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Peripheral Arterial Lines

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Sites for Peripheral Artery Catheters

  1. Radial artery
  2. Posterior tibial artery
  3. Ulnar artery
  4. Dorsalis pedis

Specific Complications

  1. Thromboembolism/vasospasm/thrombosis
    • compromise of circulation leading to blanching and possible necrosis or gangrene of tissues and extremities.
    • emboli.
  2. Damage to peripheral nerves:
    • median
    • ulnar
    • posterior tibial

Insertion and securing of a Peripheral Arterial Line

  1. Peripheral arterial line is inserted using a 24 gauge cannula.
  2. When Dr/NS-ANP has the cannula inserted, attach a BC561 and then a 3-way tap followed by a transducer set.
  3. Nurse then tapes the cannula in place with splint.
  4. Calibrate transducer and commence continuous BP measurements.

Set Up for Peripheral Arterial Line

Peripheral arterial line

Management of a Peripheral Arterial Line

The following are checked at beginning of the shift and throughout the duty to ensure safety of baby is maintained and to minimise complications:

  1. Use cannula for sampling only.
    • No parenteral feeding.
    • No drugs.
    • No blood administration.
    Use heparinised saline only.
  2. Elevate and support limb gently to prevent back flow of blood.
  3. Do not position limb in an unnatural position as this may cause damage to joint and underlying nerves.
  4. Check colour and circulation of site and extremities. Any compromised circulation must be reported to the Doctor/NS-ANP/CCN immediately.
  5. Ensure no air bubbles are in the line.
  6. Ensure the site and extremities are exposed so that circulation can be monitored.

Blood Sampling from all Peripheral Arterial Lines

  1. Use 1ml or 2ml syringe and shrouded needle to remove 1ml of fluid/blood to clear line using sample port.
  2. Withdraw required amount of blood using blood gas syringe and 1ml syringe if further blood tests required.
  3. The 1ml of blood/fluid withdrawn to clear the line is not to be returned via the peripheral arterial line. If IV Luer is available return this fluid via peripheral IV. If not, discuss with the medical staff/NS-ANP - it may hae to be discarded. This will extend the life of these peripheral IA lines.
  4. Gently and slowly flush line with hep saline using a 2ml syringe.

Removal of Peripheral Arterial Catheter

  1. Withdraw peripheral arterial catheter.
  2. Apply pressure to site for 5 minutes ensuring circulation to hand/foot is maintained.
  3. Then check to see if bleeding has stopped. If it hasn't continue applying pressure for further 2-3 minutes before checking again.
  4. Cover site with a small piece of sterile cotton wool and tape.
  5. Document that peripheral arterial line has been removed in the following places:
    • observation chart
    • multidisciplinary notes.

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Document Control

  • Date last published: 31 October 2006
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years