From the Guidelines
Registered nurses (RNs) with appropriate training and demonstrated competency can safely insert radial arterial lines in many healthcare settings. This practice requires specialized education, supervised clinical experience, and formal competency validation, as emphasized in the association of anaesthetists of great britain and ireland guidelines 1. Training typically includes anatomy of the radial artery, indications and contraindications, sterile technique, equipment preparation, insertion techniques, troubleshooting, and complication management.
Key Considerations for RNs Inserting Radial Arterial Lines
- RNs should complete both didactic education and hands-on training with a minimum number of supervised successful insertions (often 5-10) before independent practice.
- Complications to monitor include hematoma, arterial spasm, thrombosis, infection, and accidental disconnection.
- Prior to insertion, an assessment of collateral circulation should be considered, although the reliability of Allen's test is disputed 1.
- The procedure requires sterile technique with chlorhexidine skin preparation, local anesthesia (1-2% lidocaine), and proper securement after placement.
- Regular competency assessments and quality monitoring should be implemented to ensure ongoing safe practice, as this approach allows for more timely arterial line placement, particularly in critical care settings where continuous blood pressure monitoring and frequent arterial blood sampling are needed, as highlighted in a recent recommendation 1.
From the Research
Radial Arterial Line Placement by Registered Nurses (RNs)
- The ability of Registered Nurses (RNs) to insert radial arterial lines has been explored in various studies 2, 3.
- A study published in 2011 found that ICU nurses can safely insert radial arterial lines with a success rate of 63% and no reports of adverse events 2.
- Another study published in 2023 found that nurse-led distal radial access is effective, with a technical feasibility of 89% and a low rate of minor complications 3.
- The use of ultrasound guidance has been shown to improve the success rate of radial arterial line placement, with one study finding a first-pass success rate of 75% using ultrasound guidance versus 0% using landmark-guided palpation 4.
Training and Competency
- Studies have shown that proper training and competency are essential for successful radial arterial line placement by RNs 2, 3.
- A study published in 2011 found that 11 out of 21 nurses achieved competency in radial arterial line placement after completing a training program, with a minimum of two successful cannulations 2.
- Another study published in 2023 found that the learning curve for nurse-led distal radial access improved with experience, with a significant reduction in failure rates after the first 50 cases 3.
Safety and Efficacy
- The safety and efficacy of radial arterial line placement by RNs have been demonstrated in several studies 2, 3, 4.
- A study published in 2011 found no reports of adverse events and a success rate of 63% for radial arterial line placement by ICU nurses 2.
- Another study published in 2023 found a low rate of minor complications and a technical feasibility of 89% for nurse-led distal radial access 3.