Ultrasound-Guided Radial Arterial Line

Ultrasound for Radial Arterial Line?


Do I really need to use an ultrasound for radial arterial lines?  For years I have used ultrasound guidance for brachial and femoral arterial line placement because the risk associated with puncturing or lacerating a large end artery are great.  However, it has always seemed like such a chore to find the ultrasound, position the machine in the room, apply the sterile sheath etc. all for a little radial arterial line.  And I have always had success with radial arterial lines.  Then I had a few misses:  couldn’t get a flash, got a flash but couldn’t thread, threaded but no blood return.  So after I reviewed a few articles including a metaanalysis that showed improved first attempt success rates using ultrasound, I decided to give it a try.   I now use the ultrasound every time I place a radial arterial line.  I use a longitudinal approach in which I visualize the needle, then the guide wire then the catheter as they puncture and cannulate the vessel.  I have yet to fail using this technique, and learned a few things as well.  For example, did you know that you can puncture the radial artery and not get a flash?  On several occasions I have watched the needle into the vessels, seen no blood in the flash chamber, successfully threaded the catheter and obtained pulsatile blood with an arterial waveform.  I wonder how many times I punctured (or lacerated) the radial artery using a blind technique but did not attempt to thread the catheter because did not obtain a flash.  Ultrasound adds a small amount of preparation time to radial arterial line insertion.  When considering the increased success rate and safety, this is time well spent.

Ultrasound-guided arterial line catheterization in the critically il:  technique and review.  J Vasc Access.  2010 Apr-Jun;11(2):106-11.

A prospective comparison of ultrasound-guided and blindly placed radial arterial catheters.  Acad Emerg Med.  2006 Dec;13(12):1275-9.

Read all articles in Arterial line, medical procedures
Tags: Arterial lines, HPC updates, ultrasound-guided arterial lines, ultrasound-guided procedures

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