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This Guideline is applicable to all Medical and nursing staff working in neonatal units in the West of Scotland. Only a suitable trained and competent medical practitioner/ANNP should undertake arterial cannulation. Separate guidance is available for aseptic technique for procedures and for taking blood samples from an indwelling arterial catheter.
Staff should also be familiar with the use of equipment to which the arterial catheters will be connected, including: syringe driver; invasive blood pressure monitoring system; and blood sampling circuits. The use of these is covered in separate guidance
An indwelling peripheral arterial line may be used when:
Umbilical arterial lines should be sited in preference to peripheral arterial lines during the immediate newborn period unless contraindicated.
The decision to site a peripheral arterial line should be discussed with the attending neonatal consultant. The need for arterial lines should be reviewed on a daily basis on the consultant ward round.
Where time permits explain the procedure to the parents, including what the procedure involves, the reason for the cannula, the potential risks of a cannula.
Peripheral arterial catheters should be sited where there is good collateral circulation
Other sites should be avoided, except by agreement with the attending consultant.
Contraindications to peripheral arterial line insertion include:
All arterial lines must be connected to a pressure monitoring system.
This allows invasive blood pressure monitoring and also provides a warning of disconnection or occlusion of the catheter.
The pressure monitor will be connected to a closed circuit blood sampling set
The arterial pressure monitoring system and blood sampling line should be primed before use and calibrated.
Patency of the peripheral arterial line is maintained with an infusion of 0.45% sodium chloride for infusion with 1 unit of heparin per ml (known as hepsal) running at a rate of 0.5-1ml /hour.
The Heparinised saline should be changed every 24 hours
NB – No other fluids / medications are to be given via an arterial line
Choose the most appropriate artery to cannulate. If a radial artery is selected check that an ulnar artery is present and patent using Allen’s test - see appendix 2
When inserting a peripheral arterial line, a sterile procedure should be adopted in line with the applicable antisepsis guideline.
Preparation of Equipment
Prepare the following equipment on clean procedure trolley
Post-procedural care of the Cannula
Once successfully inserted, inspect the cannula site every hour and document findings on the observation chart. As these observations need to be made frequently staff should ensure that the site is easily visible and not covered with blankets or bedding.
If any concerns are identified they should be reported immediately to the medical staff
Accidental displacement of the arterial cannula will require immediate application of pressure to the site for 5-15 mins or until bleeding has stopped
Peripheral Arterial cannula should be removed when no longer required, or if there are complications or contraindications.
Continuous arterial blood pressure monitoring will be carried out on all babies with intra-arterial lines in situ. Arterial waveform analysis provides valuable information as well as the absolute systolic and diastolic pressures. The normal wave should have a sharp peak systole upstroke and a definite end diastole.
Diagram 2. Comparison of normal, resonant and damped arterial traces.
The transducer must be zeroed:
During calibration it is essential that the transducer is level with the RIGHT ATRIUM so calibration should also be checked when the child’s position is changed.
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Last reviewed: 20 February 2019
Next review: 01 March 2022
Author(s): L. Raeside - ANNP RHSC/SGH; Dr J Simpson - Neonatal Consultant RHSC/SGH
Approved By: WoS Neonatology MCN