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How To Succeed At Arterial Line Insertion (Anatomical Landmark-Guided)

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Ki-Jinn Chin

Radial arterial cannulation is a core skill in anesthesiology, intensive care, emergency medicine, and other acute care specialities. This video summarizes key principles for success with the anatomical landmarkguided (LMG) technique while minimizing complications.
These include: (1) developing a tactile sense for locating the artery by palpation; (2) accurate alignment during cannula advancement; (3) adopting an appropriately shallow trajectory to avoid transfixion (which increases risk of complications such as hematoma, thrombosis, etc); (4) confirming intraluminal cannula placement before attempting to thread it in.
Ultrasound guidance may still be needed to rescue difficult LMG arterial lines. Two common scenarios for this are presented: (a) anomalous superficial radial artery; (b) calcified radial artery. See a short guide to USGarterial lines here    • Essential guide to ultrasoundguided ...  
See also a superb discussion in the comments about rescuing failed attempts with transfixion, with great tips from ‪@mdkc‬ . These include (a) the importance of a flat trajectory (b) not withdrawing the stylet too far back into the cannula the rigidity that the stylet provides is needed for the floppy cannula to overcome the resistance/friction to advancement through the skin/tissues/arterial wall; it will buckle otherwise.

Chapters
00:05 Long vs short cannula
00:32 Position and taping
01:06 Line of sight insertion
01:44 Draping the hand
02:01 Palpation of artery
02:15 Insertion point
02:35 "Poke" vs "Puncture" point
03:07 Insertion trajectory
03:53 Advancing the cannula
04:25 Confirming intraluminal cannula tip placement
06:08 Connection of line tubing
06:45 Securing the cannula in place
07:39 Redirection to locate artery
08:24 Superficial radial artery
09:35 Calcified radial artery

posted by galactosa3b