Overview
What is arterial line placement?
When is arterial line placement indicated?
What are the contraindications for arterial line placement?
What anatomy is relevant to perform arterial line placement?
What are best practices when performing an arterial line placement?
Periprocedural Care
What equipment is needed to perform an arterial line placement?
What equipment is needed to perform a radial arterial line placement?
What equipment is needed to perform a femoral arterial line placement?
What is included in patient preparation for arterial line placement?
How is anesthesia administered for arterial line placement?
How is the patient positioned for arterial line placement?
How is a sterile field created for arterial line placement?
Technique
What is the role of ultrasonography during arterial line placement?
How is the choice of arterial line placement method determined?
What is the role of the Allen test prior to arterial line placement?
How is the catheter-over-needle technique for arterial line placement performed?
What is the catheter-over-wire technique for arterial line placement?
What is the Seldinger technique for arterial line placement performed?
How is the modified Seldinger technique for arterial line placement performed?
What are the possible complications of arterial line placement?
Medications
What is the role of medications in the treatment of arterial line placement?
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Anatomy of radial artery.
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Anatomy of femoral triangle.
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Wrist position for radial artery line placement.
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Modified Allen test. Return of perfusion to hand after release of compression of ulnar artery.
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Radial artery cannulation. Positioning of hand.
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Radial artery cannulation. Palpation of radial artery.
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Radial artery cannulation (catheter over needle). Catheter introduction through skin.
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Radial artery cannulation (catheter over needle). Puncture of radial artery.
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Radial artery cannulation (catheter over needle). Catheter advanced into radial artery.
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Radial artery cannulation (catheter over needle). Arterial line tubing attached to radial artery catheter.
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Radial artery cannulation (Seldinger). Catheter-over-wire arterial line kit.
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Radial artery cannulation (Seldinger). Palpation of radial artery.
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Radial artery cannulation (Seldinger). Puncture of skin with finder needle.
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Radial artery cannulation (Seldinger). Puncture of radial artery with return of blood.
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Radial artery cannulation (Seldinger). Introduction of guide wire into radial artery.
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Radial artery cannulation (Seldinger). Skin incision over needle.
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Radial artery cannulation (Seldinger). Advancement of catheter over guide wire.
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Radial artery cannulation (Seldinger). Attachment of arterial line tubing to catheter.
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Femoral artery cannulation (modified Seldinger). Catheter-over-wire arterial line kit.
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Radial artery cannulation (modified Seldinger). Catheter and wire assembled.
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Radial artery cannulation (modified Seldinger). Wire advancement through catheter.
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Allen test. Examiner occludes both radial and ulnar arteries while patient makes fist.
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Allen test. Radial and ulnar arteries remain occluded after hand is opened.
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Allen test. Pressure on ulnar artery is released, and time to observed return of color to hand is measured.
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Radial artery cannulation (modified Seldinger). Radial artery catheter kit.
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Radial artery cannulation (modified Seldinger). Radial artery catheter.
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Positioning of wrist for radial artery cannulation.
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Radial artery cannulation (modified Seldinger). Radial artery prepared and draped in sterile fashion.
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Radial artery cannulation (modified Seldinger). Introduction of radial artery catheter.
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Radial artery cannulation (modified Seldinger). Angle of introduction of radial artery catheter.
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Radial artery cannulation (modified Seldinger). Flashback of blood into radial artery catheter hub.
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Radial artery cannulation (modified Seldinger). Radial artery catheter entering artery.
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Radial artery cannulation (modified Seldinger). Advancement of guide wire into radial artery.
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Radial artery cannulation (modified Seldinger). Advancement of guide wire into radial artery.
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Radial artery cannulation (modified Seldinger). Stabilization of catheter while introducer is removed.
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Radial artery cannulation (modified Seldinger). Stabilization of catheter while introducer is removed.
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Radial artery cannulation (modified Seldinger). Pressure transducer attached to radial artery catheter.
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Radial artery cannulation (modified Seldinger). Radial artery cannula sutured in place.
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Radial artery cannulation (modified Seldinger). Sterile dressing applied over radial artery cannula.
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Radial artery cannulation (modified Seldinger). Inline 3-way stopcocks attached for blood sampling.
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Angiocatheter used for radial artery cannulation in infants and small children.
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Radial artery cannulation (catheter over needle). Introduction of angiocatheter into radial artery.
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Radial artery cannulation (catheter over needle). Flashback of blood into angiocatheter hub.
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Radial artery cannulation (catheter over needle). Needle entering radial artery with bevel facing up.
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Radial artery cannulation (catheter over needle). Stabilization of catheter while needle introducer is removed.
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Radial artery cannulation (catheter over needle). Pressure transducer attached to radial artery catheter.
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Radial artery cannulation (catheter over needle). Radial artery catheter secured in place with Steri-Strips.
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Radial artery cannulation (catheter over needle). Sterile dressing applied over radial artery cannula.
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Femoral artery cannulation (catheter over needle). Insertion of 20-gauge 1.75-in. catheter over needle into femoral artery. Note 45° insertion angle.
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Femoral artery cannulation (catheter over needle). Removal of needle after artery has been cannulated and catheter has been inserted into lumen of artery.
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Femoral artery cannulation (combination technique). Insertion of guide wire through catheter into femoral artery lumen.
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Femoral artery cannulation (combination technique). Final placement of 20-gauge 5-in. catheter into femoral artery (note yellow plastic spring wire insertion adapter).
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Femoral artery cannulation (Seldinger). Puncture of femoral artery with 18-gauge 3-in. hollow introducer needle. Note 45° insertion angle.
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Femoral artery cannulation (Seldinger). Guide wire being inserted into femoral artery lumen.
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Femoral artery cannulation (Seldinger). 2-mm incision is made next to guide wire with No. 11 scalpel blade.
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Femoral artery cannulation (Seldinger). Insertion of 20-gauge 5-in. catheter over guide wire into femoral artery.
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Equipment setup for ultrasound-guided radial arterial line placement.
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Ultrasound probe with sterile sheath.
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External view of ultrasound-guided short-axis view.
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Identification of radial artery in short-axis view. Yellow circle surrounds radial artery.
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Identification of radial artery with color Doppler ultrasonography.
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External view of ultrasound-guided long-axis view.
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Identification of radial artery with long-axis view. Yellow arrows highlight radial artery.
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Short-axis view of needle entering soft tissue and targeting radial artery. Red arrow identifies radiopaque needle near radial artery.
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Long-axis view of needle entering soft tissue and targeting radial artery. Yellow arrows highlight radial artery. Red stars identify radiopaque needle near radial artery.
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Needle within radial artery in short-axis view. Red arrow identifies radiopaque needle within lumen of radial artery.
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Long-axis view of needle within lumen of radial artery. Yellow arrows highlight radial artery. Red stars identify radiopaque needle within lumen of radial artery.