What are the steps for arterial puncture?

The main thing about arterial puncture is to find the puncture path first. When puncturing, you should choose the most obvious artery. After removing the needle, press the needle hole with medical gauze or cotton balls to prevent blood from seeping out. When the arm is bent sixty degrees, the artery is most obvious and easiest to puncture.

1. Puncture path

(1) Radial artery: The patient's wrist is straightened with the palm facing up and the hand is relaxed. The puncture point is located at the arterial pulse 1 to 2 cm above the transverse line of the palm.

(2) Brachial artery: The patient's upper limb is straightened and slightly abducted with the palm facing up. The puncture point is located at the arterial pulsation above the cubital crease.

(3) Femoral artery: The patient lies supine with the lower limbs straight and slightly abducted. The puncture point is located at the arterial pulse 1 to 2 cm below the midpoint of the inguinal ligament.

2. Steps (taking radial artery and femoral artery puncture and cannulation as an example)

(1) Radial artery puncture and cannulation: usually the left hand is used. The patient's hand and forearm were fixed on a wooden board with a gauze roll placed under the wrist so that the wrist was dorsiflexed to 60°. The operator's left middle finger touches the radial artery, locates it proximal to the radial styloid process, and gently pulls its distal end with the index finger. The puncture point is between the two fingers (Figure 6-83). After routine skin disinfection and draping, and local anesthesia with 1% procaine or lidocaine, the operator holds the needle in his right hand and inserts the needle at a 15° angle to the skin, aiming at the direction of the radial artery touched by the middle finger, and punctures the artery only when it is close to the artery. If blood gushes out from the tail of the needle, the guide wire can be inserted; if no blood flows out, the needle can be slowly withdrawn until blood gushes out, indicating that the puncture is successful. There should be no resistance when inserting the guide wire. If there is resistance, it should not be inserted, otherwise it will penetrate the artery and enter the soft tissue. Finally, insert the plastic catheter (Figure 6-84) through the guide wire, fix the catheter, and then measure the pressure.

(2) Femoral artery puncture and cannulation: Touch the femoral artery pulse 1 to 2 cm below the midpoint of the inguinal ligament. Place the index and middle fingers of the left hand on the surface of the arterial pulse, separate the index and middle fingers, and select the puncture point between the two fingers. Routine skin disinfection, draping and local anesthesia are performed. The needle is held in the right hand and inserted at a 45° angle to the skin. The rest is the same as the radial artery puncture and catheterization (Figure 6-85).

3. Notes

1. Arterial puncture is only used when arterial blood sampling and arterial shock injection therapy are required.

2. The puncture point should be chosen where the arterial pulsation is most obvious.

3. After removing the needle, use gauze or cotton balls to apply pressure to stop the bleeding. If bleeding still occurs after pressure, apply pressure bandage until the bleeding stops completely to prevent the formation of hematoma.

4. The catheterization time should not exceed 4 days to prevent catheter-related infection.

5. The indwelling catheter should be continuously flushed with heparin solution (rate of 3 ml/h, heparin concentration of 2 u/ml) to ensure the patency of the pipeline and avoid local thrombosis and distal embolism.