Ulnar Art lines

[Airway]

I think they get called a couple times a year for a brachial pseudoaneurysm and then by sheer recall bias just assume that the complication rate must be super high.

It's my feeling that this complication is a result of a combination of several things.

1) us holding pressure on the vessel while pulling the wire out (instead of distal to wire) causing trauma
2) inadequate (duration or intensity) deeper pressure when pulling the catheter out, ie treating it like a superificial arterial line
3) multiple attempt hitting it (duh).

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[LifeofGas]

I’ve only done Ulnar once. I was in the OR trying for the life me and couldn’t thread the fricking wire over the radial artery...the older guy in my group came in a just shifted the probe to ulnar and that was that, a huge ulnar pulsating artery. I ended up placing it for the first time. Needless to say, I was extremely paranoid. I kept the hand warm and put a pulse ox on just to make my self feel better that its getting perfusion. It was fine after...but yeah... looking back...probably won’t do it again.

 

[drmwvr]

With u/s and long catheters. pretty rare (never?) to not be able to catheterize the radial somewhere up the arm.....even if the catheter tip sits proximal to the bifurcation, not being able to hit the radial on one side or another shouldn't be a reason to go ulnar...not in this day and age...

 

[GassYous]

The idea that they are somehow not safe is really deeply seeded, I had a vascular surgeon give me a horrified look when I said I was going to place one... is everyone just uneducated about them?

They are so easy and reliable. And my arrow catheter is certainly not going to obstruct flow in that big artery . I dont get the risk..

We did brachials regularly for difficult sticks as well as bilateral arterial lines for robot valves, livers, thoracic aortas and I don't think anything bad ever happened to them. The bad a line complications were on trauma patients. I remember one weak attending insisting on an a line for a short washout and somehow the jv resident managed to shear the catheter and lose a piece of it in the vessel. Surgeons had to explore the artery. Embarrassing.

 

[woopedazz]

My new department uses femoral lines as standard in the majority of cases. Any recommendations for your favourite femoral lines?

 

[GassYous]

My new department uses femoral lines as standard in the majority of cases. Any recommendations for your favourite femoral lines?

peds ijs

 

[nimbus]

My new department uses femoral lines as standard in the majority of cases. Any recommendations for your favourite femoral lines?

We use 5fr introducer.

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[fakin' the funk]

I totally respect you Blade, but 10k seems awfully high. If you’ve been in practice for 25 years, that’s 400 a year which is almost 1.5-2/day every day you’ve worked. In residency we put in a lines for just about every case it seemed. In PP we put them in much, much less frequently.

Admittedly I put in an ulnar art line as a resident when someone called me for help since they were struggling. That attending was pretty chill but don’t think he was all too happy with that. Patient did fine post op.

It's almost like BladeMDA is absolutely full of ****.

 

[fakin' the funk]

Assuming no funky anatomical considerations (innominates involved eg)
1) radial
2) higher radial, deep to brachioradialis
3) femoral, if you really need it.
Most importantly, the above shouldn't take more than 10-20 minutes no matter how bad it is.

Oh also I forgot to mention that I've done 37 billion arterial cannulations

 

[sevoflurane]

My new department uses femoral lines as standard in the majority of cases. Any recommendations for your favourite femoral lines?

femoral over radial? interesting.... wonder why.

 

[woopedazz]

femoral over radial? interesting.... wonder why.

Prevalence of haemodialysis in the indigenous community where I currently work is greater than 1 in 100. Of 350 beds they account for over >65-70% of inpatients at any given time. Basically, we need to protect every vessel from wrist to shoulder for fistula formation. A lot are on HD from early 30s.