Ultrasound Guided Femoral Arterial Line

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We’re prepping the right groin area with a chlorhexidine swab.  We prep with a back and forth motion and  a wide prep of the entire right groin area, up to the top of the pubic synthesis.  It’s important to allow the chlorhexidine to dry for several minutes in the groin area for proper antisepsis.
We’re now using a sterile blue towels to drape the area.  It’s important to have a wide sterile drape for arterial lines, just like with central lines because the rate of catheter related blood stream infections is just as high with arterial lines as it is with central venous catheters.  That is why an additional wide sterile drape is applied after the sterile blue towels as is shown here.
Now we’re preparing the wire that is going to be used for the procedure.  We’re getting all of our equipment out so we can easily grasp the equipment when needed during the procedure.
Now we will draw up some 1% lidocaine which we will use for local anesthesia of the skin and the soft tissue.  We’re going to draw up the lidocaine into a 3 mL syringe, connected to a 25 gauge needle.
Now we’re going to apply a sterile sheet onto a linear array ultrasound probe.  The ultrasound probe has some non-sterile gel applied to the top of it which will go inside the sterile sheet.  The sterile sheet is now being pulled over the ultrasound probe and its cord so that the area of our sterile field remains sterile.  We pull the sheet to eliminate all air bubbles from the top of the probe and then we’ll secure the sheet on the probe using sterile rubber bands, as is shown here.
Now we’re using sterile ultrasound gel on our field.  We’re visualizing the femoral artery and the femoral vein.  The femoral vein is on the right and is compressible.  The femoral artery is on the left.  It is not compressible.  We’re viewing this in the transverse plane.  Now we’re turning the probe into the longitudinal plane.  We can now see the femoral artery in the longitudinal plane.
We’re introducing the introducer needle along the—using an in-plane technique under the linear ray probe.  You can see the needle being advanced into the femoral artery and the tip is shown in the middle of the femoral artery there.
You have a pulse valve blood flow in the needle.  The syringe is removed and then the wire is threaded through the needle without any resistance.  Now the needle is removed and the wire is left in place.
We’ll now use a scalpel to make a very tiny one millimeter stab incision right over the wire.  Then we will advance the catheter over the wire.  Making sure that withdraw the wire so we can grasp the wire along the distal end of the catheter before advancing the catheter.  The catheter is then advanced all the way to the hub.  Then the wire is removed, with return of blood.
We will now grasp the arterial line transducing tubing with a sterile 4x4 so as not to contaminate our sterile gloves.  We’re attaching the pressure to the catheter.
Now we’re going to use a straight needle attached to a 206 silk suture, to suture the catheter in place.  Because the femoral artery is fairly deep, we can easily pass the suture underneath the groove of the femoral artery catheter without fear of injuring the artery.  This technique would not be performed if we were doing a radial arterial line.
The suture is then passed several times through the groove of the femoral artery catheter, as is shown here.  We always pass the blunt end of the needle first, to minimize the chance of a needle stick.  Now we are tying the two ends of the suture with [inaudible] to secure the catheter in place.  We’ll use a scalpel to cut the suture.
Now we’re going to apply an antimicrobial patch called an Patch with the blue side towards the sky.
Now we’re going to apply a sterile occlusive dressing to complete the procedure.  And applying the wing of the occlusive dressing, we want to make sure that the hole that remains for the pressure tubing is as small as possible to minimize the chance of contamination later on.