Arterial Cannulation (Internal Medicine)

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  • Continuous real-time blood pressure monitoring
  • Blood pressure monitoring when noninvasive methods have failed
  • Repeated sampling of arterial blood
  • There are no absolute contraindications to arterial catheterization.
  • Coagulopathy and bleeding disorders
  • Compromised distal circulation
  • Skin-cleansing agent
  • Sterile drape and sterile gloves, mask, gown **STERILE TECHNIQUE** **UNIVERSAL PRECAUTIONS**
  • Positioning aids, such as arm board, roll of gauze, and tape
  • 3- to 5-mL syringe, 25- to 30-gauge needle, 1% lidocaine (no epinephrine)
  • Arterial catheter assembly or intravenous catheter without safety device
    • Standard intravenous catheters, either alone or with a guidewire (20 gauge, 3.2-5.1 cm) (not for femoral artery catheterization)
    • Arterial catheterization set (preferred method for larger arteries)
  • Guidewire (optional)
  • Transduction system
  • Needle driver and suture (2-0 silk or 5-0 nylon) or other securing device
  • Antibiotic ointment and sterile dressing
  • The radial artery: volar wrist, medial and proximal to the radial styloid
  • The femoral artery: between the symphysis pubis and anterior superior iliac spine. lateral to the femoral vein, medial to the femoral nerve
  • The brachial artery: in the medial antecubital fossa, lateral to the medial epicondyle, medial to the biceps brachii tendon
  • Dorsalis pedis artery: highly variable; locate with palpation of the pulse; in the midfoot, lateral and parallel to the extensor hallicus longus tendon.

Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Check for vascular compromise distal to the catheter.
  • Compare blood pressure readings to manual readings for accuracy.
  • Keep the arterial catheter visible to avoid undetected accidental disconnection.
  • Routinely check for loose connections, backflow, and deflation of the pressure bag (300 mm Hg).
  • Change the tubing every 48-72 hours, and the catheter every 7-8 days.
  • Transient ischemia is common.
  • Accidental disconnection of the transducer tubing can lead to exsanguination.
  • Hematomas are relatively common (can lead to compression neuropathy).
  • Massive intraperitoneal or retroperitoneal hemorrhage (femoral catheter)
  • Infection is rare: prophylactic antibiotics are not indicated.
  • Injury to adjacent structures leading to pseudoaneurysm and AV fistula
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