Radial Arterial Cannulation

imagesDirect arterial blood sampling


imagesContinuous arterial blood pressure monitoring


CONTRAINDICATIONS



imagesAbsolute: None


imagesRelative Contraindications


   imagesCoagulopathy or recent thrombolysis


   imagesOverlying infection, burn, or skin damage


   imagesSevere peripheral atherosclerosis


RISKS/CONSENT ISSUES



imagesThrombosis and occlusion of the vessel are common (30%–40%) but almost all resolve spontaneously without requiring intervention, and ischemic complications are rare/case-reportable


imagesRisk of bleeding and infection are low



imagesGeneral Basic Steps


   imagesPosition patient


   imagesLocate radial artery


   imagesAnesthetize


   imagesPerform procedure


LANDMARKS



imagesRadial artery cannulation site is just medial and proximal to the radial styloid on the volar surface of the wrist


TECHNIQUE



imagesPosition the patient’s supinated wrist in 60 degree of extension. Placement of a gauze or towel under the dorsal surface of the wrist and taping the wrist in extension may facilitate positioning.


imagesPrepare and drape the area in a sterile manner


imagesAnesthetize the skin over the radial artery with a small wheal of 1% lidocaine


imagesOpen the packaging and remove unit. Remove the protective shield. To ensure proper feeding, advance and retract the spring-wire guide through the needle via the lever. Then retract the wire proximally as far as possible before using.


imagesPalpate the course of the artery with the middle and index fingers of the nondominant hand. Hold the needle at a 45-degree angle to the skin, pointing cephalad, and puncture the skin. Advance the needle until a flash of bright red blood is seen in the clear hub of the needle.


imagesDecrease the angle of the needle to 20 degrees and advance the guidewire (via actuating lever) into the artery. Do not force the wire if resistance is encountered.


imagesHold the clear transducer needle and advance the catheter forward into the vessel. A rotating motion can be applied to the catheter if resistance is encountered (FIGURES. 27.1 and 27.2).


imagesHolding the catheter in place, remove the introducer needle, guidewire, and feed tube assembly. Pulsatile flow indicates successful cannulation.


imagesAttach a stopcock and injection tubing to the catheter hub. Suture into place. Apply dressing.



images

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Radial Arterial Cannulation

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