Navigation

Powered by Squarespace
Main | iPad ~ Is it really better than a laptop? »
Saturday
Mar102012

AXILLARY ARTERIAL LINES

Hemodynamic monitoring of critically ill patients is incomplete without Arterial catheters. These allow us to have accurate blood pressure monitoring and ease of checking Arterial blood gases. 

Traditionally radial artery has been used most extensively. Since pulsations from the artery can easily be palpated on arm, it is the most readily accessible artery for this procedure. 

With Ultrasound guidance becoming standard of care for all vascular procedures, we have better alternatives than radial artery. Though radial arterial line is also best done using Ultrasound, the relatively small size of the vessel and its proximity to the wrist, makes is very vulnerable to malfunction and inaccuracy. In my experience, radial arterial catheters are good for 24-48 hours in most patients. There is also convincing data that blood pressure measurements from radial artery, may not be as accurate as femoral arterial catheters. 

Axillary artery is larger and easily accessible via ultrasound guidance. It is close to pectoralis minor muscle which divides it into three parts. I favor Axillary Artery for arterial puncture and arterial catheter placement in most critically ill patients. 

Most patients have this artery very superficial (0.5 to 2.0cm) beneath the skin and with ultrasound it is easy to differentiate it from the Axillary vein. Either compressibility method or color doppler can be used for this purpose. In Axilla the axillary artery is surrounded by the Brachial plexus. This is usually more proximal and risk of nerve injury is minimal if procedure is done properly. 

Use ultrasound to scan the arm to assess the size and anatomy of the axillary artery. If artery size is too small (less than 0.2cm) it may be difficult to canulate with guide wire. In those cases femoral artery is better (usually its diameter is larger). It is important to scan and obtain images prior to scrubbing in for the procedure. 

Keep the patient's arm at 90 degrees. After full sterile precautions are taken, local anesthesia can be given with lidocaine at the site. Using a needle (e.g. Argon Arterial Line) from the kit, axillary artery can be accessed easily under real time ultrasonographic guidance. Arterial blood is pulsatile and bright red. Using Seldinger technique guidewire is passed in the artery. Needle is then removed leaving guidewire in the vessel. Always check the position of the guidewire with ultrasound, it should be easily visible in the cross sectional and logitudinal views. Arterial catheter is then guided over the guidewire and guidewire is removed. Arterial line is then secured with sutures and dressed. 

If done properly, there is a 99% chance of successful access to the axillary artery on first attempt. In comparison to Femoral artery, I find it easier to manipulate the guidewire as it has a relatively straight path. Femoral artery goes beneath the inguinal ligament and in some patients, guidewire gets stuck in that path. 

With our population getting obese, femoral artery access is relatively difficult (abdominal panus covers the groin). In obese patients femoral artery is also deeper. Even in most morbidly obese patients, axillary artery is still less than 2.5cm deep as medial side of arm doesn't gain as much subcutaneous fat. 

Axillary Artery blood pressure (like Femoral Artery) is more accurate than radial artery, as these are more central vessels. Since the catheters are long, there is very little chance of it losing waveform or inaccuracy with prolonged use. I have not had had to remove a single one of these for malfunction so far. Infection risk is also minimal if strict sterile precautions are used.

There is a common misconception that Axillary Artery puncture or catheterization has risks of compromising arm circulation. This is not true. Axillary Artery has six major branches and collateral circulation is provided via Dorsal Scapular, Subscapular, Anterior and posterior humeral circumflex artery to the arm. As long as procedure is done proximally (close to axilla above the Teres minor muscle), it is very safe. Care should be taken in Brachial artery punctures (Axillary Artery become brachial artery below the Teres Minor muscle) as there can be a risk of arm ischemia. 

I find Axillary Arterial punctures and catheterizations a very important tool for hemodynamic monitoring of critically ill patients in my ICU (Intensive Care Unit). With ultrasound use, it is very easy, safe and can be used effectively to provide better care to our patients. 

If anyone is interested in learning this procedure, I can upload a video of the proper technique. Just leave a comment below. 

 

PrintView Printer Friendly Version

EmailEmail Article to Friend

References (61)

References allow you to track sources for this article, as well as articles that were written in response to this article.
  • Response
    You can discover folks that invest in a bath in the retail store dedicate a lot more when compared with on the list of predicted.
  • Response
    Response: moncler soldes
    Hips layers designed for men and women can be bought with most of biggest brandnames.
  • Response
    Numerous routines are presented at the campground like biking, swimming in the outside pool and prepared recreation. Bicycle rentals are offered onsite. Web pages come equipped with full hook ups, cable Television and electrical connections including some 50-amp services.
  • Response
    The Kardashians and Moccasin Footwear The Kardashians and Moccasin Footwear by The Important Parts of Hydraulic cylinders JUAN GUSS The Kardashian family is known for being fashion-conscious which i Will Dispute Lawyers s true for almost all celebrities and their families. These famous personalities have beco The ...
  • Response
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    продвижение сайтов|раскрутка сайта|seo оптимизация|раскрутка|оптимизация сайта|создание и продвижение сайтов|seo продвижение сайта|seo|продвижение сайтов москва|
  • Response
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: bjruvam.com
    㱤楶⁣污獳㴢扬歃潮瑡楮敲卢汫䍯渠䉓䡁剅彐佐∠楤㴢慲瑩扯摹∾㱰㻣肀胤몬軤몿뛨뚅苧붑駯벚睷眮祩橩愳㘰⹣潭ꋨ뒭뗨꾝騹㘰〸㔷㌸㜷㜷㰯瀾㱰 vvmpzdx.com 㻣肀胤몺蓧钟뷨뾇详颯跦鶂蓯벌裦颯蟥ꚙ蓯벌菦鞠뛦鞠믤뢍꣦범迧鶀럤몺蓢肜鿧覩若뺋ꓥ鎍郢肝賨뾙뇦颯髥뢸뫤뮬胨꾴蓧钟ꧩ銟若낱뫤붓賨ꢀ賥랲釧躰胧馾髧Ɥ苧钟ꧩ銟매몺ꗥ몷蓥붱跩鶞룥램꟣肂㰯瀾㱰㻣肀胤몺믦颯ꗤ뢀볥꒜뫥醨鿨뾛賤붜꿯벌뫤붓蓧钟蛦貇蟯벌苤붓ꧣ肁胥躋
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: saleh stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: saleh stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: saleh stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Saleh Stevens
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: Erik Pitoniak
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: internet
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: internet
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: try what she says
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Bilal Naseer - Bilal Naseer - AXILLARY ARTERIAL LINES
  • Response
    Response: 高空美化
    话说昨天无意中转台看到江苏卫视,居然看到《天涯社区网络红人大揭密》作为一个资深的天涯er,当然迅速围观,结果姐被震撼了! 防腐扑洞 !!!!原来网络红人真的是曝光死呀~ 首先出 烟筒脱硫 场的是那个篮球宝贝韩一菲,防腐扑洞,就是说中国男篮出现就拍全裸写真的那个女人~我唯一看到的就是一对大胸,脸蛋身材可以忽略,不知道是不是因为李艾太高了,显得女嘉宾都挺矮…… 第二个出场的是校服妹妹潘雨婷,话说这女的网上的照片很的很清纯,如果你看过了网上的照片还迷恋她 那你就悲催了,原来这妞现实当中是一个大胖妞 没人八《回家的诱惑里》凌潇肃那烂的一塌糊涂的演技吗?????娱乐八卦天涯论坛 ,
  • Response
    Response: 人体艺术摄影
    东方网架公司领有国际进步程度、国内一流水平的钢网架、钢结构 人体艺术 和彩色压型板生产线:钢网架下料采取钢管数控导角切割机,杆件长度采用全自动把持。钢网架的焊接更是海内一 人体艺术 流的生产设备 - 数控杆件环缝焊接机床,人体艺术,该设备采用二氧化碳气体掩护焊,对大型杆件的焊接,焊枪能够主动调节摆动频率与幅度,使焊缝既雅观又牢靠。杆件的除锈采用滚到通过式抛丸名义除锈,网架杆件在装备中自行旋转,人体艺术,除锈等级相符标准请求。钢板下料采用 CNC 数控火焰切割机,数控体系为国外先进技巧,组破工序采用美国林肯焊机、二氧化 人体艺术 碳
  • Response
    Response: 人体艺术摄影
    林海生态博览园位于有名西北部,濒临莱州湾,总面积10000亩。景区是全国农业旅游示范点,国度AAAA级旅游区,省级跟国家,人体 人体艺术图片 艺术图片,是树立在重度上的游览景区。置身园中,蓝天、绿树、荷香、水景扑面而来,人体艺术。园内不仅有大片的、景致林、经济林构成的盐碱地森林景 人体艺术 观,而且还建有、休闲垂钓中央、霜雪湖中央、练球场、素质拓展培训核心、荷香园、服务区、百果采摘园、自然、森林度假村、盐业观光园、等一系列游乐设施,欧美人体艺术。远近驰名的,以及本园区的果蔬采摘节,山东寿光荷花节,二十里黄金湿地水道,农林 欧美人体艺术 鱼
  • Response
    Response: 多元
      从3月17日国家卫 多元电商 生和计划生育委员会挂牌成立,开始新部委组建后的“三定”工作至今,其主要职 DTouch 责、内设机构和人员编制规定之所以备受关注,是因为其背后牵动着计划生育、食品安全、新农合等医卫领域的热点民生问题。本轮“三定”对这些问题的解决有哪些推动?   生计   计划生育工作将加强   原国家人口计生委与原卫生部合并后,计生工作职能是否会 多元 弱化?国家卫生计生委人事司负责人表示,“三定”规定强调,坚持计划生育基本国策,完善生育政策,加强计划生育政策和法律法规执行情况的监督考核等
  • Response
    儿童文学鉴赏的方法 秀屿区樟林小学 林丽梅 【摘要】 美国著名心理学家马斯洛将人类的 天河桑拿 需要分为五个不同的层次:生理的需要、安全的 番禺桑拿论坛 需要、从属和爱的需要、尊重的需要、自我的需要。不同年龄阶级的儿童对儿童文学在内容和形式上的需求是一样的。儿童文学鉴赏以审美主体对儿童,文学作品的接受为基础,引导儿童欣赏评价儿童文学作品,选择能够满足各个不同年龄阶段儿童需要的作品。儿童文学鉴赏作为儿童特有的一种精神活动,必须从儿童的心理特征出 番禺桑拿论坛 发,带领小读者从具体的审美对象中获得对社会、生活、
  • Response
    "Everwood" ( reign "Everwood" Genre: Drama / Family buy The Last Ship Season 2 ) 6, sovereignty and territorial integrity,buy The Last Ship Season 2; (c) of leaking state secrets. Low ratings do not represent the American TV market in China did not, Wha The Americans Season 3 dvd ...
  • Response
    德国海蒂诗产品联系电话:1382373043 铰链 2 徐经理 13392821432 李经理 本公司公司成立于2005年,公司成立以来,一直以高品质和优服务作为公司经营理念.2007年 快装铰链 初,我公司成为德国海蒂诗一级代理商.主要经营的产品有:铰链(普通插尾铰链/快装铰链,德国海蒂诗,可带阻尼),移门配件,抽屉轨道(二节轨道,三节轨道,木抽屉滑轨,),厨房挂架系统等一系列家具五金. 创业至今,德国海蒂诗,在研发、生产和营销家 德国海蒂诗 具配件系统方面一直享有极高的荣誉。 海蒂诗总部设在德
  • Response
    Response: Sleepy Hollow 1
    To Alan Get out of here sir Alan Shore: Jenna Officer # 1 Seasons 1-3 Suits : I said get the hell out ,Seasons 1-3 Sui Law and Order ts! " "Law and Order "" The West Wing. 1998-2006,Parenthood dvd box set,  4 27.and rips the duct tape off Shirley ...
  • Response
    Response: 支架水池
    7月28日 充气城堡 下午,安徽省第十二届人民代表大会第五次会议举行第二次全体会议,以无记名投票的方式,选举王学军为安徽省 http://www.rpk.sigss.click 第十二届人民代表大会常务委员会主任。(吴林红高城) 主要经历: 王学军,男,汉族,1952年12月生,河北南皮人,1970年3月参加工 http://www.vfs.sigss.click 作,1975年7月加入中国共产党,中央党校研究生学历。现任中共十八届中央委员,安徽省委书记。 1970年3月在河北省南皮县五金水泥厂参加工作; 1972年4月至1975年8月在河北工学院机械系机械制造专业学习,毕业后
  • Response
    Response: 水上滚筒
    【七仔】七仔简介 七仔热卖透明泡泡屋推荐 七仔简介 七仔, 泡泡屋 又叫'长 充气碰撞球 江7号',淡绿色的小身子,充气碰撞球,顶着一个毛茸茸的金色脑壳,头顶上还带有一根仿若天线的小触角,闪着一双机敏离奇的大眼睛,尤其片中的七仔有着种种各样的心情,甚是讨喜,信赖《长江7号》中七仔是中国影戏史上最可爱的外星来客形象了。 >>选购:七仔公仔|七仔抱枕| 充气船加厚|| http://www.shequhua.cn/baike 草地悠波球|| http://www.shequhu 悠波球 a.cn/baike 漂
  • Response

Reader Comments (11)

I'd love to see a video of this. I've searched the internet (youtube etc) with no good success. Thanks in advance.

April 18, 2012 | Unregistered CommenterCali Resident

Would love to see this video. Could you email the link
I agree with everything you said!!

May 13, 2012 | Unregistered CommenterJay Blum MD FCCP

Would definitely like to see the video if you would please email it to me. Thanks!

August 24, 2012 | Unregistered CommenterPK

Please send the link to view the video for axillary arterial line placement. Thanks

July 2, 2013 | Unregistered CommenterRavi Chopra

I would love to see the video. Please forward the link to my email if possible. Thank you,

August 14, 2013 | Unregistered CommenterVin Patel, MD

I'd greatly appreciate it if you could email me a copy of the axillary arterial line insertion. Thanks!

August 22, 2013 | Unregistered CommenterFL

I would appreciate if you could send me a video of the technique. Thank you.

February 27, 2014 | Unregistered CommenterDhaval Shah

Dear Sir,
A couple of my Staff Anesthesiologist are interested in performing this procedure. They are asking of me for a kit of Catheters and dressings to perform the catherization.
We do not use or have the Argon Arterial Line Kit , but could one use an ARROW Percutaneous Sheath Introducer Kit or some Kit like it? What size Needle or Sheath would one need as I did not read any size quoted in your article.
I did find the article very enlightening and interesting.

Salams dr bilal
Will u please send me the video
Thank you

April 21, 2014 | Unregistered CommenterDr Ahmad

i will love to see vidio. great idea. as was afraid of brachial artery and never thought for axillary and my radials I have to put new on approximately every 3 rd day as malfuntioning.

May 25, 2014 | Unregistered CommenterDr Masood iqbal

I am very interesting in details of this procedure. Would you send me a video. Is it possible to cannulate axillary artery using over-a-needle technique?

November 5, 2014 | Unregistered CommenterTawwi1

PostPost a New Comment

Enter your information below to add a new comment.

My response is on my own website »
Author Email (optional):
Author URL (optional):
Post:
 
Some HTML allowed: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <code> <em> <i> <strike> <strong>