From the Guidelines
A patient might need both a radial arterial line and a central line to the neck when they require continuous blood pressure monitoring and frequent blood sampling alongside reliable venous access for medication administration, particularly in high-risk surgical patients or those with hemodynamic instability, as recommended by recent guidelines 1. This is particularly relevant in emergency laparotomy cases where the use of arterial lines and/or central venous pressure catheters is recommended at an early stage to aid in physiological assessment and to deliver and titrate vasopressors and fluid therapy 1. The radial arterial line provides beat-to-beat blood pressure measurements and allows for arterial blood gas sampling without repeated needle sticks, which is essential for patients with hemodynamic instability or those requiring vasopressors like norepinephrine or vasopressin. Meanwhile, the central line (typically placed in the internal jugular or subclavian vein) offers reliable access for administering medications that would be damaging to peripheral veins, such as vasopressors, chemotherapy, or total parenteral nutrition, and allows for central venous pressure monitoring and rapid infusion of fluids during resuscitation, as supported by guidelines for adult advanced cardiovascular life support 1. Key considerations for the placement of these lines include the patient's individual risk factors, the potential benefits of continuous monitoring and reliable medication administration, and the risks associated with the procedures, such as infection, bleeding, thrombosis, and pneumothorax. In clinical practice, the decision to use both a radial arterial line and a central line should be based on a thorough assessment of the patient's needs and the potential benefits and risks of the procedures, with the goal of optimizing hemodynamic management and improving patient outcomes, as emphasized in recent consensus guidelines for perioperative care 1.
From the Research
Need for Both Radial Arterial Line and Central Line
- A radial arterial line is required for continuous blood pressure monitoring and arterial blood sampling in critically ill patients 2.
- However, radial artery pressure may underestimate central arterial pressure, especially in patients receiving high-dose vasopressor therapy, making central line monitoring necessary 3.
- Central lines, such as those inserted in the neck, provide more accurate blood pressure readings and allow for the administration of certain medications and fluids 4.
- The use of both radial arterial lines and central lines may be necessary in critically ill patients to ensure accurate blood pressure monitoring and to provide a reliable means of administering medications and fluids.
Clinical Scenarios
- In patients with sepsis or shock, the use of both radial arterial lines and central lines may be necessary to ensure accurate blood pressure monitoring and to provide a reliable means of administering vasopressors and other medications 3, 4.
- In patients with traumatic brain injury, the use of both radial arterial lines and central lines may be necessary to ensure accurate blood pressure monitoring and to provide a reliable means of administering medications and fluids 4.
- The decision to use both radial arterial lines and central lines should be based on the individual patient's needs and clinical scenario, taking into account the potential benefits and risks of each type of line 2, 3, 4.
Insertion Techniques and Complications
- The insertion of arterial lines and central lines requires careful consideration of the technique and potential complications, including infection, mechanical complications, and thrombosis 5, 6, 4.
- The use of ultrasound guidance may help to reduce the risk of complications and improve the success rate of arterial line and central line insertion 6.
- The choice of catheter type and material may also affect the risk of complications, with polyurethane catheters potentially being less likely to block or become infected than Teflon catheters 5.