All Arterial Line
Prepare the equipment
- Use a linear-array transducer.
- Select the arterial examination setting.
- Maintain appropriate sterile technique according to institutional policy.
Position the patient
- Place the patient supine.
- Abduct the arm approximately 45° and externally rotate it.
- Extend the wrist by placing a small roll beneath the wrist crease.
Place the transducer
- Position the transducer transversely just proximal to the wrist crease.
- Direct the orientation marker toward the patient’s right.
Identify the radial artery
- Locate the superficial radial artery as a round, anechoic, pulsatile structure.
- It is found on the lateral aspect of the wrist among static, echogenic tissue.
- Identify the two accompanying radial veins; they should compress with gentle transducer pressure.
- Recognize the radius as a hyperechoic structure approximately 1 cm posterior to the artery.
Center the artery
- Adjust the transducer until the radial artery is centered in the ultrasound image.
Begin needle insertion
- Position the needle just superior to the transducer.
- Slowly advance it adjacent to the transducer’s center line.
- The needle should initially appear as a small, bright dot.
Use the short-axis, dynamic needle-tip technique
- When the needle tip becomes visible, slide the transducer a short distance away until the tip disappears.
- Advance the needle slowly until the tip reappears.
- Repeat this sequence to track the needle tip continuously under direct ultrasound visualization.
Puncture the artery
- Continue advancing slowly until the needle tip indents and then punctures the radial artery.
Confirm needle position
- Rotate the transducer 90° to obtain an in-plane, longitudinal view.
- Confirm that the needle tip is positioned within the midportion of the radial artery.
Proceed according to institutional protocol
- Complete catheter advancement, confirmation, securing, and post-procedure care using approved local guidelines.
