What are the steps for arterial line placement?

From the Guidelines

Arterial line placement should be performed using a POCUS-guided technique.

Steps for Arterial Line Placement

• Use ultrasound guidance to visualize the artery and surrounding structures 1
• Choose the appropriate location for arterial line placement, such as the radial or femoral artery
• Use a sterile technique and local anesthesia as needed
• Insert the needle under ultrasound guidance, using an in-plane approach to visualize the needle and artery in real-time 1
• Once the artery is cannulated, advance the catheter and secure it in place
• Verify the placement of the arterial line using ultrasound and check for any complications, such as hematoma or arterial spasm 1

Benefits of POCUS-Guided Technique

• Higher success rates on first attempt
• Decreased risk of cannulation failure and arterial puncture
• Decreased incidence of complications, such as hematoma or nerve injury
• Faster placement times and reduced number of attempts 1

From the Research

Arterial Line Placement Steps

The steps for arterial line placement are not explicitly outlined in a single study, but various techniques and methods are discussed in the provided evidence.

• The use of ultrasound guidance is recommended for improving success rates and reducing complications 2, 3.
• The Seldinger technique, which involves using a catheter with a separate guide wire, is also recommended for arterial line insertion 4.
• The choice of catheter type, such as polyurethane or Teflon, can affect the likelihood of catheter blockage and the need for re-insertion 4.
• The use of a respiratory therapist-based line placement service can standardize and improve the placement of arterial lines 5.
• Landmark-guided palpation is an alternative method, but it has been shown to have lower success rates compared to ultrasound guidance 3.

Techniques and Methods

Different techniques and methods are compared in the studies, including:

• Ultrasound-guided approach vs. traditional approach 2
• Ultrasound guidance vs. landmark-guided palpation 3
• Direct-puncture technique vs. Seldinger technique vs. modified Seldinger technique 4
• Use of different catheter types, such as polyurethane and Teflon 4

Success Rates and Complications

The success rates and complications associated with arterial line placement are reported in the studies, including:

• First-attempt and overall success rates for ultrasound-guided and traditional approaches 2
• Success rates for novice emergency medicine interns using ultrasound guidance vs. landmark-guided palpation 3
• Complication rates for different techniques and methods 3, 4