Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Urethral catheterization
- Percutaneous suprapubic catheterization
- Vascular access
- Arterial cannulation
- Central line insertion
- Lumbar puncture
- Airway
- Chest drain insertion
- Thoracocentesis
- Pericardiocentesis
- Nasogastric tubes
- Abdominal paracentesis
- Diagnostic peritoneal lavage (DPL)
- Rigid sigmoidoscopy
- Proctoscopy
- Oesophago-gastro-duodenoscopy (OGD)
- Endoscopic retrograde cholangio-pancreatography (ERCP)
- Colonoscopy and flexible sigmoidoscopy
- Local anaesthesia
- Regional nerve blocks
- Sutures
- Bowel anastomoses
- Skin grafts and flaps
- Principles of laparoscopy
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Arterial cannulation
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Urethral catheterization
- Percutaneous suprapubic catheterization
- Vascular access
- Arterial cannulation
- Central line insertion
- Lumbar puncture
- Airway
- Chest drain insertion
- Thoracocentesis
- Pericardiocentesis
- Nasogastric tubes
- Abdominal paracentesis
- Diagnostic peritoneal lavage (DPL)
- Rigid sigmoidoscopy
- Proctoscopy
- Oesophago-gastro-duodenoscopy (OGD)
- Endoscopic retrograde cholangio-pancreatography (ERCP)
- Colonoscopy and flexible sigmoidoscopy
- Local anaesthesia
- Regional nerve blocks
- Sutures
- Bowel anastomoses
- Skin grafts and flaps
- Principles of laparoscopy
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Summary
Indications
▪ Continuous blood pressure monitoring
▪ Arterial blood gas analysis.
Complications
▪ Infection
▪ Thrombosis with distal ischaemia (risk factors are: size of catheter, multiple attempts, duration in situ, ischaemia, and pre-existing hypertension)
▪ False aneurysm.
Equipment
▪ Sterile drape and gloves
▪ Aseptic solution
▪ Local anaesthetic with needle and syringe
▪ Clear dressing
▪ Continuous flushing device
▪ 20 g Teflon cannula (e.g. Abbocath) and 2 ml syringe (plunger removed) or Seldinger arterial kit.
Sites
▪ Radial artery: accessible site, with good collateral flow. 10% have either poor collateral flow or incomplete palmar arch, therefore Allen's test (see Examination of the Vascular System Chapter) is used to confirm ulnar artery blood supply. Position for insertion of arterial line: hyper-extending the wrist with thumb abducted.
▪ Brachial artery: generally avoided, as if occluded, the collateral supply around the elbow may be insufficient.
▪ Axillary artery: generally avoided as difficult and uncomfortable for patient.
▪ Femoral artery: Higher infection risk.
▪ Dorsalis pedis: small calibre vessel, difficult cannulation.
Technique
Three techniques are commonly practiced:
1. Direct cannulation: similar to peripheral intravenous access:
▪ Palpate the artery and its course.
▪ Insert local anaesthetic subcutaneously.
▪ Aseptic precautions.
▪ Attach the 2 ml syringe to the cannula.
▪ Insert as per an intravenous cannula (the 2 ml syringe acts as a reservoir for blood and confirms that the bevel is still within the artery).
▪ Attach to continuous flushing device (see Figure 126).
▪ Apply dressing to secure.
▪ Discard sharps appropriately.
- Type
- Chapter
- Information
- Hospital SurgeryFoundations in Surgical Practice, pp. 604 - 606Publisher: Cambridge University PressPrint publication year: 2009