Radial artery Tendon

Radial artery Tendon

A. Figure 2-3. The radial artery on ultrasonography. A. A high-frequency linear transducer is used to locate the vessel

based on anatomic landmarks. The ultrasound probe is oriented toward the patient's thumb. B. If there are other

vascu lar structures in the image, color Doppler can be used to locate the artery by identifyi ng pulsati le flow.

ARTERIAL BLOOD GAS

COMPLICATIONS

Complications from this procedure are rare but include

infection, bleeding, arterial laceration, pseudoaneurysm or

arteriovenous malformation, and nerve injury.

SUGGESTED READING

Dev SP, Hillmer MD, Ferri M. Arterial puncture for blood gas

analysis. N Engl J Med. 20 11; 364:e7.

Giner J, et al. Pain during arterial puncture. Chest. 1 996; 1 1 0:

1443-1445.

Hajiseyedjavady H, et al. Less painful arterial blood g as sampling

using jet injection of 2o/o lidocaine: a randomized controlled

clinical trial. Am ] Emerg Med. 20 1 2;30:1 1 00-1 104.

Haynes JM, Mitchell H. Ultrasound-guided arterial puncture.

Resp Care. 2010;55:1 754-1 756.

Shiver S, Blaivas M, Lyon M. A prospective comparison of

ultrasound-guided and blindly placed radial arterial cathe ­

ters. Acad Emerg Med. 2006;13:1 275-1279.

Central Venous Access

Basem F. Khishfe, MD

Rashid E. Kysia, MD

Key Points

• The abil ity to access the centra l venous circulation is an

imperative ski ll for emergency physicians and is often

needed for l ife-savi ng measures.

• The central venous circulation can be accessed both

above and below the diaphragm. The site should be

INDICATIONS

The most common reason for placement of a central

venous catheter in the emergency department (ED) is for

resuscitation of the critically ill medical or trauma patient.

Medical patients may require central access for large volume fluid resuscitation, central venous pressure monitoring, IV pressors or other medications caustic to the

peripheral veins (dextrose, hypertonic saline, total parenteral nutrition), transvenous pacing, or emergent dialysis.

Trauma patients most often require central access for

large-volume resuscitation with both fluids and blood.

Central access is also used in ED patients with difficult

peripheral IV access.