The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

ULTRASOUND GUIDED ARTERIAL CANNULATION IN CONTINUOUS FLOW VENTRICULAR ASSIST DEVICES.

Julie A. Colquist, Amy Muir, Jeanine Moorhead, Kevin Romney, Bhavesh Patel; Respiratory Care, Mayo Clinic Hospital, Phoenix, AZ

Background: 5 million Americans experience heart failure which affects 10 in every 1000 people over 65 years old. Continuous flow left ventricular assist devices (cfVAD) are increasingly used for cardiac support with more than 4300 patients supported as of June 2011. These patients require close monitoring of blood pressure, are at increased risk of infection and bleeding, and typically require more arterial catheter days than other patient populations. These 2nd generation devices create limited pulse pressure making non invasive blood pressure monitoring challenging. Invasive monitoring is a challenge for the same reason and the use of ultrasound (US) guidance for arterial cannulation may improve the rate of successful arterial cannulation. Method: We conducted a retrospective review of US guided arterial cannulation by a dedicated team of critical care therapists on a cardiac surgical ICU with cfVAD patients from Jan 2011 to May 2012. Success rates and complication rates were abstracted. Cannulation technique is described. Results: 21 unique patients reviewed received 24 successful US guided arterial lines with an average of 5 catheter days. The average pulse pressure on insertion was 17mmHG with 15 patients having a pulse pressure of less than 15mmHG. 1 patient required alternate sites, femoral and pedal, due to unsuccessful radial cannulation. No major complications were noted. The radial artery is selected as the first choice for cannulation, brachial may be used if necessary. If more than two attempts are required, a second skilled therapist or physician may attempt an alternate site. Femoral or pedal sites are utilized by a physician if upper extremity flow is not present on US or access is unsuccessful. The iLook ™ or SICU™ (Sonosite, Bothell, WA) is used to identify the artery with the transducer in the transverse plane. Compressibility, pulsatility and blood flow directionality with 2D imaging and color flow Doppler are used to differentiate venous and arterial vessels. Real time visualization was used during arterial catheter insertion with the Seldinger technique. Conclusion: The use of US guided arterial line placement by a dedicated team of critical care therapists may reduce the number of attempts and the number of sites required for cannulation while minimizing the risk of complications in this unique population. Sponsored Research - None