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Arterial Catheter
An arterial line (also art-line or a-line) is a thin catheter inserted into an artery. Use Arterial lines are most commonly used in intensive care medicine and anesthesia to monitor blood pressure directly and in real-time (rather than by intermittent and indirect measurement) and to obtain samples for arterial blood gas analysis. Arterial lines are generally not used to administer medication, since many injectable drugs may lead to serious tissue damage and even require amputation of the limb if administered into an artery rather than a vein. An arterial line is usually inserted into the radial artery in the wrist, but can also be inserted into the brachial artery at the elbow, into the femoral artery in the groin, into the dorsalis pedis artery in the foot, or into the ulnar artery in the wrist. A golden rule is that there has to be collateral circulation to the area affected by the chosen artery, so that peripheral circulation is maintained by another artery even if circ ...
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Radial Artery
In human anatomy, the radial artery is the main artery of the lateral aspect of the forearm. Structure The radial artery arises from the bifurcation of the brachial artery in the antecubital fossa. It runs distally on the anterior part of the forearm. There, it serves as a landmark for the division between the anterior and posterior compartments of the forearm, with the posterior compartment beginning just lateral to the artery. The artery winds laterally around the wrist, passing through the anatomical snuff box and between the heads of the first dorsal interosseous muscle. It passes anteriorly between the heads of the adductor pollicis, and becomes the deep palmar arch, which joins with the deep branch of the ulnar artery. Along its course, it is accompanied by a similarly named vein, the radial vein. Branches The named branches of the radial artery may be divided into three groups, corresponding with the three regions in which the vessel is situated. In the fore ...
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Vasospasm
Vasospasm refers to a condition in which an arterial spasm leads to vasoconstriction. This can lead to tissue ischemia and tissue death (necrosis). Cerebral vasospasm may arise in the context of subarachnoid hemorrhage. Symptomatic vasospasm or delayed cerebral ischemia is a major contributor to post-operative stroke and death especially after aneurysmal subarachnoid hemorrhage. Vasospasm typically appears 4 to 10 days after subarachnoid hemorrhage. Along with physical resistance, vasospasm is a main cause of ischemia. Like physical resistance, vasospasms can occur due to atherosclerosis. Vasospasm is the major cause of Prinzmetal's angina. Pathophysiology Normally endothelial cells release prostacyclin and nitric oxide (NO) which induce relaxation of the smooth muscle cells, and reduce aggregation of platelets. Aggregating platelets stimulate ADP to act on endothelial cells and help them induce relaxation of the smooth muscle cells. However, aggregating platelets also s ...
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Lidocaine
Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, lidocaine typically begins working within several minutes and lasts for half an hour to three hours. Lidocaine mixtures may also be applied directly to the skin or mucous membranes to numb the area. It is often used mixed with a small amount of adrenaline (epinephrine) to prolong its local effects and to decrease bleeding. If injected intravenously, it may cause cerebral effects such as confusion, changes in vision, numbness, tingling, and vomiting. It can cause low blood pressure and an irregular heart rate. There are concerns that injecting it into a joint can cause problems with the cartilage. It appears to be generally safe for use in pregnancy. A lower dose may be required in those with liver problems. It is generally safe to use i ...
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Collateral Circulation
Collateral circulation is the alternate circulation around a blocked artery or vein via another path, such as nearby minor vessels. It may occur via preexisting vascular redundancy (analogous to engineered redundancy), as in the circle of Willis in the brain, or it may occur via new branches formed between adjacent blood vessels (neovascularization), as in the eye after a retinal embolism or in the brain when moyamoya occurs. Its formation may be provoked by pathological conditions such as high vascular resistance or ischaemia. An example of the usefulness of collateral circulation is a systemic thromboembolism in cats. This is when a thrombotic embolus lodges above the external iliac artery (common iliac artery), blocking the external and internal iliac arteries and effectively shutting off all blood supply to the hind leg. Even though the main vessels to the leg are blocked, enough blood can get to the tissues in the leg via the collateral circulation to keep them alive. Br ...
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Ulnar Artery
The ulnar artery is the main blood vessel, with oxygenated blood, of the medial aspects of the forearm. It arises from the brachial artery and terminates in the superficial palmar arch, which joins with the superficial branch of the radial artery. It is palpable on the anterior and medial aspect of the wrist. Along its course, it is accompanied by a similarly named vein or veins, the ulnar vein or ulnar veins. The ulnar artery, the larger of the two terminal branches of the brachial, begins a little below the bend of the elbow in the cubital fossa, and, passing obliquely downward, reaches the ulnar side of the forearm at a point about midway between the elbow and the wrist. It then runs along the ulnar border to the wrist, crosses the transverse carpal ligament on the radial side of the pisiform bone, and immediately beyond this bone divides into two branches, which enter into the formation of the superficial and deep volar arches. Branches Forearm: Anterior ulnar recurr ...
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Dorsalis Pedis Artery
In human anatomy, the dorsalis pedis artery (dorsal artery of foot) is a blood vessel of the lower limb. It arises from the anterior tibial artery, and ends at the first intermetatarsal space (as the first dorsal metatarsal artery and the deep plantar artery). It carries oxygenated blood to the dorsal side of the foot. It is useful for taking a pulse. It is also at risk during anaesthesia of the deep peroneal nerve. Structure The dorsalis pedis artery is located 1/3 from medial malleolus of the ankle. It arises at the anterior aspect of the ankle joint and is a continuation of the anterior tibial artery. It ends at the proximal part of the first intermetatarsal space. Here, it divides into two branches, the first dorsal metatarsal artery, and the deep plantar artery. It is covered by skin and fascia, but is fairly superficial. The dorsalis pedis communicates with the plantar blood supply of the foot through the deep plantar artery. Along its course, it is accompanied by a deep ...
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Femoral Artery
The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery or profunda femoris artery and descends along the anteromedial part of the thigh in the femoral triangle. It enters and passes through the adductor canal, and becomes the popliteal artery as it passes through the adductor hiatus in the adductor magnus near the junction of the middle and distal thirds of the thigh. Structure The femoral artery enters the thigh from behind the inguinal ligament as the continuation of the external iliac artery. Here, it lies midway between the anterior superior iliac spine and the symphysis pubis (Mid-inguinal point). Segments In clinical parlance, the femoral artery has the following segments: *The common femoral artery (CFA) is the segment of the femoral artery between the inferior margin of the inguinal ligament and the branching point of the deep femoral artery/profunda femoris artery ...
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Brachial Artery
The brachial artery is the major blood vessel of the (upper) arm. It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa at the elbow. It then divides into the radial and ulnar arteries which run down the forearm. In some individuals, the bifurcation occurs much earlier and the ulnar and radial arteries extend through the upper arm. The pulse of the brachial artery is palpable on the anterior aspect of the elbow, medial to the tendon of the biceps, and, with the use of a stethoscope and sphygmomanometer (blood pressure cuff), often used to measure the blood pressure. The brachial artery is closely related to the median nerve; in proximal regions, the median nerve is immediately lateral to the brachial artery. Distally, the median nerve crosses the medial side of the brachial artery and lies anterior to the elbow joint. Structure The brachial artery gives ...
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Arterial Blood Gas
An arterial blood gas (ABG) test, or arterial blood gas analysis (ABGA) measures the amounts of arterial gases, such as oxygen and carbon dioxide. An ABG test requires that a small volume of blood be drawn from the radial artery with a syringe and a thin needle, but sometimes the femoral artery in the groin or another site is used. The blood can also be drawn from an arterial catheter. An ABG test measures the blood gas tension values of the arterial partial pressure of oxygen (PaO2), and the arterial partial pressure of carbon dioxide (PaCO2), and the blood's pH. In addition, the arterial oxygen saturation (SaO2) can be determined. Such information is vital when caring for patients with critical illnesses or respiratory disease. Therefore, the ABG test is one of the most common tests performed on patients in intensive-care units. In other levels of care, pulse oximetry plus transcutaneous carbon-dioxide measurement is a less invasive, alternative method of obtaining simil ...
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Arterial Kateter (Seldinger)
An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pulmonary and the umbilical arteries, which carry deoxygenated blood to the organs that oxygenate it (lungs and placenta, respectively). The effective arterial blood volume is that extracellular fluid which fills the arterial system. The arteries are part of the circulatory system, that is responsible for the delivery of oxygen and nutrients to all cells, as well as the removal of carbon dioxide and waste products, the maintenance of optimum blood pH, and the circulation of proteins and cells of the immune system. Arteries contrast with veins, which carry blood back towards the heart. Structure The anatomy of arteries can be separated into gross anatomy, at the macroscopic level, and microanatomy, which must be studied with a microsco ...
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Sphygmomanometer
A sphygmomanometer ( ), a blood pressure monitor, or blood pressure gauge, is a device used to measure blood pressure, composed of an inflatable cuff to collapse and then release the artery under the cuff in a controlled manner, and a mercury or aneroid manometer to measure the pressure. Manual sphygmomanometers are used with a stethoscope when using the auscultatory technique. A sphygmomanometer consists of an inflatable cuff, a measuring unit (the mercury manometer, or aneroid gauge), and a mechanism for inflation which may be a manually operated bulb and valve or a pump operated electrically. Types Both manual and digital meters are currently employed, with different trade-offs in accuracy versus convenience. Manual A stethoscope is required for auscultation ( see below). Manual meters are best used by trained practitioners, and, while it is possible to obtain a basic reading through palpation alone, this yields only the systolic pressure. * Mercury sphygmomanomete ...
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