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Pediatrics
Vascular AccessPART DEUX: Arterial Catheterization
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Objectives
•By the end of this workshop, the learner will be able to:
‐Recall at least 3 indications and 3 contraindications for arterial catheterization
‐Name at least 5 complications associated with arterial catheterization
‐Describe the anatomic landmarks used to guide arterial catheterization at specified sites of insertion
‐ Identify the potential sites for arterial catheterization
‐Choose the appropriate sized vascular catheter according to the patient’s size
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Indications
•Arterial blood sampling
‐Oxygenation
‐Ventilation
•Frequent blood sampling
•Continuous monitoring of blood pressure
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Contraindications
•Known deficiencies of collateral circulation
•Infection at site of insertion
•Trauma injury
•Coagulopathy
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Complication
•Arterial spasm
•Thrombosis
‐Mottling proximal/distal to catheter site
•Emboli
•Hemorrhage
‐Axillary sheath hematoma
•Infection
‐Low incidence
•Skin necrosis
•Fistula
•Aneurysm
•Brachial plexus injury
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Sites of insertion
•Radial/Ulnar
•Axillary
•Dorsalis pedis
•Posterior tibial
•Femoral
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•Anatomy
•Surface Landmarks
•Positioning
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Radial
•Most common site
•Lies in longitudinal groove formed by FCRM and distal radius
•Check for collateral flow
•Thrombosis is common
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Axillary
•Large artery
•Excellent collateral flow
•Air/thrombus embolism can cause brain/hand ischemia
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Femoral
•Also large artery
•May still be palpable with marked hypotension
•Lack of collateral flow
•Air/thrombus embolism can cause foot/toe ischemia
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Dorsalis pedis
•Descends down dorsum of foot parallel & lateral to EHLT
•Check for collateral flow
‐Occlude artery
‐Blanch great toe for several seconds
‐Release pressure & observe for flushing
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Posterior tibial
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•Confirm via pressure transduction
•Tubing used for pressure monitoring should include a Luer-lock design
•Papaverine-containing heparin solution prolongs arterial catheter life
•If you cannot transduce……
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TAKE IT OUT!!!
TAKE IT OUT!
TAKE IT OUT!!
