"Arterial Line Placement" by James DiNardo, MD, FAAP for OPENPediatrics

Learn about placing arterial pressure monitoring catheters, including indications, contraindications, equipment, and procedural techniques.

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Hi, my name is Jim DiNardo. I am an associate professor of anesthesia at Harvard Medical School and I’m one of the cardiac anesthesiologists and cardiac ICU attendings here at Children's Hospital Boston. We are going to be talking about arterial pressure monitoring today, specifically placement of arterial pressure monitoring catheters.



Indications:

The indications for placing an arterial line include patients who require continuous blood pressure monitoring, such as those who: are hemodynamically unstable, require vasoactive agents or active volume resuscitation, or in whom non-invasive blood pressure monitoring is unreliable or unobtainable. Patients who require significant respiratory support and need frequent lab sampling, including regular arterial blood gases. But these indications must be weighed against the potential risks: infection, trauma to the artery, potential thrombosis, hematoma.



Contraindications:

Some healthcare providers would refrain from performing this procedure in patients with: infection at the insertion site, traumatic injury proximal to the insertion site, inadequate collateral circulation of the extremity indicated by a failed Allen’s test.



Complications:

The complications that you may observe include: infection, trauma to the artery, thrombosis.



Equipment:

You will need the following equipment to perform the procedure: arm board, tape, chlorhexadine prep solution, arterial catheter, guidewire (we must make sure that the guidewire fits through the catheter), T-connector, sterile occlusive dressing, sterile gloves, sterile towels, transducer system, saline flush.

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