1. Arterial Line

2. Outline Definition. Indication Contraindication. EQUIPMENT Arterial Sites Nursing Skills Standard

3. Arterial Line An intra-arterial catheter (A-Line) is a very small plastic tube (called catheter) placed in one of blood vessels (an artery) by highly trained personnel. This is usually done during or before certain types of surgery or in the intensive care unite

4. INDICATIONS Continuous blood pressure measurement is necessary because of homodynamic instability. For the safety of certain anesthetic techniques, such as hypotension, cardiopulmonary bypass, or major vascular surgery involving arterial clamping. Continuous blood pressure measurement is necessary for monitoring administration of vasoactive drugs. Frequent blood gas measurements are needed. Noninvasive blood pressure monitoring is difficult or impossible, such as in patients who are severely obese, have burned extremities, or are in shock.

5. CONTRAINDICATIONS Absolute contraindications  Infection at the site of insertion  Traumatic injury proximal to the site of insertion. Relative contraindications; may be outweighed by other considerations  Presence of arteriovenous (AV) shunt in the limb of insertion.  History of surgery disrupting lymphatics of the upper extremity, such as a mastectomy with lymph node dissection  Arterial insufficiency in the distribution of the artery to be cannulated

6. EQUIPMENT Sterile prep solution, preferably chlorhexidine 1% lidocaine solution if patient is awake 2o to 22-gauge angiographic catheter and needle Arm board Sterile dressing Tape Transduction system for monitoring

8. Arterial Sites The Radial artery. The Brachial artery. The Axillary artery. The Femoral artery. The Dorsalis pedis.

10. Nursing Skills Standard Setting up the circuit The nurse is responsible for the: Priming the line. Zeroing the transducer. Monitoring haemodynamic and wave form.

11. Maintain accuracy Transducers should be zeroed for each set up, and leveled at the med- Axillary's line. Transducer level should be validated each shift and with change position …prior even to C.V.P or PWP. Documentation is required.

12. Monitoring Blood Pressure Continuous blood pressure, every 1 hr. for patients receiving fluids and medication affects the homodynamic status. Evaluate the pressure wave form prior to recording the homodynamic. Comparing the NIBP with ABP. Should be from the same limb.

13. Maintain Arterial line Alarms. Appropriate alarm must be on for all the time … continous measuring. High and low alarms should be confirmed each shift. Document any change in alarm settings.

14. Maintain closed system  All stop cocks must have dead end or caps.  All the line enteries should kept closed if not used.  Clearly label the arterial line to prevent misidentification of the line as venous, with subsequent unintentional injection of drugs or other therapeutic substances into a peripheral artery.

15. Obtain Blood Sample Clinical nurse may drew sample. Flush the line with heparin saline. When drawing sample for culture. Follow aseptic technique.

16. Change Dressing Arterila kine dressing shoud be changed every 2 days. Use minimal dressing material. Use transparent dressing.

17. Monitor the Arterial Site. Observe,Bleeding, Hematoma. Observe Local infection, Damage to surrounding tissues Clearly label the arterial line to prevent misidentification of the line as venous, with subsequent unintentional injection of drugs or other therapeutic substances into a peripheral artery.

18. Accurate Documentation. Incidence report filling.

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