Healthcare and Medicine Reference
In-Depth Information
Figure 20.4 A Seldinger type arterial cannula (Leader cath™).
Box 20.2 Equipment for insertion of arterial cannula
Figure 20.5 Equipment for insertion of arterial cannula.
Prepare using aseptic no-touch technique wearing non-sterile gloves
and apron.
Sterile drapes
3
Don sterile gloves. Clean the wrist with a skin antiseptic (2%
chlorhexidine in 70% isopropyl alcohol is recommended) and
drape the area (Figure 20.6b). A sterile technique should be
maintained throughout insertion and securing the cannula.
Palpate the radial artery and infi ltrate local anaesthetic (0.5-1 mL
Sterile gloves
Gauze
4
Skin antiseptic solution
1% lidocaine) subcutaneously (Figure 20.6c,d).
Whilst palpating the artery with the non-dominant hand hold
Arterial cannula
5
Lidocaine 1%
the arterial cannula like a pencil with the bevel facing up the arm.
Puncture the skin at an angle of 30-40° (Figure 20.6e).
Advance the needle until a fl ashback of blood is seen in the hub
25G needle for lidocaine infi ltration
5-mL syringe
6
of the needle (Figure 20.6f).
The cannula can then be advanced off the needle up the lumen
Saline fl ush
7
Suture
of the artery (Figure 20.6g).
Dressing
Pressurised transducer system
Alternatively, a transfi xing technique can be used whereby the
needle and cannula pass through both walls of the artery. This is
described below and in Figure 20.7, omitting step 7 above.
Continue to advance the needle deeper through the arterial
Step-by-step guide: insertion of arterial cannula
A suitable site should be chosen by examining the patient and
assessing for any contraindications.
7
lumen and a further few millimetres out of the other side of the
artery so the artery is now transfi xed by the cannula.
Keeping the cannula in position, withdraw the needle until the
8
tip of the needle can be seen at the level of the skin.
Flatten the angle of the cannula down to 10-20° to the skin and
Give a full explanation to the patient in simple terms and
ensure they consent to the procedure (if able).
Set up your trolley (Box 20.2 and Figure 20.5).
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slowly withdraw the cannula. As the tip of the cannula is pulled
back into the lumen of the artery a fl ash of blood will be seen
in the cannula lumen indicating that the tip of the cannula is in
the arterial lumen.
The cannula can then be gently advanced up the lumen of the
Ensure the pressurised monitoring system is set up.
Prepare your trolley as a sterile fi eld. Wear a plastic
disposable apron and non-sterile gloves, and take alcohol
hand rub with you.
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artery.
Remove the needle, disposing of it safely, closing the FloSwitch™
Insertion at the radial artery (the most commonly used site) is
described fi rst using the FloSwitch™ cannula.
After setting up the trolley, discard gloves and apron used, rewash
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to prevent blood loss.
1
hands and don a new pair of non-sterile gloves and apron.
Before putting on sterile gloves, position the patient with the
For cannulation using the Seldinger technique for a Leader cath™
the preparation is the same up to step 3 , then:
Whilst palpating the artery with the non-dominant hand
2
wrist dorsifl exed (Figure 20.6a). This can be achieved using a
rolled towel or bag of intravenous fl uid placed under the forearm
with the hand taped, hyperextended, to the bed.
4
puncture the skin, at an angle of 30-40°, with the supplied 20G
needle.
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