Arterial catheters: indications, insertion and use in critical care

This article provides an overview of arterial catheters and their use within critical care. The indications for arterial catheterization are presented and the insertion techniques are discussed. The nursing care of patients with an arterial catheter is explained, with a focus on safety, haemodynamic monitoring and arterial blood sampling. The procedure for removal of an arterial catheter is described in a step-by-step guide. Post-procedure care and complications are also discussed and evidence-based strategies for the prevention of complications are suggested.     

Central line insertion bundle: experiences and challenges in an adult ICU

Background: Central venous catheters are used frequently in the intensive care unit (ICU). However, there is an associated morbidity, mortality and cost derived from their infectious and mechanical complications. The Scottish Patient Safety Programme (SPSP) has developed a multi faceted care bundle, with the aim of reducing catheter-related blood stream infections. Aim: This paper aims to identify and describe the experience and challenges in implementing the SPSP central line insertion bundle in one adult ICU, in a large inner city teaching hospital. Interventions:'Plan-Do-Study-Act' cycles, checklists for insertion and a standardized trolley were adopted to implement the central line insertion bundle in clinical practice. Conclusion/Implications: Improving the reliability of the central line insertion bundle has reduced infections. Key steps in the process were setting clear aims and ensuring staff understand the change process and measurement of results. This is fundamental to the success of any quality improvement process.     

Inadvertent transpericardial insertion of a central venous line with cardiac tamponade failure of preventive practices

A 56-year-old man who had undergone cardiac surgery suffered from cardiac tamponade after administration of contrast-medium through a central venous catheter. Pericardiotomy showed the catheter transversing the pericardial sac just beneath an unusual high reflection and then reentering the superior vena cava. Preventive practices including chest radiography, confirming free venous blood return and manometry may fail to detect catheter malposition in rare cases. Knowledge of potential pitfalls in using generally recommended safety practices and continuous vigilance are essential for the anesthesiologist and intensivist in avoiding potentially lethal hazards. Received: 6 December 1999 Final revision received: 11 April 2000 Accepted: 26 April 2000     

Arterial line in prehospital emergency settings - A feasibility study in four physician-staffed emergency medical systems

Background and aim of the study

Arterial lines are widely used in operating rooms, critical care and emergency departments. Although invasive arterial blood pressure monitoring and arterial blood gas analysis are prehospitally available, the use of arterial lines in the field remains an exception. This study evaluates the feasibility, indications and therapeutic consequences of prehospital arterial line insertion.

Methods

Prospective observational study in four physician-staffed emergency medical systems (EMS), documenting patient status, indications, location of puncture, number of tries and time for puncture and therapeutic consequences.

Results

During the one-year observation period, arterial line placement succeeded in 115 (83.9%) of 137 patients. The median time for successful arterial cannulation was 2 min (IQR 1, 3 min; range: 30-600 s), for preparing the invasive blood pressure monitoring 3 min (IQR 2, 4 min, range: 30-600 s). Main indications were cardiopulmonary resuscitation (36.5%), post-resuscitation care (16.8%), respiratory insufficiency (24.1%) and unconsciousness (22.6%). Therapeutic consequences depended on whether the EMS was equipped with a blood gas analyzer or not and were, overall, reported in 51.3% of patients: fluids, vasoactive or antihypertensive therapy, correction of ventilation or acidosis. No complications occurred during the prehospital phase.

Conclusion

The insertion of arterial lines is feasible under prehospital conditions, without delaying or complicating patient care. Indications originating from intrahospital use are also valid in the field. In particular when combined with arterial blood gas measurement, the use of arterial lines often leads to important therapeutic consequences.     

Arterial line for monitoring SpO<Subscript>2</Subscript> in patients with ischemic peripheries

Monitoring the oxygenation status of patients with poor peripheral perfusion or ischemic peripheries is challenging in view of unreliable or unrecordable pulse oximeter data. In this article we describe a very simple and innovative technique of using the arterial line for reliable recording of arterial oxygen saturation (SpO₂) in such patients. We conclude that the arterial line can be used as an extension of the artery and SpO₂ may be reliably measured using the arterial line in such patients as long as the blood in the arterial tubing is pulsatile and a good contact is ensured between the arterial tubing and the sensor of the pulse oximeter.     

Arterial fibromuscular dysplasia

Fibromuscular dysplasia is a nonatherosclerotic, noninflammatory vascular disease that involves primarily the renal and internal carotid arteries and less often the vertebral, iliac, subclavian, and visceral arteries. Although its pathogenesis is not completely understood, humoral, mechanical, and genetic factors as well as mural ischemia may play a role. The natural history is relatively benign, with progression occurring in only a minority of the patients. Typical clinical manifestations are renovascular hypertension, stroke, subarachnoid hemorrhage, abdominal angina, or claudication of the legs or arms. In patients with symptoms, percutaneous transluminal angioplasty has emerged as the treatment of choice in most involved vascular beds.     

Arterial blood gases

Blood gas determination provides physicians with detailed information regarding cardiopulmonary and metabolic homeostasis in the emergency patient. When integrated with the history and physical examination, the rapidly available arterial blood gas (ABG) analysis is useful in the resuscitation of the acutely ill or injured patient. This article discusses the physiology, analysis, and interpretation of ABG.     

Pulmonary Arterial Hypertension

Better recognition of primary pulmonary hypertension can produce better treatment by comprehensive therapists.     

Arterial catheterization.

Arterial catheterization is used frequently in the management of critically ill patients, both for continuous blood pressure monitoring and access to the arterial circulation to obtain frequent blood gas measurements. The procedure is usually easily accomplished at the bedside using percutaneous methods such as the Seldinger technique to cannulate the radial, brachial, axillary, femoral, or dorsalis pedis artery. Meticulous attention to aseptic technique is necessary during insertion and catheter maintenance to minimize the risk of catheter-related infection. Other potential complications include hemorrhage, ischemia, arteriovenous fistula, and pseudoaneurysm formation.