Arterial line

[coffeebythelake]

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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?

No. Usually unnecessary (both the ultrasound, and your use of long axis view)

 

[deleted162650]

I go long axis for a-lines and IV’s, but don’t go straight to U/S typically.

 

[pgg]

I use ultrasound for all routine awake a-lines because it's what I would want if it was my radial artery getting needled. If the machine is right there I'll start with it for asleep a-lines too. Why not? Most a-lines are chip shots but the tough ones aren't always obvious.

The short axis view has always worked easy enough. If I'm using an Arrow kit I'm going to have to drop the u/s to advance the wire anyway. If I'm just using an angiocath I could see how long axis might be useful. I'm not sure there's enough payoff to changing my method to long axis at this point, however short the learning curve is.

 

[DM27]

I have done both, but I prefer short axis by far and mainly just use long axis for the novelty of it when I feel like it. I ultimately find the lateral-medial information given by short axis to be of more value than the superficial-deep information given by long axis since I am usually more just asking where the artery is and if I am aligned enough with it to hit it, which I think short axis answers quicker.

 

[Lecithin5]

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?

Props to you. But I would venture that long axis is more difficult than short for most folks.

 

[deleted162650]

long axis is more difficult than short for most folks.

That’s what she said.

 

[T-burglar]

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.

Someone placed a palpation A line in cardiac arrest ?

Another reason to be fast and facile with US is you will have no question whether you cannulated a vein or artery in cardiac arrest. Does this matter? It can, you could theoretically be administering drugs and fluids and air bubbles into the carotid artery if you miscnnulate in the neck and it could mean the difference betweeen a neuro intact recovery and a discharge from the icu with a major stroke.

 

[lymphocyte]

Props to you. But I would venture that long axis is more difficult than short for most folks.

I keep back-walling it on short axis, which is admittedly a sign of poor technique. In long axis, I can follow it to exactly where I want it.

 

[WholeLottaGame7]

Someone placed a palpation A line in cardiac arrest ?

Why not? Them's some high-quality chest compressions.

 

[abolt18]

Someone placed a palpation A line in cardiac arrest ?

Another reason to be fast and facile with US is you will have no question whether you cannulated a vein or artery in cardiac arrest. Does this matter? It can, you could theoretically be administering drugs and fluids and air bubbles into the carotid artery if you miscnnulate in the neck and it could mean the difference betweeen a neuro intact recovery and a discharge from the icu with a major stroke.

Yes, but as I had stepped out of the room to get the US, I don't know if they got ROSC before or after that art line went in. Can't remember all the details anyway, being that time has passed and some of that code has become a blur in my mind.