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Ott 22, 2021

Arterial catheterization: accesses and positioning techniques

Arterial catheterization refers to the introduction of a cannula or catheter into a palpable artery. This allows continuous measurement of blood pressure (systolic, mean and diastolic) and to take blood samples to carry out a blood gas analysis.

This procedure is mainly used in the intensive care, sub-intensive care, and operating room settings.

In this article, we see more details about arterial catheterization, on accesses and on catheter placement techniques.

Arterial catheters and choice of insertion site

An arterial catheter is usually inserted in the radial or femoral artery, but access can also be possible via the ulnar, pedicle, axillary, or brachial artery.

Through arterial catheterization it is possible to:

  • blood gas control in subjects with respiratory insufficiency undergoing artificial ventilation;
  • hemodynamic control in patients undergoing cardiovascular drug therapy, to evaluate its effects;
  • invasive hemodynamic control during and/or after the execution of complex, long and bleeding surgery;
  • determination of cardiac output, through the analysis of the pressure wave.

In the choice of the insertion site, several factors must be evaluated, not only from the point of view of comfort and safety, but also with regard to the management of antisepsis, the presence of other catheters, the presence of any anatomical deformations and the risk of mechanical complications (eg, bleeding).

Below, we see what are the advantages and disadvantages related to access via radial and femoral artery:

  • radial artery. Advantages: it is superficial, easy to recognize and cannulate. Accessible site during many types of surgery, comfortable for the patient and easy to fix. Low risk of distal vascular insufficiency. Disadvantages: possible thrombus formation after prolonged placement. Hematoma or puncture trauma to adjacent radial nerve may occur during insertion. The diameter of the artery requires a smaller catheter size, and it is more prone to thrombotic phenomena or occlusion and over-tensioning of the pressure wave;
  • femoral artery. Advantages: indicated for longer use, palpable even in a shock setting when other peripheral arteries are not detectable. A larger diameter catheter with higher frequency response can be used. Infections and thrombosis are very rare. Disadvantages: presence of atherosclerotic plaque, making catheter passage or placement difficult. Possibility of retroperitoneal hematoma, frequent at removal. Difficult to fix, especially in agitated patients. This artery is contraindicated in aorto-femoral vascular surgery.

Arterial catheterization: placement techniques and Delta Med devices

Arterial catheter placement can be performed by direct technique (with short catheter) or Seldinger technique (with catheter between 10 and 25 cm).

In adults, catheter access is preferred in the upper extremities (usually radial artery) compared with the lower ones, which are associated with a higher risk of complications.

Before arterial puncture, it is important to assess blood flow to the hand and fingers, particularly the patency of the ulnar and radial artery. Through Allen's test, which does not require special instruments or devices, it is possible to verify the integrity of the collateral circulation of the hand (for further information, you can read the dedicated article here).

During the placement of the catheter in the radial artery, the arm must be fixed with the hand in extension. In addition, it is recommended to fix the arterial catheter in such a way as to keep it well stable.

Another aspect to be considered, for an optimal procedure, is the use of effective devices, made of Teflon or Pebax, which allow to:

  • optimally detect the pressure wave during the entire patient monitoring phase;
  • have different configurations, diameters and sizes, depending on the needs.

Delta Med's Alfacath line of arterial catheters is designed to ensure safe, complication-free and puncture-free positioning of peripheral arteries.

To learn more, contact us without obligation to get more information from one of our professionals.

 

sources:

Dossier Infad - Informazioni dalla letteratura scientifica per una buona pratica infermieristica (anno 3, n. 37).

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