Common sites for placement include the radial, brachial, axillary, pedal, and femoral arteries the radial, femoral, and axillary sites are the most frequently cannulated. Site selection is the first consideration for arterial cannulation.
#Heart monitor lines manual
Sequential manual replacement of each element is indicated to systematically troubleshoot the electronic components.
Errors in zeroing the transducer will not result in the desired pressure equilibration this may occur from technical difficulty related to user error or from electronic difficulty due to the phenomenon of “zero drift.” Zero drift is, literally, electronic malfunction of the transducer, transduction cable attached to the monitor, or of the monitor itself, which results in artificial offset of the arterial waveform from the zero line. Once this is done, the pressure tracing should rest on the zero line of the monitor and a pressure value of zero should be demonstrated. This provides the transducer with a pressure reference value (atmospheric pressure) against which intravascular pressure can be measured. Zeroing of the transducer is accomplished by opening a stopcock located proximal to the transducer to ambient air, followed by pressing the “zero” button on the bedside monitor. Proper monitoring of arterial waveforms requires positioning, calibration, and zeroing of the transducer system in order to prevent false elevations in blood pressure measurement or artificial dampening of the waveform. 1 The modern practitioner requires adequate knowledge of new technologies and data interpretation in order to effectively use these new modalities to enhance patient care and delivery. 1, 3 These remain compelling indications for placement of arterial catheters, however technological advances in contemporary design of catheter and monitoring systems now allow arterial lines to be used for more advanced hemodynamic monitoring, including real-time calculation of cardiac output, stroke volume, and evaluation of fluid responsiveness in suspected hypovolemic states. Historically, the indications for placement of arterial lines included: (1) continuous beat-to-beat monitoring of blood pressure (2) frequent sampling of blood for laboratory analysis and monitoring of ventilatory impairment (3) arterial administration of drugs such as thrombolytics and (4) use of an intra-aortic balloon pump. However, in critically ill and hemodynamically unstable patients indirect techniques may underestimate blood pressure 1 thus the need for more intensive blood pressure monitoring via arterial catheterization may be beneficial. In the majority of hospitalized patients, non-invasive indirect monitoring of blood pressure by auscultation of Korotkoff sounds is sufficient. This chapter will review general principles of arterial line placement, monitoring, and care. 1, 3, 4, 5 Newer technologies for hemodynamic monitoring such as measurement of stroke volume variation and cardiac output are also facilitated by the presence of an arterial line. Arterial line placement remains a readily acceptable intervention for unstable patients requiring continuous monitoring of blood pressure, frequent blood sampling, and blood gas analysis.
1, 2, 3, 4 Although arterial catheterization was traditionally performed by physicians, contemporary practice in many organizations allows credentialing for this procedure to be performed routinely by nonphysician providers including nurse practitioners, certified registered nurse anesthetists, and physician assistants. It is generally considered to be a safe procedure with few serious complications and a major complication rate ranging between 1% and 5%. Arterial catheterization is one of the most frequently performed invasive procedures performed on critically ill patients.
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