Arterial Lines

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Arterial Lines

Online Theory Module

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Please Choose ALL Correct Answers

Points are awarded for all correct answers chosen. If you're not sure leave it blank. There is negative marking for each incorrect answer.

What does the dicrotic notch on the arterial line represent? *

Aortic valve closure at end systole

Aortic valve closure at end diastole

Aortic valve opening at systole

Mean arterial pressure

Required

Which of the following clinical scenario is an indication for arterial line placement? *

Patient undergoing major abdominal surgery with significant fluid shifts

Patient with multitrauma including head chest and spinal injuries

Patient post total hip replacement with SBP 80 mmHg with normal end organ perfusion and appears well

All patients with morbid obesity

When arrhythmias make noninvasive monitoring unreliable with patient considered for haemodynamic support

Required

Which of the following is an absolute contraindication for arterial line placement? *

Mild peripheral vascular disease

History of Raynaud’s phenomenon without spasm

Previous saphenous graft harvest for coronary artery bypass grafting

AV fistula at forearm

Arterial dissection of affected artery

Required

Which of the following clinical information is not available from arterial line monitoring? *

Heart rate

Respiratory phasic variation in pulse pressure

Recovery of cardiac function for a patient on VA ECMO

Volume status of the patient

Required

Which of the following clinical scenario is NOT an indication to remove arterial line monitoring? *

Arterial line pressure reading an abnormally dampened pressure waveform and unable to aspirate any blood despite appropriate troubleshooting

Intraarterial injection of medication without features of distal ischaemia

Stable patient awaiting ward bed in intensive care delayed from discharge due to bed block

Patient with radial arterial line with delayed capillary refill of fingers distally

Required

Regarding relevant anatomy and site selection for arterial cannulation *

The femoral artery lies lateral to the femoral nerve and medial to the femoral vein

Brachial artery is preferred to femoral artery in a patient with difficulty accessing radial arteries bilaterally

The radial artery sits proximal and medial to the radial styloid process and just lateral to the flexor carpi radialis tendon

The ulnar artery should be used after an initial failed attempt of the ipsilateral radial artery given the area is already prepared and operator maintains an aseptic technique

Allen’s test is an accurate assessment of collateral supply of the hand and has direct correlation with perfusion or ischaemic complications of radial artery cannulation

Required

Complications of arterial lines include: *

Volkman’s ischaemic contraction of the forearm

Anaemia

Blood stream infection

Venous bleeding

Pneumothorax

Required

The following increase damping in an arterial line system *

A deflated pressure bag in the flushing system

Blood clots

Air bubbles

Stiff tubing

A kinked cannula

Required

Regarding principles of invasive blood pressure monitoring: *

In an optimally damped system following the square wave displacement of the fast flush test the displacement should immediately return to the baseline

The fast flush test is used to assess the patency of a system

A high damping coefficient results in overdamping

The phlebostatic axis is located in the 4th intercostal space in the mid clavicular line

The natural frequency or resonance is the frequency at which a transducing system will oscillate without sustained stimulus

Required

When inserting an arterial line: *

Ultrasound should be used for all arterial line insertion

Local anaesthetic must be used in all situations

Insertion should only be attempted at a site if an arterial pulsation is palpated at that site

The catheter should be inserted at a 30 to 45o angle to the skin; Direction of the needle path is not important as long as it is towards the maximal pulsation

Resistance on advancing the guidewire may be due to the wire in the arterial wall or perivascular space or vasospasm

Required

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