DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
PERIPHERAL ARTERIAL LINES
Indications
-
Frequent monitoring of blood gases
-
Direct monitoring of arterial blood pressure
-
Exchange transfusion (peripheral venous and arterial catheters ‛continuous’ technique) or partial exchange transfusion
Contraindications
- Bleeding disorder
- Inadequate patency of ulnar artery on transillumination or failed Allen’s test (if cannulating radial artery) or vice-versa
- Pre-existing evidence of circulatory insufficiency in limb
- Local skin infection
- Malformation of limb being considered for line insertion
Possible sites of arterial entry
- Radial (most used); the only procedure discussed in this guideline
- Posterior tibial
- Dorsalis pedis
EQUIPMENT
- Gloves
- Cleaning solution as per unit policy
- 24 G cannula
- T-connector with Luer lock
- Adhesive tape
- Splint
- Sodium chloride 0.9% flush in 2 mL syringe, primed through T-connector
- Transillumination fibre-optic light source
- 3-way tap
PROCEDURE USING RADIAL ARTERY
Preparation
- Wash hands
- Check patency of ipsilateral ulnar artery using Allen’s test and proceed only if patent
- Put on gloves
- Extend baby’s wrist with palm of hand upwards
- Transilluminate radial artery with fibre-optic light source behind baby’s wrist or palpate pulse
- Clean skin with antiseptic cleaning solution
Procedure
- Enter artery with 24 G cannula just proximal to wrist crease at 25–30° angle
- Remove stylet from cannula and advance cannula into artery
- Connect cannula to T-connector primed with sodium chloride 0.9%, and flush gently
- Secure cannula with tape, ensuring fingers are visible for frequent inspection, and apply splint
- Connect T-connector to infusion line (sodium chloride 0.9% or 0.45% with heparin 1 unit/mL), with 3-way tap in situ for blood sampling
Documentation
- Document clearly in notes all attempts at cannulation, including those that are unsuccessful
AFTERCARE
Monitor
- Inspect distal digits regularly for circulatory status; if blanching does not recover after 5 min, discuss further management with consultant
- Avoid excessive hyperextension of wrist, as this can result in occlusion of artery
- Ensure a continuous pressure waveform tracing is displayed on monitor screen at all times; if flushing line does not restore lost tracing, change position of limb/dressing
Usage
- Do not administer rapid boluses of fluid as this can lead to retrograde embolisation of clot or air; use minimal volume when flushing after sampling and inject slowly
- Use cannula only for sampling or removal of blood during exchange transfusion, and infuse sodium chloride 0.9% or 0.45% with heparin 1 unit/mL
- Remove cannula as soon as no longer required
Removal
- Aseptic removal of arterial line: apply pressure for ≥5 min (longer if coagulopathy/low platelets), until no bleeding
- dressings do not prevent bleeding or bruising
- do not send tip for culture routinely
COMPLICATIONS
-
Thromboembolism/vasospasm/thrombosis
-
Blanching and partial loss of digits (radial artery)
-
Necrosis
-
Skin ulceration
-
Reversible occlusion of artery
-
Extravasation of sodium chloride infusate
-
Infection (rarely associated with line infection)
-
Haematoma
-
Haemorrhage
-
Air embolism