Funny this thread came up. Today I couldn't get my first a-line in a month of 2-3/day (cardiac rotation). I was feeling good after ~40-50 in a row, not exactly cocky, but well on my way. 🙂 Typical vasculopath trainwreck for CABG, though no explicit history of PVD.
I use the 20g 1.88 in angiocaths without a wire. (Dislike the long Arrow kits, and only use wires to rescue the occasional failed direct attempts.) Today was frustrating - first stick, right in the artery, great flash. Figured it would be another 30-seconds-til-tape a-line start. Catheter wouldn't advance easily so I went through & through. Got a wire, pulled back until I had pulsatile flow again - strong spurts. Could not thread the wire to save my life.
2nd attempt, exact same problem. Attending starts working on the other side. Over the next 15 minutes, total of 5 good arterial hits from the two of us. He also used the 20 g angiocath, also couldn't thread it, also couldn't get a wire to pass despite pulsing return. Now her radial pulses are a bit thready so we figure vasospasm is making things worse.
We ended up putting in a brachial art line.
I've never used the spin-180 technique, but I think I'll do my next 20 or 30 that way. Don't know if it would have made a difference in this patient's crusty arteries, but I'm hoping it'll reduce the number of attempts I need to rescue with wires.