Art line kit

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PpfSuxTube

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Anyone Use this one?

Short-Dated Arrow FA-04018-SD 18G eaches... - Synergy Surgical™

Short Dated Short-Dated Arrow Arterial Line FA-04018-SD Arrow Artery Catheterization Set 18G eaches
www.synergysurgical.com www.synergysurgical.com

we got stock of them and they seem cool idea until you try pierce the skin. The needle is so long you can't pierce the skin easily for me anyway with one hand holding the apparatus back @ the catheter hub?

anyone any idea or video how to use?
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PpfSuxTube said:
Anyone Use this one?

Short-Dated Arrow FA-04018-SD 18G eaches... - Synergy Surgical™

Short Dated Short-Dated Arrow Arterial Line FA-04018-SD Arrow Artery Catheterization Set 18G eaches
www.synergysurgical.com www.synergysurgical.com

we got stock of them and they seem cool idea until you try pierce the skin. The needle is so long you can't pierce the skin easily for me anyway with one hand holding the apparatus back @ the catheter hub?

anyone any idea or video how to use?
Click to expand...

The Arrow lines are often blunt. You could consider using a sharper angio cath needle for initial skin piercing.
 
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Remember the old arrow kits with a green scalpel for the initial skin nick?
 
We have the Arrow quick flash radial artery catheters. They’re a pos. I’m used to the longer arrows with a line on the plastic tubing to show when the wire is just exiting the catheter. I would just use a long 20 g iv angiocath or micro puncture kit.
 
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IIRC you can take the wire out of that kit and it’s pretty useful. I also used that catheter to transduce some central lines where it was deep and challenging.
 
9 times out of 10 I just use the 20g Arrow with the integrated wire.

The micropuncture kits with the thinner flexible wire are very nice for brachials, or replacing radials that are damped/positional. But they're kind of a pain in that you've got to get sterile gloves, ought to have at least a small sterile field, and you've got to touch the wire directly. They're just inherently slower than the Arrows so I don't use them every time.

chessknt said:
Most of the IR people I know use micropuncture kits for initial arterial access exclusively.
Click to expand...

If I was a cardiologist or interventional radiologist and had a staff of procedure butlers to prep my field and lay out my stuff I'd use them every time too. They're great kits. But sadly for most art lines my real estate is limited to the arm board on an OR table, or six inches of gurney in preop holding. (2" if the patient is huge.) The self-contained nature of the Arrows is convenient.
 
pgg said:
9 times out of 10 I just use the 20g Arrow with the integrated wire.

The micropuncture kits with the thinner flexible wire are very nice for brachials, or replacing radials that are damped/positional. But they're kind of a pain in that you've got to get sterile gloves, ought to have at least a small sterile field, and you've got to touch the wire directly. They're just inherently slower than the Arrows so I don't use them every time.



If I was a cardiologist or interventional radiologist and had a staff of procedure butlers to prep my field and lay out my stuff I'd use them every time too. They're great kits. But sadly for most art lines my real estate is limited to the arm board on an OR table, or six inches of gurney in preop holding. (2" if the patient is huge.) The self-contained nature of the Arrows is convenient.
Click to expand...
This is my approach as well, although our anesthesia technicians are tremendous assistants with procedures and will get us anything we want. Generally the surgeons/proceduralists are invested in our comfort and success, as well. And yet, the Arrow works the vast majority of the time. Someone mentioned how dull they are, and this is true. Using ultrasound, you can see how often the needle tip just bounces the artery to the left or right. We have longer, non-safety 20g angiocaths that are quite a bit sharper, and I use these when the Arrow isn't getting the job done. Our techs carry wires, but you can also cut the back off the Arrow device and pull the wire out the back and use that.
 
Simba1711 said:
We have the Arrow quick flash radial artery catheters. They’re a pos. I’m used to the longer arrows with a line on the plastic tubing to show when the wire is just exiting the catheter. I would just use a long 20 g iv angiocath or micro puncture kit.
Click to expand...
I understand the hate on the Quick Flash kit, but that just means I never have to worry it gets out of stock in the room. Once you figure out the quirks and features of the kit, it's actually much slicker than the long kit with the tubing.
 
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That is good to know. How do you tell if the wire is in the lumen with the quick flash ? With the long arrows if the wire don’t go past the line I would advance very slightly after flattening the angle. With the quick flash I don’t know until I’m trying to thread the catheter. I’ve caused a few hematomas

DrN2O said:
I understand the hate on the Quick Flash kit, but that just means I never have to worry it gets out of stock in the room. Once you figure out the quirks and features of the kit, it's actually much slicker than the long kit with the tubing.
Click to expand...
 
Simba1711 said:
That is good to know. How do you tell if the wire is in the lumen with the quick flash ? With the long arrows if the wire don’t go past the line I would advance very slightly after flattening the angle. With the quick flash I don’t know until I’m trying to thread the catheter. I’ve caused a few hematomas
Click to expand...

Never used the quick flash, but if you use ultrasound, you can ensure the needle and catheter is 100% dead center of the artery before you advance the wire, virtually 100% of the time. Instead of trying to thread the wire immediately after blood return, keep advancing the needle under ultrasound guidance a few more millimeters, then thread wire and catheter. No hematomas. No through-and-through. No shearing the side of the artery or dissecting the artery with the wire. The catheter is ensured to be in the vessel before advancing so it can't get caught and force the needle out.

Some of my CV partners have made jokes about me always using ultrasound for my arterial lines. And the nurses certainly get annoyed at times having to go get the ultrasound. But then I'll have a bring-back heart and go to place my arterial line and find that their wrist was used as a pincushion a few days prior and there's 4-6 holes. I throw on the ultrasound and get mine in within seconds. One puncture, nearly every time.

One day, eventually, the nurses will just remember that I want the ultrasound so they'll have it in the room before we get started instead of them having to scramble to go get it all the time. One day.
 
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Thank you for the advice. Yeah I’ve never used the quick flash either until my new job. The other hospitals in the same system at my current job , my previous jobs , and my residency all use the long arrows catheters. I don’t see the benefit that Dr N2o is alluding to but my experience with them has been about 6 months using them.
 
cchoukal said:
Someone mentioned how dull they are, and this is true. Using ultrasound, you can see how often the needle tip just bounces the artery to the left or right.
Click to expand...

abolt18 said:
Never used the quick flash, but if you use ultrasound, you can ensure the needle and catheter is 100% dead center of the artery before you advance the wire, virtually 100% of the time. Instead of trying to thread the wire immediately after blood return, keep advancing the needle under ultrasound guidance a few more millimeters, then thread wire and catheter. No hematomas. No through-and-through. No shearing the side of the artery or dissecting the artery with the wire. The catheter is ensured to be in the vessel before advancing so it can't get caught and force the needle out.
Click to expand...

As an aside, these are also reasons why people should always use ultrasound to start art lines. It amazes me that there are people out there who still do them blind and think they're better/faster that way.

I hope I never age into that breed of dinosaur.
 
DrN2O said:
I understand the hate on the Quick Flash kit, but that just means I never have to worry it gets out of stock in the room. Once you figure out the quirks and features of the kit, it's actually much slicker than the long kit with the tubing.
Click to expand...
The quick flash is great for convenience and lack of mess but if you're doing 150-200 art lines a year, working with vascular patients, there is prob 3-5% where it sucks. If you're not using ultrasound it's very unreliable. Many times I'm very much in the lumen but I get no flash. I thread the wire because I'm very confidently in based on ultrasound. If you're blind you won't know and then you get the possible spasm or hematoma. Even with ultrasound there are small caliber vessels close to the surface where the needle is far too blunt and it can be a real challenge. Jelco is nice middle ground between quick flash and the big kit.
 
pgg said:
As an aside, these are also reasons why people should always use ultrasound to start art lines. It amazes me that there are people out there who still do them blind and think they're better/faster that way.

I hope I never age into that breed of dinosaur.
Click to expand...
Amen. I added a blurb about that in my edit. My many colleagues who want to go blind and stick the arm to death then call for ultrasound as a last ditch effort... Major eye roll.
 
abolt18 said:
Amen. I added a blurb about that in my edit. My many colleagues who want to go blind and stick the arm to death then call for ultrasound as a last ditch effort... Major eye roll.
Click to expand...
I did a blind one the other day and got a LOT of funny looks. I'd failed twice on one arm with ultrasound (pt had spinal shock and was in spasm). At the other arm, I poked while they were moving and setting up the ultrasound and happened to get it. It was really clear to me no one had seen any of us do one blind in a LONG time, which I took comfort in.
 
cchoukal said:
I did a blind one the other day and got a LOT of funny looks. I'd failed twice on one arm with ultrasound (pt had spinal shock and was in spasm). At the other arm, I poked while they were moving and setting up the ultrasound and happened to get it. It was really clear to me no one had seen any of us do one blind in a LONG time, which I took comfort in.
Click to expand...
These are patients I might go straight to a brachial with. A radial short 20g Arrow in a vasospasm/clamped-down patient has decent odds of being problematic (ie damped, can't draw back) sooner or later.

I sometimes wonder if I should go brachial on all of my hearts because radials can be so flaky in the immediate post CPB period.
 
pgg said:
These are patients I might go straight to a brachial with. A radial short 20g Arrow in a vasospasm/clamped-down patient has decent odds of being problematic (ie damped, can't draw back) sooner or later.

I sometimes wonder if I should go brachial on all of my hearts because radials can be so flaky in the immediate post CPB period.
Click to expand...
I wish that was standardized here. I have a relatively lower threshold to go brachial for my hearts if I don't like the target I see with ultrasound at the radial, but ICU doesn't like them and so the surgeon will often end up placing a fem line and then the ICU pulls the brachial. Still only ended up placing only a couple last year.
 
pgg said:
These are patients I might go straight to a brachial with. A radial short 20g Arrow in a vasospasm/clamped-down patient has decent odds of being problematic (ie damped, can't draw back) sooner or later.

I sometimes wonder if I should go brachial on all of my hearts because radials can be so flaky in the immediate post CPB period.
Click to expand...


We never did hearts with a single radial. Always radial+femoral or radial+brachial.
 
crash2500 said:
The quick flash is great for convenience and lack of mess but if you're doing 150-200 art lines a year, working with vascular patients, there is prob 3-5% where it sucks. If you're not using ultrasound it's very unreliable. Many times I'm very much in the lumen but I get no flash. I thread the wire because I'm very confidently in based on ultrasound. If you're blind you won't know and then you get the possible spasm or hematoma. Even with ultrasound there are small caliber vessels close to the surface where the needle is far too blunt and it can be a real challenge. Jelco is nice middle ground between quick flash and the big kit.
Click to expand...
Have you look at and taken apart the quick flash--needle, catheter, wire, etc? Do you know how far from the needle tip is the wire? The wire does not thread smoothly because it needs to have a catch at the top. Knowing when it exit the needle is no different than knowing when the micropuncture wire transitions from soft to stiff. The prevalence of US also has you looking away from the flash in the needle. The arterial flash in the needle for quick flash is very different from the column of blood in the longer kit, and you will miss it if staring at the screen.

Excuse me, it's not blind, it's landmark based with palpation and visual confirmation. I will admit that I do it because I can when most other no longer can and it's a flex. I will go to US if I have to come out and make a second skin poke.
 
DrN2O said:
Have you look at and taken apart the quick flash--needle, catheter, wire, etc? Do you know how far from the needle tip is the wire? The wire does not thread smoothly because it needs to have a catch at the top. Knowing when it exit the needle is no different than knowing when the micropuncture wire transitions from soft to stiff. The prevalence of US also has you looking away from the flash in the needle. The arterial flash in the needle for quick flash is very different from the column of blood in the longer kit, and you will miss it if staring at the screen.

Excuse me, it's not blind, it's landmark based with palpation and visual confirmation. I will admit that I do it because I can when most other no longer can and it's a flex. I will go to US if I have to come out and make a second skin poke.
Click to expand...
Maybe you and I are talking about different kits.

Arrow® Integrated Arterial Catheter | US | Teleflex

teleflex.com teleflex.com

This is the kit we all refer to as quick flash and it's only benefit is convenience.

Also, if you use ultrasound, you wont be making a second stick 95% of the time.
 
pgg said:
It amazes me that there are people out there who still do them blind and think they're better/faster that way.

I hope I never age into that breed of dinosaur.
Click to expand...
Ha ha ha im right here.

Just cause you ain't got the hands, don't hate...
 
2019medstudent said:
Sure, but if my family or I were getting an A-line, I would 100% want it to be done with an ultrasound
Click to expand...
Good luck to them and you then.
My surgeons and colleagues trust me in a very high volume and acuity centre. I dont need your approval thanks

im excellent with uss lines btw, just faster without it.

Research cant capture skill/dexterity.
Not much different to the glidescope agenda
 
PpfSuxTube said:
Good luck to them and you then.
My surgeons and colleagues trust me in a very high volume and acuity centre. I dont need your approval thanks

im excellent with uss lines btw, just faster without it.

Research cant capture skill/dexterity.
Not much different to the glidescope agenda
Click to expand...
Ultrasounds are everywhere these days. It’s easy to request someone to do it with an ultrasound. I’m sure you’re good at it blind. For most patients, there won’t be a difference. It's those 1-5% difficult ones where the ultrasound (for someone who’s good at it) will prevent digging/fanning around, multiple pokes, hematomas, or small dissections that it’s useful for.
 
PpfSuxTube said:
Good luck to them and you then.
My surgeons and colleagues trust me in a very high volume and acuity centre. I dont need your approval thanks

im excellent with uss lines btw, just faster without it.

Research cant capture skill/dexterity.
Not much different to the glidescope agenda
Click to expand...


I use ultrasound for every a-line and a glidescope to intubate every patient 🙂 Didn’t have access to either my first 5-10 years out. I just think it’s a better way.
 
DrN2O said:
Excuse me, it's not blind, it's landmark based with palpation and visual confirmation. I will admit that I do it because I can when most other no longer can and it's a flex. I will go to US if I have to come out and make a second skin poke.
Click to expand...

PpfSuxTube said:
Ha ha ha im right here.

Just cause you ain't got the hands, don't hate...
Click to expand...

With respect, this is exactly what dinosaurs do and it's not the flex you think it is.

Maybe you're in a lower acuity place with healthier patients, but I often encounter patients who have radial arteries that are simply unsuitable for cannulation. Clot, extensive plaques/calcium ... torturosity that greatly increases odds of eventual catheter dampening. All things that are immediately obvious on ultrasound and lead me to change insertion site to the proximal radial, the other arm, or a brachial artery. This happens multiple times per month. My one stick, first pass, no redirection success rate is extremely high.

It's also more comfortable for the patient because I can carefully deposit local in the skin and around the artery with high precision.

I learned before ultrasound was everywhere and my old technique was angiocath only, no wire at all. Ain't nothing wrong with my hands, but there's something wrong with y'all's brains 🙂 if you're still making blind attempts and think that's a superior technique.

If you practice you'll develop the hands to use ultrasound efficiently. 🙂 Don't fear newfangled technology.

And yeah it's blind, the same way an epidural is blind, because we don't have x-ray vision.

I would not want or permit anyone to start an a-line in me or a family member without ultrasound, no matter how confidently they strolled into the room.
 
pgg said:
With respect, this is exactly what dinosaurs do and it's not the flex you think it is.

Maybe you're in a lower acuity place with healthier patients, but I often encounter patients who have radial arteries that are simply unsuitable for cannulation. Clot, extensive plaques/calcium ... torturosity that greatly increases odds of eventual catheter dampening. All things that are immediately obvious on ultrasound and lead me to change insertion site to the proximal radial, the other arm, or a brachial artery. This happens multiple times per month. My one stick, first pass, no redirection success rate is extremely high.

It's also more comfortable for the patient because I can carefully deposit local in the skin and around the artery with high precision.

I learned before ultrasound was everywhere and my old technique was angiocath only, no wire at all. Ain't nothing wrong with my hands, but there's something wrong with y'all's brains 🙂 if you're still making blind attempts and think that's a superior technique.

If you practice you'll develop the hands to use ultrasound efficiently. 🙂 Don't fear newfangled technology.

And yeah it's blind, the same way an epidural is blind, because we don't have x-ray vision.

I would not want or permit anyone to start an a-line in me or a family member without ultrasound, no matter how confidently they strolled into the room.
Click to expand...
If You're doing radials for your version of cardiac surgery then you're in a lower acuity place than me brother.
We abandoned those random number generators a long time ago unless the simplest case
 
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How many cardiologist use uss for their radials? Do they happen to give anything special to dilate their radials?
 
PpfSuxTube said:
How many cardiologist use uss for their radials?
Click to expand...
All of ours do, AFAIK. When we do TAVRs, if they use a radial for secondary access they use ultrasound to access it.

PpfSuxTube said:
Do they happen to give anything special to dilate their radials?
Click to expand...
Occasionally ours will push some verapamil through them.


PpfSuxTube said:
If You're doing radials for your version of cardiac surgery then you're in a lower acuity place than me brother.
We abandoned those random number generators a long time ago unless the simplest case
Click to expand...

Those cases typically get femoral art lines in addition to whatever gets put in the arms, which is often a brachial. (Do you do those blind, too?)

I'm going to guess that the reason so many of your radial art lines don't work or fail or become "random number generators" is because they're marginal in the first place, because you didn't use ultrasound and didn't know they were borderline unsuitable for cannulation in the first place.

Evem the best radial art line can be a bit damped in the initial POST-CPB period but even then the MAPs are typically accurate.


Whatever - we can snipe about who's got the sicker patients or bigger cases, but if you're not using ultrasound for arterial lines you're not much different than the guys who still do landmark IJs or landmark blocks. They get by, for the most part. But they're behind, and either unaware or uncaring that there's a better way. You do you!
 
Landmark & U/S guided A-lines are part of my practice. The points are 1) patient selection and 2) equipment availability. We are a large site and don’t have dedicated ultrasounds for every room. First starts put a crunch on availability. Having the ability to place a line in a non-fluffy arm with a great pulse allows for keeping care moving along.

For example: stroke patient who already got tPA, the patient with therapeutic anticoag will always have a U/S line by me. Risk vs benefit.
 
pgg said:
(Do you do those blind, too?)
Click to expand...
Yep.
Never had a complication from any art line. Sorry I need to work on my complication rate to keep you happy.

I look @ the case, the surgeon and I feel the artery then I act appropriately. If landmark is fine, landmark will be fine. If the artery is ****e of course I don't stick it. You guys are so stuck in your dogma, you cant treat whats in front of you... good luck with that.

Some radials are as big and visible to the naked eye as the vein. Can you not see them? Are you going to mandate uss for every piv too?
 
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