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Arterial Line Insertion
Purpose: To monitor arterial blood pressure and to obtain arterial blood samples for laboratory analysis.
Supplies: 1% xylocaine (lidocaine) ( 1 ) 1cc syringe, 19g and 25g needle (1 needle for drawing up the xylocaine from the vial; 1 small needle for injection) *Filter needle if glass xylocaine container used 20g jelco, 20g radial arterial catheter, or femoral arterial catheter Specific suture (2-0 silk or 3-0 silk) Cut down tray available if needed All of the items listed above are already present in a pre-packaged femoral or radial arterial line insertion kit OR they can be removed individually from the Line Insertion Cart. Chlorahexadine gluconate swabs (CHG) Gown, mask, goggles as needed Tape, sterile 4X4 gauze, or transparent dressing CHG impregnated sponge (BioPatch) If physician requests, portable ultrasound Spacelabs pressure cardule, dual pressure cable adapter, pressure cable *See Appendix, Picture 1, Page 5 Disposable pressure monitoring tubing with transducer and VAMP 500ml NS Pressure bag IV Pole Transducer pole mount device (clips to IV pole) Laser level (if available) Arm board if necessary
Procedure (Step by Step):
- Explain the procedure to the patient and/or family.
- Gather equipment.
- Perform hand hygiene and don clean gloves.
- Prepare the flush system and transducer according to Transducer Monitoring System Set up Policy. a. Open disposable pressure monitoring tubing with transducer and VAMP kit using aseptic technique. b. Tighten all luer-lock connections on transducer tubing. c. Push the reservoir plunger to the closed and locked position. d. Place the transducer on the pole mount at the level of the Phlebostatic axis i. The transducer is placed properly in the pole mount when the white cable is able to passively point towards the ground.
ii. Phlebostatic axis is the level of right atrium and is defined as the mid- point between the anterior and posterior diameter of the chest, 4th intercostals space. *See Appendix, Picture 2, Page 5 e. Spike the 500ml bag of NS with transducer tubing. f. De-air the bag of NS by turning it upside down and squeezing it until all of the air is removed and the drip chamber is filled half way with fluid. g. Hang the bag of NS on the IV pole. h. Pull the blue snap tab to prime the tubing until fluid comes out of the vented cap on the first stopcock. i. Turn the stopcock off to the vented cap and replace the original vented cap with the blue non-vented cap provided in the kit. *See Appendix, Picture 3, Page 6 j. Pull the blue snap tab to prim the pressure reservoir and the remaining tubing until fluid exits out of the vented cap on the distal end of the tubing. k. Inflate pressure bag to 300mmHG.
- Zero the transducer to the space labs monitor. a. Place spacelabs pressure cardule into the spacelabs monitor. b. Place the dual pressure cable adapter into red opening on spacelabs module (it is labeled P1-2). c. Connect the grey pressure cable into one of the two open spots on the pressure cardule. d. Connect the other end of the grey pressure cable to the white connection on the bottom of the transducer tubing. *See Appendix, Picture 4, Page 6 e. In a moment the spacelabs monitor will automatically display a new parameter on the screen. If it does not default to arterial line, select the newly displayed parameter. Next click on change label. Select arterial line. f. Turn stopcock on transducer off to tubing leading to the patient (stiff tubing). g. Remove cap from stopcock. h. Pull the blue snap tab until a fluid filled bubble is seen on the end of the stopcock. i. Select arterial line on spacelabs monitor. j. Press “Zero” on the spacelabs monitor. k. Place cap back on stopcock and return stopcock to original position (off to non- vented cap).
- Position patient for arterial line insertion. For radial arterial line insertion some physicians prefer to place a rolled up towel under the patient’s wrist to hyperextend their wrist. Depending on physician preference they may prefer to have ultrasound available.
- Physician now will prep the site using chlorahexadine.
- The 2016 INS standards recommend that the physician wears a cap, mask, sterile gloves, eyewear, and uses a large, sterile fenestrated drape when placing an arterial line.
- Lidocaine may be used by the physician prior to arterial line insertion.
- Physician inserts arterial line and ensures arterial blood is obtained. Arterial blood is bright red and pulsing.
- The cap on the distal end of the transducer is removed by the RN when the physician is ready to connect the transducer to the arterial catheter.
- Once transducer is connected to patient, flush the system (by pulling blue snap tab) to remove any blood from the arterial catheter tubing.
Gorski, L., Hadaway, L., Hagle, M. E., McGoldrick, M., Orr, M., & Doellman, D. (2016). Infusion therapy standards of practice. Journal of Infusion Nursing , 39 (1), 1-159.
Lexington Medical Center. (2015, November 18). Arterial catheter, insertion & general care of drawing blood from a closed system, removal of/troubleshooting.
Appendix Picture 1:
Appendix Picture 2:
Dual Pressure Cable Adapter
Pressure Cardule Pressure Cable
