If needed, lidocaine + syringe + needles to draw it up
Setup:
Lower side railings
Raise bed as high as you need (usually higher than you might expect)
Use ultrasound to look at radial arteries and select which side you think might be better
Perform Allen's test - occlude both radial and ulnar arteries and ask patient to squeeze fist for 30 seconds, then look for pallor. Release one artery and look for return of normal red color to palm.
Place chuck under patient's arm and wrist
Place roll of gauze or towel under patient's wrist
Put tape from the patient's palm → edge of bed on the plastic railings x 2
Use chloraprep x 1 to sterilize the patient's wrist (the extra one is for just in case you need another one)
Open up sterile towels, place it on patient and then open it slowly from the edges to maintain a sterile field
Drop all your other stuff sterilely onto the field - A-line kit, ultrasound probe cover, suture + needle driver, suture removal kit / scalpel, tegaderm, lidocaine syringe/needles
Put on your sterile gloves
Ask someone to help you put the sterile ultrasound probe cover on. Squeeze out any air bubbles and put the rubber bands on to secure it
Ask someone to help hold the lidocaine while you draw it up. Get a bunch of air before you poke the lidocaine bottle and inject it in there because this will help you draw back more easily. Use the big syringe to draw back. Then switch to the small syringe and numb the patient. Try to to use the ultrasound to guide you to make a small wheal right over the radial artery. Make sure to draw back each time you advance to make sure you aren't in a blood vessel when you inject
Take cover off the Arrow, move the catheter tip back and forth to make sure it isn't stuck, thread the guidewire all the way down the Arrow to make sure it goes through without issues
Put sterile ultrasound gel on your sterile field
Procedure:
Find your artery and center it in the screen
Decrease depth on ultrasound machine to improve visualization
Take Arrow right at the center of your ultrasound probe and advance through the skin at about 30 degree angle
Find your needle tip (move ultrasound probe back and forth until you find hyperechoic dot, can also fan the probe as demonstrated in some of the below videos)
Advance towards artery
Once you get a flash back, try to drop the angle a little bit and advance an additional 1-2mm
Thread your guidewire
Advance the catheter tip
Remove guidewire and Arrow device, should have pulsatile return of blood
Hold pressure or put thumb on top of catheter to prevent blood from spurting
Attach the A-line transducer securely
Suture (parallel to catheter, then loop the needle around the catheter to rest in the groove and tie it down tightly)
Clean up, place tegaderm, loop the A-line around and add an additional piece of tape to secure