CURRENT Essentials of Critical Care.pdf

4 Current Essentials of Critical Care■■Arterial Pressure MonitoringEssential Concepts• Allows continuous, accurate, repeated measurement of bloodpressure when needed (hypotension, hypertension, highly vasoactivedrugs)• Helpful for repeated sampling of arterial blood for blood gases• Complications: bleeding, infection, thrombosis, “downstream”arterial emboli with ischemia• Contraindications: increased risk of bleeding (coagulopathy,thrombocytopenia), local infection, hypercoagulable states, anticipateduse of thrombolytic agentsEssentials of Management• Use 16- to 20-g catheter inserted into radial or dorsalis pedisartery• Avoid brachial artery (high risk for serious complications) andfemoral artery (high risk for bleeding)• Attach to continuous pressure infuser with low-dose continuousheparin infusion• Measure pressure with transducer attached using nondistensibletubing• Remove air bubbles to avoid damped arterial waveform (falselylow systolic and high diastolic pressure)• Check insertion site at least daily for bleeding, infection, adequatedistal pulses• Remove catheter if local complications or within 3–4 days• Relative contraindications: coagulopathy or thrombocytopenia,bacteremia, anticipated use of thrombolytic agents• Complications during placement: bleeding, arterial damage• Complications during use: infection, in situ thrombosis, distalarterial emboli with limb ischemia■ PearlArterial catheter blood pressure may be lower or higher than measuredby cuff, depending on vascular disease, age, and stroke volume.ReferenceMartin C et al: Long-term arterial cannulation in ICU patients using the radialartery or dorsalis pedis artery. Chest 2001;119:901. [PMID: 11243975]