Today, we talk about arterial lines. I love arterial lines: monitoring, true MAPs, easy blood draw, easy blood gases, fluid status--what's not to love.

This turned into a 2-parter. Part 1 covers radial art lines

Here is Arterial Lines - Part 2

covers everything else below

The (Essentials of EM)Crit Conference

go to EMCritConference.com

use the promo code "emcrit" when you sign up

Part 1 Covers:

Radial Arterial Lines

Peripheral vs. Central Arterial Lines

Sterility

Here is a systematic review of most of the literature

[cite]24413576[/cite]

My take on it is, use sterile gloves, mask, chlorhexidine prep, and if you can grab a fenestrated drape or some OR towels.

Technique

* Kit (The one I use is Arrow RA-04020)

* Ultrasound

* Threading

* How to Save it

* Allen Test

Securing

Tegaderm alone is not enough. I suture, but I really wish we had arterial line stat-locks

I always loop around the thumb and secure with tape outside of the tegaderm--I hate replacing pulled out art lines

Central vs. Peripheral Arterial Pressures

[cite]28523028[/cite]

Part 2 Covers:

Femoral

Sterility-Full Sterile

unless you are going for speed or the Dirty Double

Technique

Use Ultrasound

Find the Common Femoral Artery

 

Use of a central line kit?--No!

Back of wire? Check, but yes!

Axillary

Need Ultrasound

Brachial

Is it safe?

Dorsalis Pedis

https://www.ncbi.nlm.nih.gov/pubmed/28523028

The Arterial Line Set-Up

How to set up an art line pressure transducer

You do not need to wait for crash arterial lines

Heparin Flush

Pimping Ammunition - Where is that Catheter

sent by Intensivist, Mark Dunn

Central vs. Distal Arterial Discrepancies

* Risk Factors Involved in Central-to-Radial Arterial Pressure Gradient During Cardiac Surgery PMID: 26599795

* Pulmcrit with far more on this

Now on to the podcast (and Remember: Here is Part 2)...