From the Guidelines
ICU nurses should use ultrasound guidance when inserting arterial lines, especially in cases of multiple failed attempts or when the arterial pulse is not palpable, as it is considered a basic skill and improves safety and effectiveness 1.
Key Recommendations for Arterial Line Insertion
- The use of ultrasound guidance for arterial cannulation is strongly recommended, particularly in situations where anatomical evaluation is challenging or when the arterial pulse is not palpable 1.
- ICU nurses should be trained in ultrasound guidance skills, including continuous visualization of the needle tip during its trajectory, to avoid penetration of the posterior wall of the vessel 1.
- The procedure for inserting arterial lines involves preparing sterile equipment, identifying the appropriate artery using ultrasound, administering local anesthesia, inserting the catheter using either direct puncture or Seldinger technique, securing the line, and confirming placement with waveform analysis.
- Nurses must also be trained to recognize and manage potential complications such as bleeding, thrombosis, infection, or vascular compromise.
Important Considerations
- Relative contraindications for arterial access include severe peripheral vascular disease, coagulopathy, and local synthetic grafts 1.
- Ultrasound can be used to assess vessel patency and size, and is recommended for radial arterial cannulation as it increases the success rate on the first attempt 1.
- The use of saline heparin as the only safe solution to flush catheters is recommended to prevent severe hypoglycaemia from misdirected administration of insulin 1.
Training and Competency
- ICU nurses must complete specialized training that includes anatomy review, procedural techniques, ultrasound guidance skills, and supervised practice insertions to demonstrate competency in inserting arterial lines.
- Hospitals have different policies regarding nurse-inserted art lines, with some requiring additional credentialing beyond basic ICU certification.
- The training typically requires demonstration of competency through a minimum number of successful insertions under supervision before independent practice is permitted.
From the Research
Guidelines for Inserting Arterial Lines
The guidelines for Intensive Care Unit (ICU) nurses when inserting arterial lines (art lines) include:
- Using ultrasound guidance to increase the likelihood of successful cannulation and decrease complications 2, 3
- Following proper antiseptic techniques, such as using sterile gloves, a surgical cap, a surgical mask, and a small sterile drape 4
- Selecting the appropriate site for insertion, with the radial artery being a common site 5, 2
- Ensuring proper securement and maintenance of the arterial line to prevent complications 6
Key Considerations
When inserting arterial lines, ICU nurses should consider the following:
- The patient's condition, including hypotension, peripheral edema, and obesity, which can increase the difficulty of cannulation 2, 3
- The use of limited barrier precautions during arterial catheter insertion, as recommended by the Centers for Disease Control and Prevention 4
- The importance of proper training and competency in inserting arterial lines, as demonstrated by the success of a radial artery cannulation training program for ICU nurses 5
Best Practices
Best practices for inserting arterial lines include:
- Using ultrasound guidance to facilitate successful cannulation 2, 3
- Following proper infection prevention practices, including the use of antiseptic techniques and barrier precautions 4
- Ensuring proper securement and maintenance of the arterial line to prevent complications 6
- Continuously monitoring the patient's condition and the arterial line to quickly identify and address any issues that may arise 5, 2