Cost of an Arrow A line catheter?

[RickKane]

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Does anyone happen to know what an Arrow A line catheter costs?

I'm just curious because I just saw about 6 of them wasted before the ICU attending thought it would be a good idea to stop mutilating the patient and break out the US.

I don't know, it just seems wasteful to burn threw those bad boys without asking for help or grabbing an U/S. I would have chimmed in with my two cents but I am rounding with Cards (just 4 more weeks of this medicine BS) and didn't think it was my place.

 

[SleepIsGood]

Does anyone happen to know what an Arrow A line catheter costs?

I'm just curious because I just saw about 6 of them wasted before the ICU attending thought it would be a good idea to stop mutilating the patient and break out the US.

I don't know, it just seems wasteful to burn threw those bad boys without asking for help or grabbing an U/S. I would have chimmed in with my two cents but I am rounding with Cards (just 4 more weeks of this medicine BS) and didn't think it was my place.

Stuff happens.

My little grasshopper, that guy may be you in 4 weeks! 😉😉

Congrats on finishing medicine.

 

[Bertelman]

Does anyone happen to know what an Arrow A line catheter costs?

Those six kits probably cost about as much as his daily lab assault, or one hour in the ICU. I wouldn't be too worried about that.

 

[proman]

$8 is what I've heard. 20 cents for the angio.

 

[seamonkey]

after 6 attempts on the same artery, i wonder what is left to find with the u/s, that thing may have spasmed down a bit

 

[Planktonmd]

You don't need any "kits" to start an A line!
All you need is a 20 gauge angiocatheter and some skills.

 

[RickKane]

You don't need any "kits" to start an A line!
All you need is a 20 gauge angiocatheter and some skills.

I hope I get to that point. Unfortunately, right now I need not only a kit but an act of divine intervention to get those suckers in there. After this intern year I feeling pretty comfortable with central lines and straight forward intubations but the A lines keep me up at night.

 

[Planktonmd]

I hope I get to that point. Unfortunately, right now I need not only a kit but an act of divine intervention to get those suckers in there. After this intern year I feeling pretty comfortable with central lines and straight forward intubations but the A lines keep me up at night.

There are some valuable tips about A lines in the FAQs of this forum.
Here is what I usually tell people:
Try to imagine where the artery is and feel it with the tips of your fingers.
Insert the 20 angiocath as if you are starting an IV (30-45 degrees), and when you get the flash of arterial blood don't get too excited, push the needle 1mm more and make sure you are still seeing pulsatile blood, it helps to have a 3cc syringe or the catheter cover attached to the needle ( my favorite) while you are doing that, now you can advance the catheter and you will be successful.
The most important factor to success is confidence and that applies to every procedure we do.

 

[urge]

You don't need any "kits" to start an A line!
All you need is a 20 gauge angiocatheter and some skills.

True.

The kit has some benefits, though. I'll let the residents look it up.

 

[aphistis]

I hope I get to that point. Unfortunately, right now I need not only a kit but an act of divine intervention to get those suckers in there. After this intern year I feeling pretty comfortable with central lines and straight forward intubations but the A lines keep me up at night.

I hated art lines for the first few months of residency. They took me longer to get any good at art lines than probably any other procedure. The good news for you is that I'm not even a real doctor, and I eventually figured them out (mostly, and it's definitely an ongoing work in progress); you'll get the hang of them just fine.

 

[pgg]

You don't need any "kits" to start an A line!
All you need is a 20 gauge angiocatheter and some skills.

Amen to that, except I think in the end the plain old Angiocath is an easier technique with a higher success rate. In some crusty old vasculopaths, it seems that wire is as likely to push the artery off the needle as it is to smoothly enter the lumen.

Everyone I know saw their success rate go up when they quit using the Arrow kits and started using plain old 20g angiocaths. There's a bit of a dip in success as they go from moderately capable with the Arrow, to poor with the Angiocath, to better and better.

 

[DrN2O]

I've tried the through-and-through with the angiocath. Big flash and worked like a charm. What's the difference from the arrow kit? Why couldn't I get a good flash with the kit? And can I use the kit for through-and-through?

 

[proman]

The outer diameter of the Arrow catheter is larger than the Angio (which is one reason why I think people have higher success rates with the Angio). You can still transfix with the Arrow.

 

[ProRealDoc]

There are some valuable tips about A lines in the FAQs of this forum.
Here is what I usually tell people:
Try to imagine where the artery is and feel it with the tips of your fingers.
Insert the 20 angiocath as if you are starting an IV (30-45 degrees), and when you get the flash of arterial blood don't get too excited, push the needle 1mm more and make sure you are still seeing pulsatile blood, it helps to have a 3cc syringe or the catheter cover attached to the needle ( my favorite) while you are doing that, now you can advance the catheter and you will be successful.
The most important factor to success is confidence and that applies to every procedure we do.

Agree with the 20G angio cath and NO wire. Using a wire is a sign of weakness.

 

[Planktonmd]

I've tried the through-and-through with the angiocath. Big flash and worked like a charm. What's the difference from the arrow kit? Why couldn't I get a good flash with the kit? And can I use the kit for through-and-through?

I don't understand why some people feel that they need to create 2 holes in the artery to insert a catheter!
You only need 1 hole.

 

[drmwvr]

Does anyone happen to know what an Arrow A line catheter costs?

I'm just curious because I just saw about 6 of them wasted before the ICU attending thought it would be a good idea to stop mutilating the patient and break out the US.

Don't know how much an arrow cath costs, but what you gain by using only one, you more than lose using U/S instead of a doppler. Just as good for an a-line.

 

[urge]

Amen to that, except I think in the end the plain old Angiocath is an easier technique with a higher success rate.

Would you care to describe the mechanics behind that?

Disclosure: I think it is in your head.

 

[anesthesiadoc]

Agree with the 20G angio cath and NO wire. Using a wire is a sign of weakness.

Call me weak, then. We're trained with the kit and a wire and we do pretty well at our hole in the wall residency program. 😉

 

[seinfeld]

THis is like the miller versus Mac debate. Both have their + and -'s . After working in the ICU for the past year cleaning up after residents unable to get lines, i have become adept at using the US for proximal forearm alines. What i have noticed is that the arrow catheters tend to displace the artery more frequently than the plain old angiocath. My hypothesis is that the cutting edge of the angio cath is better and therefore tends to enter calcified arteries better. Just a theory though.

The more i have used US the less i tend to mess around with multiple attempts b4 pulling out the sonosite.

 

[pgg]

Would you care to describe the mechanics behind that?

Disclosure: I think it is in your head.

Back when I'd use the Arrow kit, occasionally I'd get sticks with excellent flash, pumping blood coming up the kit ... and the wire wouldn't thread. Or the wire would appear to thread, but the catheter didn't get in the vessel.

My suspicion is that attempting to pass a wire into a crusty old vasculopath's dirty radial artery has a non-zero chance of getting caught up on some gunk, and doing nothing more than pushing the artery off the tip of the needle. Blam, perfectly good stick ruined by a wire.

You put the tip of the angiocath in the vessel, you slide it off. Wires are just one more thing that can go wrong.

And of course one thing that's surely not in my head is that using the Arrow kit will cost more than the angiocath. But use what works for you; no skin off my back. 🙂

 

[maceo]

THis is like the miller versus Mac debate. Both have their + and -'s . After working in the ICU for the past year cleaning up after residents unable to get lines, i have become adept at using the US for proximal forearm alines. What i have noticed is that the arrow catheters tend to displace the artery more frequently than the plain old angiocath. My hypothesis is that the cutting edge of the angio cath is better and therefore tends to enter calcified arteries better. Just a theory though.

The more i have used US the less i tend to mess around with multiple attempts b4 pulling out the sonosite.

how does the sonosite work. DO you watch the needle go into the artery with the ultrasound? and then watch the catheter being thread

 

[seinfeld]

how does the sonosite work. DO you watch the needle go into the artery with the ultrasound? and then watch the catheter being thread

I use it out of plane. I visualize entry into the middle of the artery then i usually use a wire at that point to assist with threading once a see good blood return.

 

[LovelyRita]

I take the Arrow, go through and through, remove the needle/wire, advance the wire thru the needle so I can see it, pull back the cath, then when I get arterial flow I use the arrow wire. advance cath and done. and I secure with "skin prep" or tinc of benz, steris, and a tegaderm. and then tape.