EMCrit Podcast 210 – Arterial Lines (Part 1) - a podcast by Scott D. Weingart, MD FCCM
from 2017-10-16T15:57:33
Today, we talk about arterial lines. I love arterial lines: monitoring, true MAPs, easy blood draw, easy blood gases, fluid status--what's not to love.
This turned into a 2-parter. Part 1 covers radial art lines
Here is Arterial Lines - Part 2
covers everything else below
The (Essentials of EM)Crit Conference
go to EMCritConference.com
use the promo code "emcrit" when you sign up
Part 1 Covers:
Radial Arterial Lines
Peripheral vs. Central Arterial Lines
Sterility
Here is a systematic review of most of the literature
[cite]24413576[/cite]
My take on it is, use sterile gloves, mask, chlorhexidine prep, and if you can grab a fenestrated drape or some OR towels.
Technique
* Kit (The one I use is Arrow RA-04020)
* Ultrasound
* Threading
* How to Save it
* Allen Test
Securing
Tegaderm alone is not enough. I suture, but I really wish we had arterial line stat-locks
I always loop around the thumb and secure with tape outside of the tegaderm--I hate replacing pulled out art lines
Central vs. Peripheral Arterial Pressures
[cite]28523028[/cite]
Part 2 Covers:
Femoral
Sterility-Full Sterile
unless you are going for speed or the Dirty Double
Technique
Use Ultrasound
Find the Common Femoral Artery
Use of a central line kit?--No!
Back of wire? Check, but yes!
Axillary
Need Ultrasound
Brachial
Is it safe?
Dorsalis Pedis
https://www.ncbi.nlm.nih.gov/pubmed/28523028
The Arterial Line Set-Up
How to set up an art line pressure transducer
You do not need to wait for crash arterial lines
Heparin Flush
Pimping Ammunition - Where is that Catheter
sent by Intensivist, Mark Dunn
Central vs. Distal Arterial Discrepancies
* Risk Factors Involved in Central-to-Radial Arterial Pressure Gradient During Cardiac Surgery PMID: 26599795
* Pulmcrit with far more on this
Now on to the podcast (and Remember: Here is Part 2)...
Further episodes of EMCrit Podcast
Further podcasts by Scott D. Weingart, MD FCCM
Website of Scott D. Weingart, MD FCCM