Bevel down - arterial lines

[deleted131481]

I came across this article for U/S arterial lines that shows a higher success with bevel down vs bevel up technique:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939735/

Granted this study is under U/S, but seems like it would make sense for blind sticks. I've tried a few methods of a-line insertion and normally I go bevel up, get flash, rotate 180 and try to thread. If not successful then through and through and Seldinger with a wire. Seems obvious now, but starting bevel down on entry makes more sense to me as I'd be less likely to hit posterior wall.

Thoughts? And how about this technique for tough IV sticks as well?

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[Planktonmd]

I came across this article for U/S arterial lines that shows a higher success with bevel down vs bevel up technique:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939735/

Granted this study is under U/S, but seems like it would make sense for blind sticks. I've tried a few methods of a-line insertion and normally I go bevel up, get flash, rotate 180 and try to thread. If not successful then through and through and Seldinger with a wire. Seems obvious now, but starting bevel down on entry makes more sense to me as I'd be less likely to hit posterior wall.

Thoughts? And how about this technique for tough IV sticks as well?

Go bevel up as usual and when you get a flash don't rotate, only advance the needle one more millimeter, if you still have pulsatile blood advance the catheter.

 

[WholeLottaGame7]

I came across this article for U/S arterial lines that shows a higher success with bevel down vs bevel up technique:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939735/

Granted this study is under U/S, but seems like it would make sense for blind sticks. I've tried a few methods of a-line insertion and normally I go bevel up, get flash, rotate 180 and try to thread. If not successful then through and through and Seldinger with a wire. Seems obvious now, but starting bevel down on entry makes more sense to me as I'd be less likely to hit posterior wall.

Thoughts? And how about this technique for tough IV sticks as well?

Don't get crazy, cowboy. Have you ever tried to puncture something (skin, artery wall, etc) with the bevel down? It is significantly harder unless you seriously increase the angle and that's not always ideal. Anyway, who cares about posterior wall injury? Sometimes I intentionally want to go through and through, anyway.

Also, look at who they excluded in the study (atherosclerosis, morbidly obese, etc etc). I'm a little skeptical of any study that shows a difference in the success rate of a procedure that should basically be a slam-dunk anyway.

 

[deleted162650]

I don't care if the bevel is down, just make sure you have the laces out.

 

[deleted131481]

Don't get crazy, cowboy. Have you ever tried to puncture something (skin, artery wall, etc) with the bevel down? It is significantly harder unless you seriously increase the angle and that's not always ideal. Anyway, who cares about posterior wall injury? Sometimes I intentionally want to go through and through, anyway.

Also, look at who they excluded in the study (atherosclerosis, morbidly obese, etc etc). I'm a little skeptical of any study that shows a difference in the success rate of a procedure that should basically be a slam-dunk anyway.

Makes sense that it would be a lot more difficult/shearing. And good point, if it's all easy a-lines anyways not a very convincing study. Always good to hear experienced opinions.