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Arterial line insertion

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Insertion of Invasive Lines

  1. Invasive lines are often essential to the management of critically ill children, but are associated with significant morbidity so necessity should always be carefully considered and lines should  be removed as soon as they are no longer required.

  2. Risk of thrombotic and thromboembolic events are always present, especially with relatively large cannulae in small vessels.

  3. Always position patient carefully and appropriately before beginning the  procedure to maximise the chances of successful insertion.

  4. Always use adequate sedation and pain relief (consider use of local anaesthesia). 

  5. The patient will be hidden by sterile drapes and the operator concentrating on the technical procedure, therefore, ensure appropriate monitoring is in place  (HR, pulse oximetry and blood pressure cuff), before beginning procedure.

  6. In neonates with cardiac disease or diaphragmatic hernias consider the underlying anatomy before placing lines. For example, pre-ductal arterial lines  are appropriate in infants with diaphragmatic hernias and right radial arterial lines, and right subclavian venous lines should be avoided in those who are to receive a modified Blalock-Taussig Shunt.

  7. It is prudent to transduce the waveform of a catheter before drugs are infused  into the line. This is because, especially in cyanosed and hypotensive patients, it may not always be apparent by colour or force of ejection of the blood if the vein or the artery has been cannulated.

  8. When lines are inserted in a medical emergency and strict adherence to aseptic technique cannot be adhered to lines should be changed ASAP and within 48  hours.

  9. 2% aqueous chlorhexidine should be used for skin antisepsis.

  10. Maximal sterile barrier precautions include the use of cap, mask, sterile gown  and gloves and a large sterile drape.

  11. Standard sterile precautions involve the use of sterile gloves and small sterile  drape.

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Document Control

  • Date last published: 01 June 2004
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Intensive Care Unit
  • Owner: Dave Buckley
  • Editor: John Beca
  • Review frequency: 2 years