Arterial Lines
1 unit/cc of heparin, take air out of IV bag first. Must have line open to air in order to zero.
risks: thrombosis/embolism, distal ischemia, infection
the brachial artery has much higher rates of thrombosis
can use radial, ulnar, axillary, dorsalis pedis, femoral,
upper extremity wave form has a dichrotic cleft
SPV systolic pressure variation examines the min to max variation is one respiratory cycle. The change down pressure is the 1st drop with inspiration. The change u
A significant change down=inadequate preload, no change down =CHF
dominant change up=CHF or hypervolemia
In conclusion, there is no significant difference between heparinized and nonheparinized flush solutions for the maintenance of perioperative radial artery catheter patency. (Anesth Analg 2005;100:1117-1112)
and ICU a-lines (Intensive Care Medicine 1432-1238Volume 34, Number 2 / February, 2008)
MA of ultrasound showed benefit (Chest 2011;139;524-529)
Trick from Anaesthesia 2010
In patients on vasopressors, radial arterial lines underestimate central arterial pressure (I would posit the same phenomena in sick vasoconstricted trauma patients) (Crit Care Med 1998;26:1646)
In stable critically ill patients, non-invasive matches a-lines at arm and ankle (Crit Care Med. 2012 Apr;40(4):1207-13.)
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Extracorporeal Support (ECMO) and Bypass
Two modes
venousarterial provides cario and pulmonary support
venous-venous provides only respiratory support
venous-venous is usually done with inflow to pump from IVC and blood retrun via the femoral vein
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