OUTCOMES:
* The risk of infection will be minimised through maintaining a sterile field for Intensivist to work in.
* The catheter will be located in the Radial Artery/ Femoral Artery, right or left
* The risk of infection will be minimised through the use of strict aseptic technique.
* There will be no circulatory damage to the affected limb due to placement of the Arterial Line during patients stay in Hospital.


EQUIPMENT: 500 mls Heparinize Normal Saline ( premixed) Pressure Bag
2 /0 black silk on a straight cutting needle 10 mls. 1% Plain Xylocaine
Basic dressing pack Hibitane solution

2 x 5 ml. syringes 1 x 23 G. needle
1 x 19 G. needle, 1 fenestrated drape
Surgical mask Sterile gloves
trolley Insite cannula 20 G x 2
Arm board with padding Monitoring cable and module
Disposable pressure monitoring kit # 338 Hansapor (wound dressing) 15 cm x 8 cm x 1
Rubbish bin Sterile drape for trolley
Sterile towel 10 mls Normal Saline flush x 2


PROCEDURE:
* Attach pressure monitoring kit, #338 to Heparinize Normal Saline bag. Before attachment to bag ensure all luer lock connection are tight on the monitoring kit.
* Place Heparinize Normal Saline bag in pressure bag and inflate to 300 mmHg.
* Prime pressure monitoring kit with Heparinised Normal Saline from infusion bag by pinching butterfly value together. Ensure sample port is also flushed at this time.
* Ensure three way tap is turned off to sample port and red cap is secured in place.
* Maintain sterility of end of pressure monitoring kit by leaving sterile cap at end of line in place.
* Attach monitoring cable to pressure monitoring kit and to bedside monitor. Label as Arterial on bed monitor.
* Zero pressure monitoring kit to atmospheric pressure by pressing zero label on bedside monitor display.
* Lay sterile drape on trolley. On sterile field lay out Insite cannula 20 G x 1, 2 x 5 ml. syringes, basic dressing pack, 2 /0 black silk on a straight cutting needle, fenestrated drape, 23 G. needle, 1 x 19 G. needle, Hansapor dressing and sterile gloves.
* Under trolley place 10 mls. 1% Plain Xylocaine, Hibitane solution and 10 mls Normal Saline flush x 2.
* While Intensivist is scrubbing lay out sterile towel.
* During procedure assist Intensivist with drawing up solutions and placing appropriate solutions ( maintaining sterile field) into dressing pack.
* Once the Insite cannula is in place, remove protector from end of pressure monitoring kit, thread tubing under fenestrated drape and luer lock on to end of Insite cannula. Ensure press line is secured by observing for bleeding at connection site.
* Flush Heparinised Normal Saline through line, same has priming line above.
* Observe bedside monitor for appropriate arterial line wave form tracing.
* After Intensivist has applied dressing, observe site for bleeding. Also check distal and collateral circulation in affected hand.
* Secure affected hand in padded arm board and secure pressure lines to forearm. Arterial Line site should not be compressed by arm board.
* Label dressing with time and date of change.
* Record date and time of next dressing change on flow chart.
* Note in patients' chart above procedure.