GH 5036               

 

Oxygenation

Key concepts

Oxygen 

Regional v Global 

Delivery / Consumption 

Licox

 

Key concepts

     Blood pressure

     Arterial blood

     Vasospasm

     Allen test

Introduction  - Indications - Equipment - Set Up - InsertionManagement - Maintenance - Troubleshooting - Complications - Competency - Consent

 

     

 


 

 

Introduction

 

Brain tissue O2 (btpO2)

 

 

 

    Blood pressure

 

Blood pressure results from the energy put into the blood with each contraction of the heart. This energy moves the blood forward (towards the veins and right ventricle) against the resistance of arteries that generate their resistance through the smooth muscles that line their walls.

Immediately after leaving the left ventricle arterial blood is under the pressure that the ventricle (largest and most muscular of the 4-cardiac chambers) generated when it each contracted (heart beat). The arterial pressure reflects the integrity of the physiologic systems that maintain it: cardiac and vascular. 

 

    Vasospasm  

 

Spasm of an artery that results from injury to the vessel.  During insertion of an arterial line probably results from one or both: 1. mechanical contact between the a-line needle and the arterial wall causes smooth muscles to constrict and narrow the vessel sometimes to the point that there is no flow and frequently to the point that a pulse is no longer palpable and further attempts at aterial puncture and cannulation will be futile.

 

 

   Allen test

 

 

Test to make sure it is safe to place a catheter in the radial artery at the wrist.  

 

Technique: Compress the radial artery firmly enough that that there is no flow through it. Hold for several minutes observing for ischemic changes in the hand. 

 

Reason to do test: if inadequate collaterals through ulnar arterial arcade, hand will become dusky and cold.

 

 

   Radial artery anatomy

 

 

The radial artery is located on the same side of the hand as the thumb.

 

 

  Femoral artery anatomy 

 

 

 

(The femoral artery should only be used for placement of an arterial line if cannulation of the radial artery is impossible).

 

Nerve, Artery, Vein...

 

 

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Indications

 

 

Arterial lines are indicated for:

1. Real time, continuous measurement of arterial blood pressure

2. Sampling of arterial blood

 

 

 

 

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Setup

 

 

Doug and Traci: can you give me a list of what is required for an a line:  1.  surgeon attire, 2. position of arm, ...

 

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Insertion

 

 

Doug and Traci: describe insertion of an arterial line.  step-by-step.  We can make this part of your proctoring.

 

 

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Management

Duration:  An arterial line should be left in place no longer than 5 days. 

Replacement: If an arterial line has been in so long (5 days) that it must be replaced, the replacement line should not be placed in the same artery as the original. 

 

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Competency

 

        Post-graduate year (PGY) 2 or higher.

 

 

 

Consent

       

        Required if a next-of-kin available.

 

 

 

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