Description #
This unit is intended for training of undergraduate, clerkship, and the first year of the core residency program in order to learn topographical anatomy and techniques for Arterial Access.
Learning Objectives #
At the end of this unit, students should be able to perform:
1) Arterial Puncture
2) Arterial Canulation
Overview #
It is difficult to define the basic surgical procedures and to have a general consensus as to which surgical procedures are to be considered basic. This chapter describes procedures that are simple to perform and that may be performed by family physicians or any MD regardless of their specialty. In this chapter, the theoretical basis of the procedures including indications, contraindications and complications are not discussed. This chapter describes the anatomical considerations and the techniques for the performance of the procedures.
Contents #
Arterial Puncture
Topographical Anatomy
Technique
Arterial Cannulation
Topographical Anatomy
Technique
Arterial Puncture #
Arterial puncture is performed for blood gas analysis, arterial blood pressure monitoring or delivery of drugs and contrast materials. Arterial puncture is best performed on femoral or radial arteries.
Techniques:
- Provide aseptic conditions.
- Palpate the pulse on the artery (location of the artery) (Figures 6.6a – 6.6b).
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- Insert the needle above the artery through the skin with bevel up, just under the palpated pulse. The femoral vein is located medially and the femoral artery is lateral to the vein in the femoral triangle just beneath the inguinal ligament (Figure 6.7).
- When blood appears in the needle, withdraw from the artery to the syringe (Figure 6.8). In the case of monitoring, push a Teflon catheter into the artery.
- Fix the catheter with adhesive plaster or a suture (Figure 6.9).
- Fix the needle with adhesive plaster by crossing and wrapping the needle at the hub before the junction with the IV set (Figure 6.10).
Arterial Puncture Video: #
Arterial Cannulation #
Arterial cannulation is mainly used for direct monitoring of blood pressure, cardiac and coronary artery catheterization, multiple arterial blood gas measurement, selected anesthetic procedures, and others.
The preferred sites for arterial cannulation are:
- Radial artery
- Ulnar artery
- Brachial or axillary arteries
- Femoral artery (Figure 6.72 – 6.73).
- Dorsalis Pedis artery
1- Percutanous Cannulation Technique
- Lay the patient in the supine position.
- Raise a skin wheal over the artery with local anesthesia.
- Prepare the site of cannulation with anti-septic solution.
- Identify the pulse (Figure 6.74).
- Insert a 14-16 gauge needle with a Teflon catheter into the artery (Figure 6.75). Once the needle is in the artery, advance the catheter and remove the needle. Connect the catheter with the arterial line to the pressure transducer and monitoring system.
- When Atrial Catheterization is Required:
- Introduce a J-wire through the Teflon catheter into the artery and remove the Teflon sheet (Figure 6.76).
- Make a 1-2 mm cut in the skin adjacent to the guidewire with the tip of an #11 scalpel blade.
- Pass the dilator over the guidewire to dilate a tract for insertion of the catheter.
- Remove the dilator and pass the catheter, with introducer inserted through it, over the guidewire as described in venous catheterization (Figure 6.77).
- The port is fixed and is ready to be used for the introduction of the long special catheter.
The most common site of arterial puncture is the radial and femoral arteries.
2- Direct Cannulation Technique
The direct technique is usually used in experimental conditions or for intra-operative procedures.
- For the direct technique, dissect the artery and pass two ties or umbilical tapes proximally and distally to the area designated for catheterization (Figure 6.78-6.79).
- Pass the ties or umbilical tape through a rubber tube (Figure 6.80 – 6.81).
- Pull the distal snare down and secure it with the help of a mosquito clamp in order to close the artery and interrupt the flow distally (Figure 6.82).
- Introduce a 14-16 gauge needle with a Teflon sheet into the artery proximally (Figure 6.83).
- Pull the second snare on top of the catheter to interrupt the leakage around the catheter.
- Connect the catheter to the pressure line (Figure 6.84).
- Tie and secure the line and the catheter with a silk tie to the distal rubber tube (Figure 6.85).
Arterial Cannulation Video: #
NB: Direct technique for arterial cannulation is used very rarely. It is mostly an experimental procedure.