God I hate a-lines. Can't do them. Can easily feel the pulse anywhere, can't stick the damn artery. I'd rather do a peripheral IV than an a-line. I can drop a central line in less than a minute in most cases, but damn those a-lines!
Ahem. Anyway...our county hospital still uses Swans whenever there's an unclear fluid status situation...and some of the cardiac patients get them intra-op. But other than that, they do indeed seem to be falling out of favor.
(1) ABGs, no problem. But a-lines for some reason...just impossible. I'm actually more likely to get a DP one than a radial one.
I can usually get radial lines relatively quick if the patient has a pulse. I think it has less to do with skill, and more to do with an absolute refusal to allow Anesthesia to be better than me at a procedure
that we share.
Still, on the difficult ones, I've found that
ultrasound is an excellent tool. You can see the radial artery pulsating, and can cannulate it under direct visualization. I especially like to use this when the patient's wrist already looks like a pincushion from previous attempts/ABGs/etc.
I swear, once you use ultrasound on a tough one, and it works,
you'll be sold.
As for the DP lines, I don't have that skill in my repertoire, but one of our CC attendings that trained at your program likes to do them....
Overall, I've encountered tons of people who just can't get art lines despite being very technically skilled, and I totally understand. It's funny when you do a radiocephalic fistula for the first time and see how small that artery is...all the struggles to cannulate it start to make sense.
Of course, you can always go to the groin......
