0071643192.pdf

Arterial Catheterization

INDICATIONS

■ Need for frequent monitoring of arterial blood gases

■ Need for continuous BP monitoring or inability to use indirect blood

monitoring.

■ Need for use of vasoactive agents/inotropes

CONTRAINDICATIONS

■ Strict: Inadequate circulation to the extremity, Raynaud syndrome, Buerger

disease, full-thickness burns

■ Relative: Patient on anticoagulants, coagulopathy, overlying cellulitis, par-

tial thickness burns, inadequate collateral flow

TECHNIQUE

■ Standard sterile technique should be used and when possible, local anesthesia.

■ The radial, brachial, femoral, axillary, and ulnar arteries are usual sites for

arterial puncture. Pediatric sites include the dorsalis pedis, temporal arteries,

and umbilical artery in newborns.

■ Allen’s test is performed prior to radial artery cannulation to ensure collat-

eral flow from ulnar artery.

■ Cannulation is usually placed with an over-the-needle catheter with or

without a guidewire. Larger vessels, such as femoral, always use needle

puncture of the artery followed by the catheter placed over a guidewire

(Seldinger technique).

■ The arterial pulsation is palpated with the index and middle fingers and

the vessel course identified. The skin is punctured distal to the palpated

pulse under the index finger. The needle is advanced slowly at a 30°angle

with the skin. For larger arteries, the Seldinger/guidewire technique is

used to cannulate the vessel.

■ Ultrasound or handheld Doppler can be used to assist in cannulation.

COMPLICATIONS

■ Bleeding, thrombosis leading to ischemia, infection

INTERPRETATION OFRESULTS

■ Once in the artery, the syringe plunger for blood gas collection should rise

on its own due to arterial pressure.

■ The arterial wave form has a distinctive dicrotic notch on the down slope,

caused by the closure of the aortic valve.

ABDOMINAL AND GASTROINTESTINAL PROCEDURES

Paracentesis

INDICATIONS

■ Decompressive therapy to relieve the cardiorespiratory and gastrointestinal

manifestations of tense ascites

■ Diagnostic test for patients with new onset ascites or to determine presence

of infection in patients with chronic ascites

PROCEDURES AND SKILLS