Arterial line insertion with ultrasound guidance

The following webpage and video tutorial will demonstrate the ideal method to cannulate the radial artery with ultrasound for obtaining invasive blood pressure monitoring.

Section contributors: Dr. Jeff Odenbach

Key steps

Pre procedure setup

Please see the following image to help guide preparation for this procedure.

Probe placement

The radial artery should be imaged several cm proximal to the wrist. The image demonstrates the relevant anatomy.

Vessel placement

As a quick step, if your patient has been previously cannulated or has difficult access, you can compress the vessel (should be compressible/pulsatile) and check for flow with color Doppler.

Inject local anesthestic

The following image demonstrates the ideal location to anesthetize the overlying skin.

Creep technique

Use the “creep technique” to ensure that, in the short axis, the ultrasound probe is always imaging in advance of the needle tip (and not the shaft of the needle).

Guidewire & catheter

Once you have successfully cannulated the radial artery and have a bright red flash, thread the accompanying wire (should be little to no resistance). Once the wire is threaded, remove the needle, thread on the transducer catheter and remove the wire. Secure the catheter hub and connect the line.

Guidewire and catheter

US-guided A-line tutorial

Please see this fantastic tutorial from Dr. Jeff Odenbach, emergency physician and critical care fellow.