Where should arterial lines be placed?
The initial puncture site for radial arterial cannulation should be as distal as possible on the wrist. A common location is over the radial pulse at the proximal flexor crease of the wrist.
Where should the tip of a femoral line be?
The desired point of femoral vein puncture is 1 to 2 cm inferior to the inguinal ligament. Bleeding due to a vascular impalement here can be controlled by externally compressing the vessels against the femoral head. The retroperitoneal space lies superior to the inguinal ligament.
Where is the femoral artery location?
thigh
The location of the femoral artery is at the top of your thigh in an area called the femoral triangle. The triangle is just below your groin, which is the crease where your abdomen ends and your legs begin. The femoral artery runs to the lower thigh and ends behind the knee.
When should an arterial line be placed?
Indications for placement of arterial lines include: (1) continuous beat-to-beat monitoring of blood pressure in hemodynamically unstable patients, (2) frequent sampling of blood for laboratory analysis, and (3) timing of intra-aortic balloon pump with the cardiac cycle.
What is the procedure for placing an arterial line?
Palpate the radial artery to determine its location. Clean the skin with antiseptic solution, arrange sterile drape, and inject anesthetic. Step 3. With a one-piece catheter-over-the-wire, puncture the artery and insert the cannula in a continuous motion at an approximately 45-degree angle (Figure 1).
How do you perform femoral cannulation?
Hold the catheter near its tip and insert the tip through the skin. Then, in increments of several centimeters and using a corkscrew motion as necessary, stepwise advance the entire length of the femoral catheter. Maintain your grasp on both the guidewire and the catheter.
Where do you puncture a femoral vein?
Use your index and middle fingers to locate the distal and proximal pulsations of the femoral artery, respectively. Just medial to your fingertips should be the general course of the femoral vein. Hence, you should puncture just medial to your index finger in a direction just medial to your middle finger.
Can you feel your femoral artery?
Cover the genitalia with a sheet and slightly abduct the thigh. Press deeply, below the inguinal ligament and about midway between symphysis pubis and anterior superior iliac spine. Use two hands one on top of the other to feel the femoral pulse.
How do you suture an arterial line in place?
Securing the Line
- Suture the line in place.
- Tips: Consider taping transducer tubing to thigh to help hold line in place. Take a generous bite through skin just underneath the distal portion of the catheter. Tie over top of the catheter and cut suture.
- Add biopatch and place a sterile dressing.
What are two indications for placement of an arterial line?
Which is the best location for a femoral artery puncture?
High cannulation above the inguinal ligament (in the external iliac artery) is associated with an increased risk of retroperitoneal hemorrhage due to lack of an underlying bony structure preventing effective compression and tamponade The optimal location for femoral arterial puncture is best assessed from prior femoral angiograms when available.
Is there an absolute contraindication for femoral artery access?
There is no absolute contraindication for femoral access. However, caution must be exercised and alternative routes considered in the following circumstances: Absent or weak femoral artery pulse (consider contralateral femoral artery, radial access, or use of SMART needle or ultrasound guided femoral access as described below)
How are patients selected for femoral arterial access?
Patient selection is geared toward identifying the need for the procedure, identifying the presence of features that may potentially make femoral access a less attractive option, identifying factors that require pretreatment (contrast allergy, chronic kidney disease, etc.) and recognizing complications of a prior procedure.
Which is the easiest site to cannulate an arterial line?
The femoral artery site is arguably the easiest to cannulate and provides an easy access in an emergent situation, but carries the highest risk for infection. Additionally, femoral catheterization severely limits mobility and may prevent ambulation in the alert patient.