Arterial Cannulation

1. Indications
   1. Serial Arterial Blood Gas monitoring
   2. Continuous Blood Pressure Monitoring
2. Technique: Preparation for Arterial Cannulation
   1. Perform Allen Test to confirm collateral circulation
   2. Heparinize syringe
      1. Start with 10 cc Syringe with stopcock
      2. Draw up 3-5 ml of Heparinized saline (50 units/ml)
   3. Obtain IV catheter
      1. Needle of 18 or 20 gauge with plastic cannula
      2. Flush with Heparinized saline
   4. Position patients wrist and hand
      1. Patient dorsiflexes wrist over towel pad
      2. Tape palm and upper Forearm to arm board
   5. Clean radial entry site
      1. Povidone-Iodine solution (betadine) scrub
      2. Alcohol scrub
   6. Local anesthetic at entry site
      1. Small skin wheal (1-2 ml) of Lidocaine 2%
3. Technique: Placing Arterial Line
   1. Identify radial artery with gentle pressure
   2. Needle angled 45 degrees toward arm
   3. Enter skin just distal to palpated artery site
   4. Slowly advance needle until spontaneous blood enters
   5. Guide wire passed into artery
   6. Remove needle
   7. Advance flushed plastic cannula over top of guide wire
      1. Uses modified Seldinger technique
   8. Attach syringe of Heparinized saline
   9. Re-flush cannula with 2 cc Heparinized saline
   10. Turn Stopcock to seal artery
   11. Connect transducer and high-pressure infusion set
   12. Remove pad under wrist and secure arm board
4. Complications
   1. Arterial Thrombosis
      1. Risk increases with decreasing wrist circumference
      2. Risk increases rapidly in first 24 hours, than slowly
   2. Occult bleeding
   3. Cerebral embolization
      1. Occurs with vigorous Flushing of radial catheters
      2. Gentle irrigation with 1-2 ml boluses should be used
   4. Localized infection
      1. Risk increases after 72 hours
      2. Remove catheter at earliest possible time
      3. Provide careful wound and dressing care