How To Succeed At Arterial Line Insertion (Anatomical Landmark-Guided) скачать в хорошем качестве

How To Succeed At Arterial Line Insertion (Anatomical Landmark-Guided)

Radial arterial cannulation is a core skill in anesthesiology, intensive care, emergency medicine, and other acute care specialities. This video summarizes key principles for success with the anatomical landmark-guided (LMG) technique while minimizing complications. These include: (1) developing a tactile sense for locating the artery by palpation; (2) accurate alignment during cannula advancement; (3) adopting an appropriately shallow trajectory to avoid transfixion (which increases risk of complications such as hematoma, thrombosis, etc); (4) confirming intra-luminal cannula placement before attempting to thread it in. Ultrasound guidance may still be needed to rescue difficult LMG arterial lines. Two common scenarios for this are presented: (a) anomalous superficial radial artery; (b) calcified radial artery. See a short guide to USG-arterial lines here -    • Essential guide to ultrasound-guided ...   See also a superb discussion in the comments about rescuing failed attempts with transfixion, with great tips from ‪@mdkc‬ . These include (a) the importance of a flat trajectory (b) not withdrawing the stylet too far back into the cannula - the rigidity that the stylet provides is needed for the floppy cannula to overcome the resistance/friction to advancement through the skin/tissues/arterial wall; it will buckle otherwise. Chapters 00:05 - Long vs short cannula 00:32 - Position and taping 01:06 - Line of sight insertion 01:44 - Draping the hand 02:01 - Palpation of artery 02:15 - Insertion point 02:35 - "Poke" vs "Puncture" point 03:07 - Insertion trajectory 03:53 - Advancing the cannula 04:25 - Confirming intraluminal cannula tip placement 06:08 - Connection of line tubing 06:45 - Securing the cannula in place 07:39 - Redirection to locate artery 08:24 - Superficial radial artery 09:35 - Calcified radial artery