ARTERIAL LINE & CENTRAL LINE

ARTERIAL LINE

What is an arterial line? An arterial line is a cannula usually

positioned in a peripheral artery such as Radial a. Dorsalis pedis a. Brachial a. Femeral a.

INDICATIONS FOR USING ARTERIAL LINE

Continuous monitoring of arterial blood pressure if patient is on

inotropic drugs if patient is on

vasoactive drug if patient requires

frequent arterial blood sampling

COMPLICATIONS ASSOCIATED WITH ARTERIAL LINES

HYPOVOLEMIA ACCIDENTAL INTRA-ARTERIAL

INJECTION OF DRUGS LOCAL DAMAGE TO ARTERY

THE ARTERIAL WAVEFORM

The arterial waveform reflects the pressure generated in the arteries following ventricular contraction and can be described as having:- Dicrotic notch Peak systolic

pressure Diastolic pressure

Arterial line tracing

Dampened: wide,flattened tracing Dampenning occcurs due to:

Air bubbles Over distensible tubing Catheter kinks Clot Low flush bag pressure

UNDERESTIMATE blood pressure

Resonant: spiked tracing

Due to Long, stiff ,non-complaint tubing Increase vascular resistance Non fully opened stopcock valve

OVERESTIMATE blood pressure If doubt: NIBP

Calibrate and balance transducer every 8h

เปรี�ยบเที�ยบกับ NIBP Flush สายด้ วย heparin ที�กั 1h สงเกัต อากัารีผิ�ด้ปกัต�เช่�น เลื�อด้ออกั อ�ณหภู�มิ�

สายหกั พับ งอ หลื�ด้

REMOVAL OF ARTERIAL LINE

THIS IS AN ASEPTIC PROCEDURE REMEMBER UNIVERSAL PRECAUTIONS THE PROCEDURE SHOULD BE EXPLAINED TO

THE PATIENT TAKE DRESSING OFF LINE REMOVE ARTERIAL LINE ENSURING THAT THE

ENTRY SITE IS COVERED WITH GAUZE APPLY DIGITAL PRESSURE FOR AT LEAST 5

MINUTES TO ENSURE HAEMOSTASIS DRESS SITE WITH GAUZE AND MICROPORE ASSESS THE PERIPHERAL CIRCULATION AS

THROMBOSIS CAN OCCUR AFTER REMOVAL

CENTRAL VENOUS PRESSURECVP

WHAT IS A CENTRAL LINE

It is a catheter that provides venous access via the superior vena cava or right atrium

COMMON CENTRAL LINE INSERTION SITES

Right internal jugular

left internal jugular right subclavian left subclavian femoral (as a last

resort)

Or peripherally inserted central catheters (PICC) which are inserted via the antecubital veins (basilic vein is the best) in the arm and is advanced into the central veins

TYPES OF CENTRAL LINE

SINGLE LUMEN Multilumen

CENTRAL LINES

Indications for CVP lines are:- fluid resuscitation Parenteral feeding measurement of central venous pressure poor venous access administration of irritant drugs

COMPLICATIONS FOLLOWING CVP LINE INSERTION

Malposition of the catheter

haematoma arterial puncture pneumothorax haemorrhage sepsis air emboli

Catheter embolism Thrombosis Haemothorax Cardiac

tamponade Cardiac

arrhythmias

CVP READINGS ARE USED:-

TO SERVE AS A GUIDE TO FLUID BALANCE IN CRITICALLY ILL PATIENTS

TO ESTIMATE THE CIRCULATING BLOOD VOLUME

TO ASSIST IN MONITORING CIRCULATORY FAILURE

CENTRAL VENOUS PRESSURE MONITORING

THIS IS A HELPFUL TOOL IN THE ASSESSMENT OF CARDIAC FUNCTION, CIRCULATING BLOOD VOLUME, VASCULAR TONE AND THE PATIENT’S RESPONSE TO TREATMENT

HOWEVER, CVP SHOULD NOT BE INTERPRETED SOLELY BUT IN CONJUNCTION WITH OTHER SYSTEMIC MEASUREMENTS, AS ISOLATED CVP MEASUREMENTS CAN BE MISLEADING

METHODS OF CVP MONITORING

There are two methods of CVP monitoring

manometer system: enables intermittent readings and is less accurate than the transducer system

transducer system:enables continuous readings which are displayed on a monitor.

MONITORING WITH TRANSDUCERS

Transducers enable the pressure readings from invasive monitoring to be displayed on a monitor

To maintain patency of the cannula a bag of normal saline or heparinised saline should be connected to the transducer tubing and kept under continuous pressure of 300mmHg thus facilitating a continuous flush of 3mls/hr

THE CVP WAVEFORM The CVP waveform reflects changes

in right atrial pressure during the cardiac cycle

NORMAL CVP MEASUREMENTS CVP monitoring should normally show

measurements as follows:

Mid Axilla: 0 - 8 mmHg (Woodrow 2000) -

5-12 cmH2O ,-5 to 15-25cm H2O can be normal (1 mmHg = 1.36 cm H2O)

An isolated CVP reading is of limited value; a trend of readings is much more significant and should be viewed in conjuncton with other parameters e.g. BP and urine output.

Reliability of CVP

1 Bedside test Free flow from Aspiration Rapid falling water column Fluctuation with respiration No fluctuation with heart rate

2 CVP waveform CXR ไมิ�ต�ากัว�า carina ไมิ�ส�งกัว�า head of

clavicle ไมิ�ออกัไปมิากักัว�า middle 1/3 clavicle

REMOVAL OF CENTRAL LINE

THIS IS AN ASEPTIC PROCEDURE THE PATIENT SHOULD BE SUPINE WITH HEAD

TILTED DOWN ENSURE NO DRUGS ARE ATTACHED AND

RUNNING VIA THE CENTRAL LINE REMOVE DRESSING CUT THE STITCHES SLOWLY REMOVE THE CATHETER IF THERE IS RESISTENCE THEN CALL FOR

ASSISTANCE APPLY DIGITAL PRESSURE WITH GAUZE UNTIL

BLEEDING STOPS DRESS WITH GAUZE AND CLEAR DRESSING EG

TEGADERM