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Arterial Lines

Set Up & Monitoring


Union Hospital
Emergency Department

Objectives
Introduction and review of anatomy
Indications for arterial lines
Sites for arterial pressure monitoring
Allens 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!
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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

Allens 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 300mmhg.
Purpose of pressure bag is to provide a
continuous saline flush at 3-6cc/hr that
will overcome the patients systolic
blood pressure.
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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 Contd.


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.
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Arterial Waveform

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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.

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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.

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