Invasive blood pressure monitoring – IBP:-
When beat-to-beat blood pressure monitoring becomes necessary because, in a hemodynamically unstable patient receiving inotropes and vasopressors, etc. intra-arterial cannulation and pressure monitoring are preferred.
Invasive BP site:-
- Radial artery
- Ulnar artery
- Dorsalis pedis artery Posterior tibial artery
- Femoral artery when peripheral pulses are not felt
IBP Medical Technique:-
Typically, a 20 gauge cannula without an injection port is selected for cannulation of the radial and other peripheral arteries. The femoral artery is cannulated using an 18 or 16 gauge long catheter.
Radial artery cannulation:-
Cannulation should be performed under strict aseptic precautions. Gentle dilation of the wrist helps to make the radial artery more superficial and well visible. The radial artery is touched with the index finger of one hand and the cannula extends to the radial artery just below the skin under the finger.
A flashback of blood to the cannula hub is observed as it enters the artery. At this point, the sweetie is held in place (not withdrawn) and the cannula is gently threaded forward with the needle. This technique prevents puncture of the posterior wall of the artery.
If the back wall is perforated, the sweetie is withdrawn and the cannula is slowly pulled back until a jet of blood flows through the hub. At this point, the cannula can return to the artery. This technique should be performed quickly before hematoma and deformity of the arterial lumen result.
To prevent contamination of the table or armrest with blood, an empty 2 ml syringe can be attached to the cannula hub as it is withdrawn at slightly negative pressure.
The position of the arteries in the nostrils is indicated by the free flow of blood. Connected to the manometry tubing in the syringe and the transducer cannula, the transducer is emptied and monitoring begins. Normal arterial waveforms should be displayed.
Another arterial cannulation is similar to radial artery cannulation.
IBP monitoring advantages:-
The first advantage is that it allows continuous ‘beat-to-beat’ blood pressure monitoring. It is useful for patients who have sudden changes in blood pressure (such as vascular surgery), who need intensive blood pressure control (such as patients with head injuries), or who are likely to take medication to maintain their blood pressure.
The third benefit depends on improving the patient’s well-being, especially those who require long-term blood pressure monitoring.
Other advantages include that the location of the intravascular volume can be inferred from the size of the arterial pressure, and the live arterial cannula for arterial blood gas is convenient for repeated arterial blood sampling.
IBP Medical Complications:-
Accidental injection of drugs:- No drug should be injected into the arterial line as irritation may lead to arterial spasms. To avoid this, the cannula for arterial cannulation should not have an inbuilt injection port. The 3-way faucet must cover the manometry line and the line must be labeled appropriately.
Exsanguination:- Accidental disconnection of arterial lines unnoticed can cause blood loss, especially from the femoral arteries, rapidly (damage can be up to 500 ml/min!).
Infection:- Any permanent vascular catheter can be a source of infection when poorly maintained and left in situ for a long time. However, the infection rate is low compared to central venous lines.
Ischemia of the limb: any obstruction of the cannulated vessel should not normally lead to ischemia distal due to the presence of collateral. Therefore, physicians often examine collateral using Allen’s test prior to cannulation.
For example, to examine collateral in the radial artery, both the ulnar and radial arteries are compressed until the limb becomes pale.
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