a line questions

[izzygoer]

1) do you use the arrow kit with built in guidewire or an angiocath for a lines? does one have a higher success rate than the other? other than the guidewire, the difference i see is that angiocaths are much stiffer than the arrow kit. does this improve success?

2) if a pt has a a crappy arterial pulse but strong femoral pulse, would the standard arrow kit used for radials be long enough for the femoral artery? thanks

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[anes]

1) do you use the arrow kit with built in guidewire or an angiocath for a lines? does one have a higher success rate than the other? other than the guidewire, the difference i see is that angiocaths are much stiffer than the arrow kit. does this improve success?

2) if a pt has a a crappy arterial pulse but strong femoral pulse, would the standard arrow kit used for radials be long enough for the femoral artery? thanks

Angiocaths are less stiff and, in my experience, more prone to kinking. I've used both techniques, but prefer the arrow kit. Success rate for me is about the same between the two.

And no, a radial arrow kit is too short to use femorally. Arrow makes fem kits.

 

[btbam]

I used to work in an adult setting where people only used arrow kits...now I do peds and people only use 20 or 22g angiocaths Once you become proficient with both, I don't think there's much of a difference in success rate. You can always just use a wire with an angiocath and go through the artery and come back.

 

[pjl]

The angiocath needle we use is sharper than the Arrow one.
We use Arrow long wire needles if we use them. Some of my partners will nick the skin first with a different needle when using them, but I personally haven't ever noticed a need for that.

I prefer placing angiocath over Arrow, but if I have difficulty threading catheter I switch to Arrow. I do use a wire sometimes with the angiocath, but not very often.

I dont see much clinical difference in kinking and bad waveforms, although I would agree that the angiocath catheter is less stiff than the arrow kit.

The Femoral A line kit (or the long catheter out of kit) is pretty much always needed for femoral a lines in my opinion. You may be able to get into the artery on skinny people with the other, but basically any movement and it slips out.

 

[narcusprince]

Where I trained we just used the angiocaths and treaded the angiocath over the needle into the vessel. Looked slick when it went perfectly. Oftentimes we would have to grab a guidewire. I prefer the angiocath with a external wire, versus the arrow kits, or the arrowcatheter with wire in place. They did have a mini-arrow aline catheter with a wire but it was shorter then the long arrow wire-in-catheters. Those were slick too.

 

[seinfeld]

I trained in residency exclusively with the Arrow with the self-contained wire. 6 years into practice i would choose the angiocath any day. One thing is that the angiocath is sharper and I have a better success of actually penetrating the artery and therefore the artery doesnt "roll". Also i tend to advance the needle into the artery and it helps cannulate those really calcified vessels.

Are far as kinking the arrow is better and the angiocath kinks more. In the ICU i see the arrow clot more though.

Femoral I always use the long catheter, I always like the big needle. Helps form a better tract for the catheter to glide over

 

[geogil]

How many of you use the 6inch argon or 6 inch arrow? In our cardiac practice many of the attendings prefer the longer a-lines, citing a lower rate of kinking

 

[G0S2]

Lots of cardiac. 20g Jelco angiocath. Get flash and push through. Remove needle. Back Cath out with long Arrow guidewire ready at opening. With first spurt, wire in. Angiocath out and put Arrow arterial cath over wire. I've seen the Arrow needle/caths push the artery around on ultrasound in vasculopaths. Our 20 g jelco ivs are stiffer.

I used to poo poo this method but now use it routinely. No more "can you grab me another arrow?" As I'm trying to prevent the golf ball hematomato from developing.

 

[Ignatius J]

Lots of cardiac. 20g Jelco angiocath. Get flash and push through. Remove needle. Back Cath out with long Arrow guidewire ready at opening. With first spurt, wire in. Angiocath out and put Arrow arterial cath over wire. I've seen the Arrow needle/caths push the artery around on ultrasound in vasculopaths. Our 20 g jelco ivs are stiffer.

I used to poo poo this method but now use it routinely. No more "can you grab me another arrow?" As I'm trying to prevent the golf ball hematomato from developing.

All roads lead to Rome. I have found that the Arrow Kit is the most versatile for me, meaning there are several tricks I can do with if the wire doesn't go. But other people may have the angiocath that works for them. You'll find in your practice what works for you may not work for others and vice versa.

 

[BobBarker]

Agreed. Lots of tricks with the arrow. All really based on feel and "grit" and impossible to explain.

 

[narcusprince]

Here is some advice micro puncture kit for everybody

 

[Vaporized]

At the ICU I am at we have a cook kit that is like micropunture with seldinger technique using a wire from the kit . So far put in 10 with good result. Seems easier than arrow.

 

[HollywdAnesth]

I used to be an angiocath guy, but I got tired of my art lines crapping out in the middle of long cases so I've switched to the Arrow. If you practice it enough, you can use the Arrow and not use the wire

You can use the standard Arrow kit for pediatric femoral art lines, but I wouldn't recommend them for adults.

I second the micropuncture kit. I've been using it for brachial lines on vasculopaths with great success.

 

[Ignatius J]

I used to be an angiocath guy, but I got tired of my art lines crapping out in the middle of long cases so I've switched to the Arrow. If you practice it enough, you can use the Arrow and not use the wire

You can use the standard Arrow kit for pediatric femoral art lines, but I wouldn't recommend them for adults.

I second the micropuncture kit. I've been using it for brachial lines on vasculopaths with great success.

Micropuncture kits are great. Don't use them as first line because they are more expensive but they work awesome.

 

[BLADEMDA]

http://www.researchgate.net/profile...l_patients/links/00b7d52557984cc0cb000000.pdf


http://forums.studentdoctor.net/threads/trouble-w-a-line.554791/