Ultrasound-Guided Radial Arterial Line Placement

Ultrasound-Guided Radial Arterial Line Placement

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Here we're prepping with a chlorhexidine swab and we're doing a full sterile drape.  Notice that we have a wide sterile drape on this procedure just as we do with the central line.  Here's a sterile sheath that goes over the ultrasound probe.  The probe has been preset with non-sterile gel that is over the probe prior to the sterile sheath going over it.  We are drying up one percent sterile lidocaine.  Here we're applying the sterile rubber bands over the probe sheath to secure it and applying a sterile ultrasound gel.  This is 1 percent lidocaine for local anesthesia.

We're identifying the radial artery, first in the transverse plane, and when it's in the center of the ultrasound screen we're slowly rotating the probe to the longitudinal plane so that we are now seeing the radial artery in the longitudinal plane.  With the radial artery visualized in the longitudinal plane we are now inserting the radial artery needle that is now being visualized in an enplane technique that is going into the radial artery until we see a flash.  We're now inserting the wire over or through the needle and now advancing the catheter over the wire in a rotating motion.  We're going to use some gauze underneath the catheter and then using a sterile 4 x 4 gauze to grasp the tubing that is to the arterial line.  This is so that you don't mess up your sterile gloves.  We're screwing the arterial tubing to the catheter.

Now we go to take a straight needle connected to 2-0 silk suture to secure the catheter to the skin.  We're inserting the needle through a section of the skin that is adjacent to a groove in the catheter.  We will then run the blunt end of the needle lateral to medial underneath the groove of the catheter several times and then we will tie the suture securing the catheter to the skin.  Here we are securing the suture onto the catheter.  At this point we're applying a bio-patch with the blue side of the patch oriented towards the ceiling.  This is a patch that's impregnated with chlorhexidine to minimize the risk of a catheter related bloodstream infection.  Now a sterile occlusive dressing is being applied over the bio-patch and the catheter.  And the procedure is complete.