Arterial access
The arterial access is primarily used for intravascular, continuous blood pressure measurement , for taking arterial blood for laboratory and blood gas analyzes and for inserting instruments (e.g. for cardiac catheter examinations ).
indication
Indications for an arterial puncture are:
- Hemodynamic monitoring in hemodynamically unstable patients
- Catecholamine therapy
- increased intracerebral pressure (to determine the cerebral perfusion pressure)
- Ventilation (frequent blood sampling for blood gas analysis)
Contraindication
Contraindications for an arterial puncture are:
- Clotting disorders
- local infection
- Vascular prostheses ( femoral artery )
- pathological Allen test ( radial artery )
technology
For the puncture, special indwelling arterial catheters are used, which are similar to peripheral venous catheters . As an alternative or for accesses with a larger diameter, which serve as locks for introducing instruments, for example for cardiac catheter examinations, arteries are usually punctured using the Seldinger technique under sterile conditions . It may be necessary to visualize the vessels using ultrasound . After the arterial access has been removed, sufficient compression of the puncture site must be ensured so that the bleeding is stopped quickly.
Localizations
The first choice sites for arterial access are:
- Arteria femoralis (especially suitable for accesses with a large diameter)
- Radial artery (the Allen test must be performed before puncturing the radial artery )
Second choice locations are:
- Axillary artery
- Brachial artery
- Ulnar artery (the Allen test must be performed before puncturing the ulnar artery )
Complications
Possible complications of arterial puncture are:
- Bleeding
- Thrombosis (formation of a blood clot)
- Infections
- Development of aneurysms or arteriovenous fistulas
Accidental intra-arterial injection of medication can lead to necrosis and, in the case of barbiturates , possibly to the loss of an arm. The arterial access is therefore clearly marked to avoid accidental injections.
swell
- Heck, Fresenius: Revision course anesthesiology . Springer, 2007. ISBN 978-3-540-46575-1
- www.intensivbert.de , intensive and anesthetic care