Ultrasound-guided arterial catheterization

Ultrasonography facilitates arterial catheterization compared to traditional palpation techniques, especially in small arteries. For successful catheterization without complications, practitioners should be familiar with the anatomic characteristics of the artery and ultrasound-guided techniques. There are two approaches for ultrasound-guided arterial catheterization: the short-axis view out-of-plane approach and the long-axis view in-plane approach. There are several modified techniques and tips to facilitate ultrasound-guided arterial catheterization. This review deals with the anatomy relevant to arterial catheterization, several methods to improve success rates, and decrease complications associated with arterial catheterization.

Complications Following Brachial Arterial Catheterization in the Surgical Intensive Care Unit

Clinically, complication rates of brachial arterial catheterization appear to far exceed those of the radial or common femoral arteries. The study objective was to define the complication rate after brachial arterial line insertion. All patients undergoing arterial line placement to the brachial artery in the surgical intensive care units (SICUs) at our institution were retrospectively identified and included in the study (January 2016-December 2018). Demographics, complications (distal ischemia, thrombosis/dissection, brachial sheath hematoma, catheter-related sepsis, and inadvertent dislodgement), and outcomes were collected and analyzed. Over the study period, 53 patients underwent brachial arterial catheterization. Common admitting services were cardiothoracic surgery (n = 31, 58%), transplant surgery (n = 7, 13%), and neurosurgery (n = 4, 7%). The mean age was 55 ± 17 58 (24-84) years, and 58% (n = 31) were male. The hospital length of stay (LOS) was 37 ± 35 23 (1-132) days, and ICU LOS was 30 ± 27 20 (1-127) days. Mortality was 57% (n = 30). Complications of brachial arterial line placement occurred in 21 patients (40%). In summary, brachial arterial catheters were associated with high mortality and prolonged ICU length of stay. This likely reflects the critically ill nature of patients in whom conventional-site arterial line placement is not possible. Complications following brachial arterial catheterization were unacceptably high. On this basis, we recommend that the brachial artery be avoided whenever possible for arterial line placement in the SICU.

Arterial insertion method: A new method for systematic evaluation of ultrasound-guided radial arterial catheterization

Introduction: Peripheral arterial catheter insertion is a common procedure for critically ill patients requiring frequent blood gas sampling and continuous blood pressure monitoring. There are clear advantages of ultrasound-guided arterial cannulation, which have shown to be more effective in reducing complications, time to successful cannulation, number of attempts, and overall first-time success rates. Evidence suggests that using palpation alone has a first-time success rate of less than 70% yet is still a widely performed technique. A systematic evaluation may be required to reduce variations in arterial catheterization practices. Design: The arterial insertion method is a systematic evaluation to aid in arterial catheter insertion with ultrasound guidance, intended to improve the procedural approach. The process of arterial insertion method ensures appropriate choice of zone selection to optimize catheter longevity and performance in patients requiring arterial access. Moving the insertion site proximally 4 cm from the red zone into the green zone may reduce mechanical complications and preserve catheter performance and dwell time. Conclusion: The standardization of ultrasound guidance in arterial catheterization promotes vessel health and patient safety through device and site optimization. The arterial insertion method systematic evaluation may be utilized to reduce variation in practice and promote the use of ultrasound as a standard for the insertion of radial arterial catheters.

Abnormalities of the hallux skin and nail in the course of very rare arteriovenous malformation

Arteriovenous malformations (AVMs) are usually found in the pelvic area and the brain. These vascular anomalies are rarely reported in the toes. AVMs in the toes may be asymptomatic, but can also cause atypical symptoms. Congenital AVMs can expand as patients age and manifest in adulthood. They may be provoked by injury. Acquired AVM might be caused by iatrogenic factors, venous or arterial catheterization, percutaneous invasive vascular procedures, surgery, or degenerative vascular disorders. An AVM can damage surrounding tissues and can cause destruction of skin, nails and bones. The course of the disease is often unpredictable and diagnosis is usually delayed as a result.