brachial a-lines

[toughlife]

Been having a tough time getting brachial lines in. Any advice. I know the pulse is easily palpable but I tried in a couple of 400-pounders and failed. Any tricks from the experts?

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[jetproppilot]

Been having a tough time getting brachial lines in. Any advice. I know the pulse is easily palpable but I tried in a couple of 400-pounders and failed. Any tricks from the experts?

Try and keep the skin as taut as possible, left hand on the pulse pushing down pretty hard, right hand holding the a line (i use an Arrow) with your right hand resting on the dudes forearm. gentle proximal pressure with left hand and gentle distal pressure with right hand.

Now, BE THE NEEDLE. USE THE FORCE.


One of the biggest mistakes I see people make with A lines in general is continually trying to get the wire to thread once blood starts heading up the resevoir. If the wire doesnt thread the first time, I retract the wire and go through-and-through the artery. Then pull the needle/wire-contraption all the way out of the catheter.

Next, extend the wire through the needle, hold the contraption with your right hand by the little black thing that you use to extend the wire. Take left hand and pull the catheter back VERY SLOW until good pulsatile flow is seen. Put wire through catheter. Slide catheter over wire.

Your success rate will climb if you use this lil' trick next time the wire doesnt thread.

Good luck.

 

[bubalus]

I use the through-and-through when things don't go easily. If you're using the new safety Arrow catheter, the wire can be pulled out the back end, if you'd rather have just the wire than the whole contraption.

 

[jetproppilot]

Been having a tough time getting brachial lines in. Any advice. I know the pulse is easily palpable but I tried in a couple of 400-pounders and failed. Any tricks from the experts?

Another thing to consider, Tough...in fat people, theres alotta tissue you go through (obviously) to get to the artery so for brachials you may wanna start with a longer catheter. That short Arrow (or angiocath if you use that route) will either kink or dislodge if theres too much distance between skin-entrance and the artery.

 

[urgewrx]

Another thing to consider, Tough...in fat people, theres alotta tissue you go through (obviously) to get to the artery so for brachials you may wanna start with a longer catheter. That short Arrow (or angiocath if you use that route) will either kink or dislodge if theres too much distance between skin-entrance and the artery.

I hope he is using the long brachial a-line kit.

 

[Planktonmd]

Been having a tough time getting brachial lines in. Any advice. I know the pulse is easily palpable but I tried in a couple of 400-pounders and failed. Any tricks from the experts?

Why don't you use the femoral A line kit with a simple seldinger technique?
Since I finished residency I did not have to do a brachial A line on any one, the rare occasions when I could not do a radial I either did dorsalis pedis or femoral.

 

[jetproppilot]

Why don't you use the femoral A line kit with a simple seldinger technique?
Since I finished residency I did not have to do a brachial A line on any one, the rare occasions when I could not do a radial I either did dorsalis pedis or femoral.

Put one in the anatomic-snuff-box the other day on a prone back case.

Another good little trick.

 

[toughlife]

Why don't you use the femoral A line kit with a simple seldinger technique?
Since I finished residency I did not have to do a brachial A line on any one, the rare occasions when I could not do a radial I either did dorsalis pedis or femoral.

Problems is that in the coronary ICU patients are getting ready to go to the OR and CT anesthesia likes left sided brachials for their cases so I usually like to get them in and it helps me to practice.

Usually the cards fellows end up doing the femorals since as an anesthesia intern we are not allowed to do those in their unit.

 

[toughlife]

I hope he is using the long brachial a-line kit.

interestingly enough, in the Cards ICU they don't stock those.

 

[urgewrx]

interestingly enough, in the Cards ICU they don't stock those.

Do they have the pediatric jugular kit? You can use that too.