursing Interventions
❑ PATIENT ASSESSMENT
➢ Obtain the patient’s medical history.
➢ Diseases.
➢ Patient’s allergy history.
➢ Patient’s current anticoagulation therapy.
➢ Peripheral circulation.
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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 2 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.
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Nursing Interventions
➢ 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 150 mmHg for
pediatric, and 300 mmhg for adult 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.
➢ Hep saline: 500-1000 IU/ 500 ML Ns.
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Never inject anything into an 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.
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Removal Of An Arterial Line!
➢ Use of an aseptic technique.
➢ Once dressing is withdrawn, cut the suture if in place & withdraw slowly from Pt.
➢ Apply direct pressure with sterile gauze for approximately five minutes.
➢ Dress Site With Gauze and Micro Pore.
➢ Assess The Peripheral Circulation as thrombosis can occur after Removal.
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Interview and exams questions
Thank You
