I'm having trouble knowing when an arterial line would be indicated. I know: during CPB, when wide swings in blood pressure are expected, when rigorous control of BP is necessary, and when there is a need for ABG measurements throughout the surgery. But I don't have enough OR experience to really apply that. Given the following scenarios, I need to determine whether or not an art-line is indicated.
1. healthy 23 yo s/p MVA with closed head injury for ORIF of acetabulum.
-- My thoughts: ORIF of acetabulum typically results in extensive bloodloss. With a closed head injury, you'd want to maintain the BP in a narrow range so as not to develop BP that is too high and may cause further damage or too low which may cause hypoxemia and further damage. Thus, I would think an A-line is indicated. I'm thrown off by the "healthy 23 yo," though.
2. 74 yo with stable angina for sigmoid colectomy.
--- Continuous intra-arterial pressure monitoring can reduce the risk of hemodynamic events by early identification of problems. Rapid changes in hemodynamics can quickly lead to cardiac arrest. With that in mind, I would think yes, it is safer to place an A-line. But, a colectomy is not typically associated with great amounts of blood loss, so maybe he does not need it.
3. 34 yo with morbid obesity for partial gastrectomy
--- Gastrectomy surgery may result in great blood loss and variation in electrolytes. Additionally, the pt is morbidly obese so he/she likely already has chronic resp acidosis. Thus, I think to measure ABGs and monitor BP continuously, an A-line is indicated.
4. Healthy 18 yo for lumbar fusion with expected EBL of 1000 cc.
--- Significant amount of blood loss, but patient is young and healthy and likely can tolerate brief hypotension. As the hypotension is anticipated, the patient can be given fluid pre-operatively and if necessary blood during the surgery. Because we would follow his/her hematocrit to guide whether or not to give blood products, an A-line may be indicated.
Surely an A-line is not needed in all of these procedures. I would appreciate any and all guidance on determining whether or not an A-line is indicated in those situations.
1. healthy 23 yo s/p MVA with closed head injury for ORIF of acetabulum.
-- My thoughts: ORIF of acetabulum typically results in extensive bloodloss. With a closed head injury, you'd want to maintain the BP in a narrow range so as not to develop BP that is too high and may cause further damage or too low which may cause hypoxemia and further damage. Thus, I would think an A-line is indicated. I'm thrown off by the "healthy 23 yo," though.
2. 74 yo with stable angina for sigmoid colectomy.
--- Continuous intra-arterial pressure monitoring can reduce the risk of hemodynamic events by early identification of problems. Rapid changes in hemodynamics can quickly lead to cardiac arrest. With that in mind, I would think yes, it is safer to place an A-line. But, a colectomy is not typically associated with great amounts of blood loss, so maybe he does not need it.
3. 34 yo with morbid obesity for partial gastrectomy
--- Gastrectomy surgery may result in great blood loss and variation in electrolytes. Additionally, the pt is morbidly obese so he/she likely already has chronic resp acidosis. Thus, I think to measure ABGs and monitor BP continuously, an A-line is indicated.
4. Healthy 18 yo for lumbar fusion with expected EBL of 1000 cc.
--- Significant amount of blood loss, but patient is young and healthy and likely can tolerate brief hypotension. As the hypotension is anticipated, the patient can be given fluid pre-operatively and if necessary blood during the surgery. Because we would follow his/her hematocrit to guide whether or not to give blood products, an A-line may be indicated.
Surely an A-line is not needed in all of these procedures. I would appreciate any and all guidance on determining whether or not an A-line is indicated in those situations.
