Arterial line

[mostwanted]

This is exactly what I used to do before going to ultrasound for every Aline. Then I went to ultrasound for every Aline for hearts because the machine was always in the room. It worked so well that the anesthesia techs know to bring me an ultrasound machine whenever they set up an Aline for me.

I agree the success rate is likely higher with ultrasound, but I have been in a number of situations where an ultrasound was not readily available. So I want to be comfortable doing it both ways.

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[dhb]

I kind of disagree here: assuming normo-tension if you feel a good pulse you have a good chance to have an easy cannulation whatever the method.
If you have a crappy pulse then you have a high chance of a bad artery and a difficult cannulation.
Hitting a very small or calcified artery with u/s is not easy despite what some here suggest.
That doesn't mean that u/s isn't helpfull but it's not the magic wand that will solve everything.
Some will question my ability but i've been using u/s almost daily for 10y...

 

[deleted59964]

Hitting a very small or calcified artery with u/s is not easy despite what some here suggest.
That doesn't mean that u/s isn't helpfull but it's not the magic wand that will solve everything.
Some will question my ability but i've been using u/s almost daily for 10y...

Of course, according to the laws of sdn, you should be routinely getting in a large bore iv, an art line, a cvc, and a peripheral nerve bock in under 2 minutes ... while flirting with the nurses and trading stories with the surgeon... before your third year of residency.

Frankly dhb, I expected more from you

 

[Onefellswoop87]

Of course, according to the laws of sdn, you should be routinely getting in a large bore iv, an art line, a cvc, and a peripheral nerve bock in under 2 minutes ... while flirting with the nurses and trading stories with the surgeon... before your third day of residency.

Frankly dhb, I expected more from you

Fixed it for ya. Oh, and investment banking in the OR.

 

[dannyboy1]

Arterial lines are easier with a 20g Angiocath for the reasons mentioned above, but the actual Arrow catheter itself is superior.

On Monday do this -- open an Angiocath, open an Arrow, and dispose of the needles. With your fingernails, lightly pinch down on both catheters. What you will find is that the Arrow catheter is more resilient and won't be affected at all, whereas the Angiocath will have an obvious deformity/indentation to it even after a light pinch.

What this tells me is this -- for short term perioperative use, the choice of catheter probably doesn't matter, so you can choose either with equivalent results. However, for long term arterial line cannulation (sepsis, ICU patient, etc), Arrow is probably the superior choice since the catheter itself is of higher quality and less likely to give problems down the road. I don't have any evidence to support this, but it just seems logical to me.

Had an attending that used to cannulate with the 20G piv, thread a wire through the IV catheter, then exchange the iv catheter with the arrow catheter over the wire. Seems to be the best of both.

 

[AdmiralChz]

We tried a catheter in residency where the wire came out completely of the setup so you could more easily do a through-and-through technique. I never got to se it but it looked pretty slick - looked just like the Arrow.

 

[AdmiralChz]

Fixed it for ya. Oh, and investment banking in the OR.

Come on if you can’t do a femoral catheter while on a heparin drip simultaneously adjusting your shorts based on Nikkei futures you are doin it wrong.

 

[deleted171991]

Come on if you can’t do a femoral catheter while on a heparin drip simultaneously adjusting your shorts based on Nikkei futures you are doin it wrong.

Not all of us went to a top 10 program.

 

[Modanq]

quick question: when using ultrasound do you prep the ultrasound probe with a tegaderm or actually drape the whole thing with the cord in a sterile ultrasound cover? Second, thoughts on micro puncture kits from cook?

 

[facted]

quick question: when using ultrasound do you prep the ultrasound probe with a tegaderm or actually drape the whole thing with the cord in a sterile ultrasound cover? Second, thoughts on micro puncture kits from cook?

I use a tegaderm. How sterile do you normally prep for A line without ultrasound?

 

[Twiggidy]

quick question: when using ultrasound do you prep the ultrasound probe with a tegaderm or actually drape the whole thing with the cord in a sterile ultrasound cover? Second, thoughts on micro puncture kits from cook?

here's where this thread will get legs.....long time listener. i'll take my answer off-air

 

[facted]

Second, thoughts on micro puncture kits from cook?

That kit is very expensive for a regular A-line but can be super useful in vasculopaths where you keep hitting but can't thread. It's saved me quite a few times.

 

[T-burglar]

Use the ultrasound for arterial lines and central lines - if you're more interested in clean, first pass cannulations with lower risk of carotid or nerve injuries. Because it represents progress and you care about your patients more than you care what idiots say about you and your "crutches" behind your back.

Also learn US guided supraclavicular approaches to the subclavian ( or brachiocephalic confluences depending on how you look at it ) so you have the option in an emergency under the drapes.

 

[deleted697535]

quick question: when using ultrasound do you prep the ultrasound probe with a tegaderm or actually drape the whole thing with the cord in a sterile ultrasound cover? Second, thoughts on micro puncture kits from cook?

For an or only a line I use a tegederm and just saline as the medium. ICU type lines I use a full sleeve for the USS.

Saline gives good enough visibility and means I can set it all up myself without waiting for a nurse

 

[Twiggidy]

I go « straight probe homie » for all A-lines. I only used probe cover for central venous lines

 

[Lecithin5]

I go « straight probe homie » for all A-lines. I only used probe cover for central venous lines

So straight probe with gel, and a quick alcohol swipe at the site of insertion? This is very tempting to do, as it would save some time.

 

[deleted162650]

So straight probe with gel, and a quick alcohol swipe at the site of insertion? This is very tempting to do, as it would save some time.

This is what I do, except I use chloroprep instead of alcohol - makes me feel better at least. If it was an ICU bound patient that was gonna keep the line for a while I'd probably try to cover the probe though.

 

[Nephro critical care]

So straight probe with gel, and a quick alcohol swipe at the site of insertion? This is very tempting to do, as it would save some time.

I wouldn't use the probe without a sterile probe cover as a matter of policy. The probe gets contaminated with blood and if you transfer HIV from one patient to another that would be inexcusable.

 

[AdmiralChz]

I wouldn't use the probe without a sterile probe cover as a matter of policy. The probe gets contaminated with blood and if you transfer HIV from one patient to another that would be inexcusable.

Fair, but equipment should be wiped extensively with those purple wipes anyway.

 

[facted]

I wouldn't use the probe without a sterile probe cover as a matter of policy. The probe gets contaminated with blood and if you transfer HIV from one patient to another that would be inexcusable.

We wipe down our ultrasound with wipes after every use.

 

[Twiggidy]

I wouldn't use the probe without a sterile probe cover as a matter of policy. The probe gets contaminated with blood and if you transfer HIV from one patient to another that would be inexcusable.

i’d like to know which hospital you’re at

(tongue in cheek...im just messing with you)

i personally wipe down the ultrasound after I use it. at my program i was taught to clean up after yourself and quite honestly i dont have the greatest amount of trust in our techs. ill retest the machine right in front of them because ive been burned by « tech trust

secondly, its « tongue in cheek » right? i feel like thats correct but i also feel like i say « tongue AND cheek » which makes less sense

 

[Modanq]

Fair, but equipment should be wiped extensively with those purple wipes anyway.

I thought that the chlorahexadine wipes can ruin the crystal in the ultrasound probe head and that the manufacture states to use that spray thing.
I do agree - I have seen both tegaderm approach and probe cover approach. For blocks a lot of folks use tegaderms but sometimes the blood gets everywhere doing the a line.

 

[dchz]

Also learn US guided supraclavicular approaches to the subclavian ( or brachiocephalic confluences depending on how you look at it ) so you have the option in an emergency under the drapes.

Any videos/articles/picture on this approach?

 

[vector2]

Any videos/articles/picture on this approach?

 

[polar403]

Most of these tips have been mentioned in previous posts...

1. Place a roll under the wrist and tape the thumb out.
2. Start at least 1-2 cm, above the wrist. As stated above, it's easier to thread the wire there, and it's easier to secure.
3. Use the TIP of your index finger to palpate the radial artery, start medially and move lateral. The artery is generally "always more medial" than you expect.
4. Keep moving laterally until you don't feel the pulse any more. Place the needle medial to the nail of your index finger.
5. You'll need to keep the needle 30-45 degrees. Keep in mind, the higher the angle, the more vertical exposure the bevel has with relation to the artery. So, for someone with vasculopathy, it's likely better to keep the angle lower, which decreases your vertical exposure, so the opening is likely more in the lumen, and subsequently you have a higher chance of passing the wire when you get pulsatile blood. Keeping the angle lower also means you'll have more distance to travel through the subcutaneous tissue to the artery than a higher angle.
6. Once you get flow back, if you can't pass the wire the first time, transfix the needle through the back of the artery. Slowly back the needle out mm by mm and when you get good pulsatile flow, try to pass the wire again. Don't force the wire, you'll cause problems.
7. If you still can't get it, don't be afraid to use the ultrasound. It's not a sign of weakness. It's most certainly better than wasting OR time.

Edited: added a step and corrected a mistake.

 

[Lecithin5]

Most of these tips have been mentioned in previous posts...

1. Start at least 1-2 cm, above the wrist. As stated above, it's easier to thread the wire there, and it's easier to secure.
2. Use the TIP of your index finger to palpate the radial artery, start medially and move lateral. The artery is generally "always more medial" than you expect.
3. Keep moving laterally until you don't feel the pulse any more. Place the needle medial to the nail of your index finger.
4. You'll read to keep the needle 30-45 degrees. Keep in mind, the higher the angle, the more vertical exposure the bevel has with relation to the artery. So, for someone with vasculopathy, it's likely better to keep the angle lower, which decreases your vertical exposure, so the opening is likely more in the lumen, and subsequently you have a higher chance of passing the wire when you get pulsatile blood. Keeping the angle lower also means you'll have more distance to travel through the subcutaneous tissue to the artery than a higher angle.
5. Once you get flow back, if you can't pass the wire the first time, transfix the needle through the back of the artery. Slowly back the needle out mm by mm and when you get good pulsatile flow, try to pass the wire again. Don't force the wire, you'll cause problems.
6. If you still can't get it, don't be afraid to use the ultrasound. It's not a sign of weakness. It's most certainly better than wasting OR time.

Great tips. I'll also add that it is usually more shallow than ppl think (more of a tip for those just starting out)

 

[nimbus]

Most of these tips have been mentioned in previous posts...

1. Start at least 1-2 cm, above the wrist. As stated above, it's easier to thread the wire there, and it's easier to secure.
2. Use the TIP of your index finger to palpate the radial artery, start medially and move lateral. The artery is generally "always more medial" than you expect.
3. Keep moving laterally until you don't feel the pulse any more. Place the needle medial to the nail of your index finger.
4. You'll read to keep the needle 30-45 degrees. Keep in mind, the higher the angle, the more vertical exposure the bevel has with relation to the artery. So, for someone with vasculopathy, it's likely better to keep the angle lower, which decreases your vertical exposure, so the opening is likely more in the lumen, and subsequently you have a higher chance of passing the wire when you get pulsatile blood. Keeping the angle lower also means you'll have more distance to travel through the subcutaneous tissue to the artery than a higher angle.
5. Once you get flow back, if you can't pass the wire the first time, transfix the needle through the back of the artery. Slowly back the needle out mm by mm and when you get good pulsatile flow, try to pass the wire again. Don't force the wire, you'll cause problems.
6. If you still can't get it, don't be afraid to use the ultrasound. It's not a sign of weakness. It's most certainly better than wasting OR time.

Or go straight to ultrasound, no guessing where the artery is. Does anyone do blocks or central lines without ultrasound anymore?

 

[AdmiralChz]

Or go straight to ultrasound, no guessing where the artery is. Does anyone do blocks or central lines without ultrasound anymore?

Agree to some degree, especially if you can't feel the artery straight up.

But my residency, fellowship and future job doesn't have enough portable ultrasounds for this. We have enough that we can call if we need it, but not enough to stock all the ORs. In residency we had like one ultrasound for 18 ORs which was definitely in the room for the central line so you were sorta SOL for neuro cases and the like...

 

[polar403]

Or go straight to ultrasound, no guessing where the artery is. Does anyone do blocks or central lines without ultrasound anymore?

Subclavian central lines without ultrasound. Occasionally I've done posterior sciatic nerve blocks with stim by landmarks. We don't always have a curvilinear probe available to do the anterior approach, and not all patients are thin enough to even do it with ultrasound. But yes, for the majority of blocks and lines an ultrasound is the standard of care.

I agree that ultrasound is worth using for a-lines, especially in the patients that are going to be more difficult - have it available and start with it. No need to let your ego get in the way. However, being able to place an arterial line without an ultrasound is a good skill to have. Not everyone has immediate access to them and it's not worth delaying a case to wait for an ultrasound, especially for a patient that isn't likely to be difficult (eg. thin, not a vasculopath, etc.). A balance between safety and efficiency is always key.

 

[nimbus]

Agree to some degree, especially if you can't feel the artery straight up.

But my residency, fellowship and future job doesn't have enough portable ultrasounds for this. We have enough that we can call if we need it, but not enough to stock all the ORs. In residency we had like one ultrasound for 18 ORs which was definitely in the room for the central line so you were sorta SOL for neuro cases and the like...

That’s pretty bad. We have three ultrasounds for our 10 OR main operating room, 1 for our 4 OR ASC, and 1 at our 4 OR freestanding ASC. We almost never wait for an ultrasound. When our techs set up an Aline transducer for me, they bring an ultrasound in the room.

 

[AdmiralChz]

That’s pretty bad. We have three ultrasounds for our 10 OR main operating room, 1 for our 4 OR ASC, and 1 at our 4 OR freestanding ASC.

It was awful, never mind the $200 million tower going up next door. It was getting better as I left (peds CT gone one, also general peds, vascular surgery bought some, plus probs that attached to the TEE machines). My fellowship and next job is much better.

The unique issue is that like 8-10 a-lines are being done at one time in the CV ORs for first starts, this is different than the ICUs and the ER where it's maybe two at a time.

 

[vector2]

That’s pretty bad. We have three ultrasounds for our 10 OR main operating room, 1 for our 4 OR ASC, and 1 at our 4 OR freestanding ASC. We almost never wait for an ultrasound. When our techs set up an Aline transducer for me, they bring an ultrasound in the room.

This is something that a lot of future residents don't think about. In addition to going to a strong clinical program, go somewhere that has money. You want to have gotten your hands on multiple types of ultrasounds, advanced airway devices, jet ventilators, TEEs, all the various vascular access kits, vigileo/flotrac/NICO/continuous SVO2 swans, IABP, LVAD, impella, spinal drains, EVDs, bolts etc etc. Not to mention you want to go to a program that has enough money to hire enough CRNAs so they're the ones relieving you and not vice versa.

 

[nimbus]

It was awful, never mind the $200 million tower going up next door. It was getting better as I left (peds CT gone one, also general peds, vascular surgery bought some, plus probs that attached to the TEE machines). My fellowship and next job is much better.

The unique issue is that like 8-10 a-lines are being done at one time in the CV ORs for first starts, this is different than the ICUs and the ER where it's maybe two at a time.

We only have one heart room but it has an ultrasound that lives there. When it’s not being used it can be taken where it’s needed. I do think every heart room should have its own ultrasound for necklines at least. The QA committee of my group issued a practice advisory that all necklines should be inserted using real time ultrasound. If you have 8 hearts starting in the morning, I think they all deserve an ultrasound. In fact my group staffs a new cardiovascular hospital where each OR does have its own ultrasound unit.

 

[dchz]

It was awful, never mind the $200 million tower going up next door. It was getting better as I left (peds CT gone one, also general peds, vascular surgery bought some, plus probs that attached to the TEE machines). My fellowship and next job is much better.

The unique issue is that like 8-10 a-lines are being done at one time in the CV ORs for first starts, this is different than the ICUs and the ER where it's maybe two at a time.

We only have one heart room but it has an ultrasound that lives there. When it’s not being used it can be taken where it’s needed. I do think every heart room should have its own ultrasound for necklines at least. The QA committee of my group issued a practice advisory that all necklines should be inserted using real time ultrasound. If you have 8 hearts starting in the morning, I think they all deserve an ultrasound. In fact my group staffs a new cardiovascular hospital where each OR does have its own ultrasound unit.

Agreed.

If you have a TEE machine, all you have to is spend a few K on a hockey stick transducer and it'll solve all the problems and way cheaper than a stand alone sonosite.

 

[Twiggidy]

Or go straight to ultrasound, no guessing where the artery is. Does anyone do blocks or central lines without ultrasound anymore?

CVP in the OR, depending on the patient anatomy....yes. If the anatomy is right, I can get the CVP in faster then the nurses setup the U/S for insertion

 

[deleted697535]

Thanks all, did a few today and no issues for once!

one thing i did do was give a cc of phenyl before each. The pulse was very palpable prior to giving it, but it threaded super easy. Maybe wouldve gotten it anyway...

 

[deleted697535]

Right so ive been playing with this for ages and think i have a formula that will help. (This is my thoughts after 400 arterial lines)

1 - Position well (I like wrist extended like spiderman shooting a web, and tape the thumb most importanly to the arm rest)
2 - use an arm rest in preference to the bed
3 - Sit down if you can. I havent come to a conclusion whether parallel looking up the arm is better than perpendicular to the arm yet.
3 - Dont have the nibp on the same side going off every 2 mins!
4 - Dont even bother unless NIBP systolic reads over 90 to 100. Give phenyl or ephedrine prior to starting!
5 - Absolutely crucially prior to starting is whatever cannula or kit you use, is to run the wire thru it before you break skin. Sometimes there are tiny little catches remaining from the factory
6 - Use a corkscrew motion to advance the cannula if you can (much better than just a straight push)
7 - Use at least 1.5cc of 2% lido early if doing it awake

 

[Twiggidy]

Right so ive been playing with this for ages and think i have a formula that will help. (This is my thoughts after 400 arterial lines)

1 - Position well (I like wrist extended like spiderman shooting a web, and tape the thumb most importanly to the arm rest)
2 - use an arm rest in preference to the bed
3 - Sit down if you can. I havent come to a conclusion whether parallel looking up the arm is better than perpendicular to the arm yet.
3 - Dont have the nibp on the same side going off every 2 mins!
4 - Dont even bother unless NIBP systolic reads over 90 to 100. Give phenyl or ephedrine prior to starting!
5 - Absolutely crucially prior to starting is whatever cannula or kit you use, is to run the wire thru it before you break skin. Sometimes there are tiny little catches remaining from the factory
6 - Use a corkscrew motion to advance the cannula if you can (much better than just a straight push)
7 - Use at least 1.5cc of 2% lido early if doing it awake

Very underrated piece of advice

 

[InfinitiPSI]

Doing it blind (with the arrow)-
Get it- you're done
Don't- it should be a subcutaneous prick don't fret about your academic colleagues, go medial, poke advance then come out slowly. I do two fingers, roll the artery and feel where it is. Then I occlude distally, hit the artery between my fingers at 45, drop to 20-30 (may have to advance a few mm if you don't get bloodflow), if the wire doesn't advance like butter it's a prob.
If I use U/S then micropuncture kit which gives you thinner wire for the vaculopaths. I have a minimal threshold for this.

Do you notice a difference with distal occlusion? I thought about this before, but it didn't seem to make a difference the few times I tried

 

[Paingas]

love those videos they explain it so well

 

[nimbus]

$2000 ultrasound coming down the pike. Bet it’ll be good enough for lines.

Artificial Intelligence Is Putting Ultrasound on Your Phone

 

[abolt18]

While the argument can be made for using the ultrasound every time, I think everyone needs to gain the ability to put them in blind. There are events in which time is of the essence and waiting for an ultrasound can put a major drag on your ability to care for a patient in the way you'd like to.

Just the other day, we had a patient code in the ICU due to hyperkalemia. Attending asked for an art line. I ran to get the ultrasound for my co-resident and when I got back to the room 30-40 seconds later, he had already threaded the catheter and was attaching the pressure tubing. Delaying that art line another couple minutes maybe wouldn't be life or death, but this allowed us to get an ABG a couple minutes faster and further correct her K+ (which was 7.0).

I've seen other cases as well in the OR that merited a rapidly placed arterial line (trocar through the IVC in a cholecystectomy), and being dependent on an ultrasound would have delayed care.

I guess I'm not arguing against the ultrasound so much as I'm arguing in favor of learning both skills.

 

[Hamhock]

Delaying that art line another couple minutes maybe wouldn't be life or death, but this allowed us to get an ABG a couple minutes faster and further correct her K+ (which was 7.0).

I OK with the argument that resuscitationists need to be able to place lines blindly.

However, the hyperkalemia case you presented does not support this assertion. All it does is remind us why alines are needed much less often than people think in the ICU.

"...that art line...allowed us to get and ABG...and further correct her K+" -- what ?!

I doubt that art line had any effect on her potassium correction or the "saving of her life"...unless it was to occupy the residents with busy work while the life-threatening pathology was reversed.

HH

 

[abolt18]

Like I said, sometimes it's a matter of being able to treat a patient the way you hope to treat them. This was a young, severe CHF patient who was on the edge of getting an LVAD, and this event was the tipping point that led her to VA ECMO for a couple days before placing the LVAD. The information provided by the art line definitely played a role in the clinical decision making (i.e. even after getting ROSC and correcting her electrolytes, her heart still sucked big-time). Also, it was just the most recent event I could think of where it was advantageous to quickly throw one in.

Sent from my SM-G930V using SDN mobile

 

[nimbus]

While the argument can be made for using the ultrasound every time, I think everyone needs to gain the ability to put them in blind. There are events in which time is of the essence and waiting for an ultrasound can put a major drag on your ability to care for a patient in the way you'd like to.

Just the other day, we had a patient code in the ICU due to hyperkalemia. Attending asked for an art line. I ran to get the ultrasound for my co-resident and when I got back to the room 30-40 seconds later, he had already threaded the catheter and was attaching the pressure tubing. Delaying that art line another couple minutes maybe wouldn't be life or death, but this allowed us to get an ABG a couple minutes faster and further correct her K+ (which was 7.0).

I've seen other cases as well in the OR that merited a rapidly placed arterial line (trocar through the IVC in a cholecystectomy), and being dependent on an ultrasound would have delayed care.

I guess I'm not arguing against the ultrasound so much as I'm arguing in favor of learning both skills.

I don’t disagree. I never used ultrasound for Aline’s until maybe 5 years ago. Then I used it occasionally for a year or so until saw it was a better way. If everyone had a $2000 US in their backpack/purse/briefcase, there would be no waiting. And it’s a write off.

 

[deleted697535]

While the argument can be made for using the ultrasound every time, I think everyone needs to gain the ability to put them in blind. There are events in which time is of the essence and waiting for an ultrasound can put a major drag on your ability to care for a patient in the way you'd like to.

Just the other day, we had a patient code in the ICU due to hyperkalemia. Attending asked for an art line. I ran to get the ultrasound for my co-resident and when I got back to the room 30-40 seconds later, he had already threaded the catheter and was attaching the pressure tubing. Delaying that art line another couple minutes maybe wouldn't be life or death, but this allowed us to get an ABG a couple minutes faster and further correct her K+ (which was 7.0).

I've seen other cases as well in the OR that merited a rapidly placed arterial line (trocar through the IVC in a cholecystectomy), and being dependent on an ultrasound would have delayed care.

I guess I'm not arguing against the ultrasound so much as I'm arguing in favor of learning both skills.

Your argument is based on availability of equipment not on clinical benefit to the patient.

Eventually maybe 20 years from now or more ultrasounds will be dirt cheap. So will glidescopes.

If there was a USS in every room and nursing staff were familiar with what you need, hands down USS art lines are faster, less pokes, less damage to arteries.

And anyone that gets a 'palpation' method art line in an exsanguinating patient is good obviously but there is a very large element of luck too. Or else the patient isn't really exsanguinating.

 

[abolt18]

Your argument is based on availability of equipment not on clinical benefit to the patient.

Eventually maybe 20 years from now or more ultrasounds will be dirt cheap. So will glidescopes.

If there was a USS in every room and nursing staff were familiar with what you need, hands down USS art lines are faster, less pokes, less damage to arteries.

And anyone that gets a 'palpation' method art line in an exsanguinating patient is good obviously but there is a very large element of luck too. Or else the patient isn't really exsanguinating.

Well, considering that as a resident you don't know what the availability of equipment will be at your future jobs, the argument still stands. You should be comfortable with and without US.

If you work at a hospital where US is not immediately available, then it IS clinically beneficial to your patient that you not require US as a crutch to guide you.

So in your ideal world, yes we'll all have an ultrasound hanging on the wall of every patient room and one in our scrub pocket. Until that happens, I'll learn both.

-------

Also, the resident that put it in the patient who was bleeding out, he said that he could not feel a pulse but felt like he could feel the artery and just went for it.

Sent from my SM-G930V using SDN mobile

 

[amyl]

first off everywhere has ultrasound in this country.... even my hospital in bfe - the added billing pays for itself likely thanks to the sonosite lobbyists. i routinely use u/s for alines - it usually takes two minutes and one stick. i usually use the metal needle kit and thread the wire as that needle is easier to see under ultrasound and easier to "chase" and stick arteries. Ill use the arrow kit and skip u/s if i don't want to wait for the techs to bring the stuff i like best but usually they have it all ready to go. to the OP use u/s and bill for it. better for the patient as well - fewer overall sticks. someone told me this was one of the their moca questions

 

[lunaire]

Re. arrow kit vs. regular angiocath.. You need to look at what catheter your facility is actually using. The standard IV catheters is made from polyurethrane, which is softer, and better suited to venous cannulation & peds A-line. A good adult arterial catheter is made from teflon (FEP), which is more rigid, and is associated with less intra-arterial thrombosis in the ICU patient populations.

Both Braun/Arrow/insert-your-cath-manufacturer-here produce catheters made from polyurethrane and teflon. Your hospital/practice may choose to stock either due to pricing. You should choose the correct catheter type for your patient based on how long line is staying in, and their risk factors for A-line related complications.

 

[lymphocyte]

Posting in this old thread because it's pretty useful.

I started doing radial lines long axis. Short axis to figure out the point of entry, insert needle, then turn to long axis with the probe marker right over the needle entry point (almost pressing down on the needle itself). Has worked out very slick. Does anybody else do this?