Arterial Line Placement by J. DiNardo | OPENPediatrics
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- Опубліковано 3 лис 2024
- Learn about placing arterial pressure monitoring catheters, including indications, contraindications, equipment, and procedural techniques.
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Hi, my name is Jim DiNardo. I am an associate professor of anesthesia at Harvard Medical School and I’m one of the cardiac anesthesiologists and cardiac ICU attendings here at Children's Hospital Boston. We are going to be talking about arterial pressure monitoring today, specifically placement of arterial pressure monitoring catheters.
Indications:
The indications for placing an arterial line include patients who require continuous blood pressure monitoring, such as those who: are hemodynamically unstable, require vasoactive agents or active volume resuscitation, or in whom non-invasive blood pressure monitoring is unreliable or unobtainable. Patients who require significant respiratory support and need frequent lab sampling, including regular arterial blood gases. But these indications must be weighed against the potential risks: infection, trauma to the artery, potential thrombosis, hematoma.
Contraindications:
Some healthcare providers would refrain from performing this procedure in patients with: infection at the insertion site, traumatic injury proximal to the insertion site, inadequate collateral circulation of the extremity indicated by a failed Allen’s test.
Complications:
The complications that you may observe include: infection, trauma to the artery, thrombosis.
Equipment:
You will need the following equipment to perform the procedure: arm board, tape, chlorhexadine prep solution, arterial catheter, guidewire (we must make sure that the guidewire fits through the catheter), T-connector, sterile occlusive dressing, sterile gloves, sterile towels, transducer system, saline flush.
The best teaching video of A-line placement so far in my experience as a CRNA. I wish I had instructors/professors like Dr. DiNardo!!! For those who have Dr. DiNardo, you’re so lucky!
Good point about causing an intimate flap and the guide wire not being able to pass.
The best teaching video.Thanks
What about infiltration of the site with local anesthetic before the actual arterial access.
Wonderful demonstration. Thank u
Outstanding teaching video
In the 'through and through' technique - why wouldn't the guidewire simply go out through hole you created in the posterior wall of the artery instead of going along the lumen of the artery?
There are two things to observe in this technique:
The first is that the return of pulsatile arterial blood shows that it is in the artery. If there is a flow interruption, most likely the catheter left the artery.
The second is that the guide wire has to slide easily through the catheter. The guide wire has the ability to pierce the arteira or deform in the skin if it makes too much force or has an obstruction and you insist through.
Apart from these factors, the catheter has a low risk of entering the skin and making a false path through the hole in the posterior wall of the artery.
Great video
Excellent
Would be great to show video of placing at other sites, especially posterior tibial artery
Best video 💯💯
Great video from beginning to end
Excellent teaching video
Good content and good explanation
Amazing ❤
Helpful
Great video! As a nurse who used to work in the ICU, it is nice to see such a clear explanation. I provide nurses with educational videos on my channel and think I might look at ART lines, from a nursing perspective :)
It's was lovely.. thanks 😊
the content was very good.
Excellent
IT IS SIMPLY ADEQUATE AND ABSOULTELY HELPFULL,PLEASE MAKE A VIDEO ON PRIMING IT WITH TRANSDUCER AS WELL...THANK YOU...
thanks for nice video.
This was just excellent for me, it was quite comprehensive. Thanks a lot.
Very well done. Perfect length.
Perfect. Very helpful. Thank you.
Great video, thanks!
Very well done video, thank you team, OPEN Paediatrics
This video contains enough inforation...so thanks for this video..
Thank you sir for providing information
V helpfull 👍
Hi, don't you guys routinely use USG for arterial line placement ?
Dr. Abhishek Tandon MD
Excellent vıdeo thanx a lot
So nice vedio great and easy to understand thank you so much
Great video!
A very informative video! I learned a lot.
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Very well done!
Great video to show the main elements of this procedure. I would love to see how hemodynamically unstable blood pressure is taken. Thanks. Mohammed Qutyan, Nursing Student.
thanks
Fabulous realy such a graet guidance for this
Excellent explanation! Now I know what to expect next week.
Very compact and comprehensive. Thanks
Great video, thank you
Great work Keep on
Very easy content and understandabale
nice explanation
we never used guide wire
great video
Very good
Very good content...
Very simple & good demo
nursing student... thank you
Matthew B
Great video.thanks a ton..!!
Very , very good: was too simples e Not too long! Thank you!
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good video
Nice vedio
Its vein no
i was bothered by the lack of chlorhexedine dressing placed at the end 😂
He also was not wearing a mask, even Pre-Covid it was required, Also did not discuss how to suture the catheter as the #1 Rule after any a-line is placed is "DO NOT LET IT BE PULLED OUT", So should he have used HCG-impregnated "gel dress" or "sponge dress"? Is that a universal recommend for pediatric art line placement, based on extensive research?
C'mon, this was just an educational video on a-line placement technique, not a presentation on CLABSI prevention.
Maybe he is not a very good Cardiac/Pediatric Anesthesiologist or educator? On the Contrary, as this little video made for OPENPediatrics featured James DiNardo, an actual Master of Anesthesia far beyond a-line placement. He was my "Obi-Wan" when I was a resident in early '90s, and he is still rocking it.
FWIW, In 2011 the CDC agreed with use of HCG-infused dressing for peripheral arterial lines, then in 2017 removed that rec if placed in under 18yo patients. Since then, various organizations and professional societies greatly vary on this, especially for Peds patients, the younger the more risk of significant dermatitis developing in few days.
Curious, where did you do your Anes Residency? Or perhaps Pedi ICU advanced nurse certification?
Its not an artery bcz artery blood will splash. He punchered vein
I had this done years ago in 2020, due to having COVID-19 viruses 3 times and the last one was the worst of the worst. Consider a law hauler due to the COVID.🦼🦽🚔🐾🧑🚒👮🧕🧑🦽🧑🦯🧑🦼🧑🦼💅✍️
Great video.
Great video