36140 Introduction of needle or intracatheter, upper or lower extremity artery

Name of the Procedure:

Introduction of Needle or Intracatheter, Upper or Lower Extremity Artery
Common names: Arterial Line Insertion, Arterial Catheterization

Summary

In this procedure, a needle or catheter is introduced into an artery in the arm or leg. This allows for continuous blood pressure monitoring and the collection of arterial blood samples.

Purpose

This procedure is performed to gain direct access to the arterial blood supply for the purposes of monitoring blood pressure in real-time or obtaining frequent blood samples. It is often used in critically ill patients.

Indications

• Critical illness requiring continuous blood pressure monitoring.
• Need for frequent arterial blood gas sampling.
• Major surgery, particularly cardiac or thoracic procedures.
• Severe trauma or shock conditions.

Preparation

• The patient may need to fast for a few hours before the procedure.
• Blood tests may be performed to check blood clotting times.
• The patient will be briefed on the procedure and needs to provide informed consent.

Procedure Description

1. The patient will lie down comfortably with the target extremity positioned optimally.
2. The skin will be cleaned with an antiseptic solution.
3. Local anesthesia may be administered to numb the insertion site.
4. Using ultrasound guidance or palpation, the healthcare provider will locate the artery.
5. A needle is inserted carefully into the artery.
6. If only a needle is used, it can be attached to a monitoring device or used to draw blood.
7. If an intravascular catheter is used, once the artery is punctured, a guide wire is introduced. The needle is then removed, and a catheter is threaded over the guide wire into the artery.
8. The catheter is secured in place and connected to a monitoring system if necessary.
9. The site is then dressed to reduce infection risk.

Duration

The procedure usually takes about 15 to 30 minutes.

Setting

This procedure is typically performed in a hospital setting, such as an Intensive Care Unit (ICU), operating room, or emergency department.

Personnel

• Physician (usually an anesthesiologist, intensivist, or surgeon)
• Nurse or medical assistant
• Ultrasound technician (if ultrasound is used for guidance)

Risks and Complications

• Infection at the insertion site.
• Bleeding or hematoma.
• Arterial occlusion or thrombosis.
• Damage to the artery or surrounding nerves.
• Rarely, air embolism or vessel rupture.

Benefits

• Accurate and continuous blood pressure monitoring.
• Immediate access for blood gases and other arterial blood tests.
• Helps in the management of critically ill patients.

Recovery

• Post-procedure monitoring of the insertion site for signs of infection or complications.
• The patient should avoid excessive movement of the affected limb.
• Pain management as required.
• The line will be removed once it is no longer needed, with instructions for post-removal care.

Alternatives

• Non-invasive blood pressure monitoring with a cuff.
• Venous blood sampling for less frequent testing.
• Each alternative may have its pros and cons, such as reduced accuracy in critically ill patients.

Patient Experience

• Mild discomfort or pressure during the insertion.
• Local anesthesia usually minimizes pain.
• Ongoing sensation of the catheter in the artery.
• Proper pain management and care to ensure comfort post-procedure.