Indications for Arterial Lines
Apr 23, 2024
Who needs an arterial line? As a perianaesthesia nurse, it’s handy to anticipate which patients will need one. Not only will this help you be prepared, it also demonstrates your awareness of case and patient complexity, which contributes to a shared mental model of care. 🧠✅
Here’s our guide: 👇👇
Strongly consider an arterial line:
1️⃣ Patient reasons
👉 Unstable cardiac condition
🔺 Unstable arrhythmia (eg. Rapid AF)
🔺 Severe valvular disease (eg Aortic stenosis)
🔺 Severe heart failure
👉 Pacemaker dependent patients
👉 Requiring titration of vasopressors
👉 Unknown severity of disease (eg. frail fractured hip)
2️⃣ Surgical reasons
👉 Major cavity surgery (eg. laparotomy/thoracic surgery)
👉 Intracranial surgery
👉 Possible significant blood loss (eg. placenta accreta)
👉 Trauma surgery
👉 Strict blood pressure targets (eg major flap surgery)
3️⃣ Anaesthetic team reasons
👉 Where rapid shifts in blood pressure are anticipated
🔺 Vascular surgery (eg. endovascular aortic surgery)
🔺 Neurosurgery
🔺 Liver surgery
🔺 Any surgery involving clamping of major vessels
👉 Where frequent blood sampling is required
🔺 Coagulopathy correction
🔺 Electrolyte correction
🔺 Sepsis/acidosis
🔺 Massive transfusion
👉 Where placement of an arterial in during a case may be difficult, and there is a chance you’ll need one:
🔺 Major prone/lateral surgery (eg. lumbar fusion)
🔺 Arms firmly wrapped (eg. robotic prostatectomy)
👉 Where there are concerns about the accuracy of non-invasive blood pressure monitoring.
🔺 Steep beach chair position
🔺 Arrhythmia
🔺 Patient size/shape of arms
The following situations are considered contraindications for arterial cannulation, however, these are rare and usually relating to a specific site of insertion.
Contraindications at the site:
1️⃣ Burns
2️⃣ Infection
3️⃣ Vascular abnormalities
4️⃣ Poor collateral perfusion
5️⃣ Haematoma
6️⃣ Poor flow demonstrated on doppler
Build knowledge ✅
Improve safety ✅
Ref: https://www.ncbi.nlm.nih.gov/books/NBK482242/
