Name of the Procedure:

Arterial catheterization or cannulation for sampling, monitoring, or transfusion (separate procedure); cutdown

Summary

Arterial catheterization, also known as arterial cannulation, involves the insertion of a catheter into an artery through a surgical cut (cutdown). This procedure allows for continuous monitoring of blood pressure, frequent blood sampling, or the administration of medications.

Purpose

Arterial catheterization is performed to manage critically ill patients who need continuous blood pressure monitoring, frequent arterial blood gas sampling, or direct delivery of certain medications.

Indications

• Unstable blood pressure requiring continuous monitoring
• Requiring frequent arterial blood gas analysis
• Severe trauma needing rapid blood sampling
• Cardiovascular surgeries
• Certain critical care conditions like septic shock or respiratory failure

Preparation

• Fasting for 6–8 hours before the procedure if sedation is required
• Stop certain medications as advised by the doctor
• Pre-procedure blood tests and imaging (e.g., ultrasound) to assess vascular anatomy

Procedure Description

1. The patient is positioned appropriately, and the insertion site is prepped and sterilized.
2. Local anesthesia is administered to numb the area.
3. A surgical cut (cutdown) is made to expose the targeted artery.
4. The catheter is carefully inserted into the artery and secured in place.
5. The site is stitched and covered with a sterile dressing.
6. The catheter is then connected to monitoring equipment or used for blood sampling/medication administration.

Duration

The procedure usually takes about 30 to 60 minutes.

Setting

Arterial catheterization is typically performed in a hospital setting, either in the operating room, intensive care unit (ICU), or a specialized procedure room.

Personnel

The procedure is performed by a trained physician, such as a surgeon or an intensivist, with assistance from nurses and, if needed, an anesthesiologist.

Risks and Complications

• Infection at the insertion site
• Bleeding or hematoma
• Arterial occlusion or thrombosis
• Nerve injury
• Misplacement of the catheter
• Rare risks include vascular injury and severe hemorrhage

Benefits

• Real-time and accurate blood pressure monitoring
• Easy access for frequent blood sampling
• Effective management of critically ill patients

Recovery

• Regular monitoring of the insertion site for signs of infection or complications
• Keep the catheter site clean and dry
• Follow-up appointments to assess catheter function and patient condition
• Restrictions on heavy lifting or strenuous activities until fully healed

Alternatives

• Non-invasive blood pressure monitoring (may not be as accurate or continuous)
• Central venous catheter (less suited for arterial pressure monitoring and frequent arterial blood sampling)
• Peripheral intravenous (IV) line (limited to venous access and does not provide arterial pressure monitoring)

Patient Experience

• Some discomfort during local anesthesia and insertion
• Minimal pain after the procedure, managed with over-the-counter pain relievers if needed
• Continuous feeling of the catheter at the insertion site, which is generally mild
• Routine activities might be limited initially to avoid disturbing the catheter

Pain management includes local anesthesia during the procedure and over-the-counter pain medications post-procedure. Comfort measures include proper padding and securing of the catheter to minimize irritation and discomfort.