2. Page 2
xxx00.#####.ppt 07/16/13 02:16 AM
Pediatrics
Objectives
•By the end of this workshop, the learner will be able to:
‐Recall at least 3 indications and 3 contraindications for
arterial catheterization
‐Name at least 5 complications associated with arterial
catheterization
‐Describe the anatomic landmarks used to guide arterial
catheterization at specified sites of insertion
‐Identify the potential sites for arterial catheterization
‐Choose the appropriate sized vascular catheter according to the
patient’s size
4. Page 4
xxx00.#####.ppt 07/16/13 02:16 AM
Pediatrics
Contraindications
•Known deficiencies of collateral circulation
•Infection at site of insertion
•Trauma injury
•Coagulopathy
8. Page 8
xxx00.#####.ppt 07/16/13 02:16 AM
Pediatrics
Radial
•Most common site
•Lies in longitudinal
groove formed by FCRM
and distal radius
•Check for collateral flow
•Thrombosis is common
9. Page 9
xxx00.#####.ppt 07/16/13 02:16 AM
Pediatrics
Axillary
•Large artery
•Excellent collateral flow
•Air/thrombus embolism
can cause brain/hand
ischemia
10. Page 10
xxx00.#####.ppt 07/16/13 02:16 AM
Pediatrics
Femoral
•Also large artery
•May still be palpable
with marked
hypotension
•Lack of collateral flow
•Air/thrombus embolism
can cause foot/toe
ischemia
11. Page 11
xxx00.#####.ppt 07/16/13 02:16 AM
Pediatrics
Dorsalis pedis
•Descends down dorsum
of foot parallel & lateral
to EHLT
•Check for collateral flow
‐Occlude artery
‐Blanch great toe for several
seconds
‐Release pressure &
observe for flushing
13. Page 13
xxx00.#####.ppt 07/16/13 02:16 AM
Pediatrics
•Confirm via pressure transduction
•Tubing used for pressure monitoring should include
a Luer-lock design
•Papaverine-containing heparin solution prolongs
arterial catheter life
•If you cannot transduce……
xxx00.#####.ppt 07/16/13 02:16 AM P. Text Text Text Text
xxx00.#####.ppt 07/16/13 02:16 AM P. Text Text Text Text
Thrombosis and emboli can lead to ischemia and necrosis but is dependent on adequacy of collateral flow Thrombosis longer duration and size of cath relative to arterial lumen diameter leads to greater incidence of thrombosis. Also increased incidence w/repeated punctures and intermittent flushing Emboli More common w/manual intermittent flushing Skin necrosis Prox to radial art insertion site, blood supply to to skin of distal forearm arises directly from branches of rad art. w/o ANY collateral circulation. If cath tip interferes w/these branches then ischemia to skin occurs Prevention: 1) most distal insertion site 2) smallest sized catheter so as to cause the least amt of luminal obstruction 3) prolonged catheterization xxx00.#####.ppt 07/16/13 P.
Brachial artery not recommended due to absence of collateral circulation xxx00.#####.ppt 07/16/13 P.
Palpate artery just prox to radial head Insert needle about 30 degrees to surface of skin Dorsiflex wrist for insertion then place in neutral position Suture 3-0 silk The Modified Allen's Test has been the most frequently used method to clinically assess adequacy of ulnar artery collateral flow despite the lack of evidence that it can predict ischemic complications in the setting of radial artery occlusion. xxx00.#####.ppt 07/16/13 P.
Hyperabducted & externally rotated 90 degrees from pt’s body Insert needle just parallel to lateral edge of pectoralis major muscle xxx00.#####.ppt 07/16/13 P.
Positioned similarly as for CVC 2cm below inguinal ligament 3 fingers along pulse, index/middle/ring finger, insert in between index and middle finger Insert at 45 degree angle Puncture over maximal pulsation xxx00.#####.ppt 07/16/13 P.
mid plantar flexion Occlude DP art blanch toe by Compressing toenail release pressure on nail and observe for flushing rapid return of color indicates adequate collateral flow xxx00.#####.ppt 07/16/13 P.