Guidelines for Arterial Cannula Use in Critical Care

Guidelines for Arterial Cannula Use in Critical Care

Arterial cannula is becoming increasingly prevalent in the critical care setting.arterial cannula It provides valuable information regarding the patient’s hemodynamic status and allows for accurate mean arterial pressure monitoring. It also enables blood sampling and evaluation of respiratory fluid responsiveness. Ultimately, the goal is to identify abnormal arterial waveform patterns and evaluate respirophasic variations that may predict the need for fluids.

The most common indication for arterial cannulation is monitoring of blood pressure; however, there are many clinical situations that warrant the invasive procedure.arterial cannula Indicators include significant burns, edema of the limb, comorbidities that preclude noninvasive blood pressure measurements such as diabetes or multiple fractures and patients who require frequent arterial blood samples.

Anterior femoral artery cannulation is considered in select cases where radial artery cannulation cannot be used due to the severity of the burn or limited skin integrity.arterial cannula It is not recommended for routine use due to the risk of complications such as hematoma and venous impalement.

Regardless of the anatomical site selected, the following recommendations should be adhered to during arterial catheterization:

1. Prepare for Cannulation

The patient should be prepared with a gown and sterile drapes. All equipment should be on a sterile tray and the patient should be positioned in a prone position.

2. Assess and Test

The clinician should test the cannulation device by gently stroking or pushing the insertion site. This helps to verify that the cannula will move freely through the skin. The clinician should also make sure the catheter is fully deflated, and a sterile swab is inserted into the insertion site.

3. Prepare to Insert

Assemble the required supplies and place them on a sterile catheter-over-wire (Seldinger) tray. Ensure that the J-curved end of the guidewire is within the introducer needle and use ultrasound guidance (either short or long-axis) to verify that the wire is entering the artery. Once the tip of the guidewire is in the artery, slowly advance the catheter over the wire until it is at least 8 to 10 cm within the artery.

4. Insert the Cannula

Insert the cannulation device with its bevel facing up directly over the radial pulse. Continue palpation to determine if the artery is being entered, avoiding making a skin bleb. As the cannula is advancing, the needle bevel should indent the superficial wall of the artery and cause a bright red flash of normal oxygenated blood in the reservoir or barrel of the cannulation device.

5. Maintain Steady Advancement

It is important to carefully maintain the steady advancement of the cannulation device until a blood flash is observed. If a flash does not occur, withdraw the device almost to the skin surface and change the angle and direction of insertion before trying again.

6. Monitor the Cannulation Site

It is vital to closely monitor the insertion site of an arterial cannula for signs of hematoma, infection and pain. If these complications occur, the arterial line should be withdrawn immediately on the ward to avoid further occlusion of the distal pulse.

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