Contraindications

Method

Insert the catheter (with needle) towards the radial artery and puncture the back wall (go all the way through the vessel, i.e. continue after getting flashback)
Remove the needle leaving the cannula in place
Withdraw the cannula until pulsatile flow returns
Insert the wire through the cannula
Insert the cannula (over the wire)

Wash hands and put on mask
Position the forearm so that it is flat
Put on sterile gloves
Use antiseptic solution to wash skin from the wrist to antecubital fossa
Discard sterile gloves
Wash hands again
Put on gown
Put on sterile gloves
Drape the patient exposing only the clean area from the wrist to the antecubital fossa
Have an assistant clean the USS with a antiseptic wipe
Cover the USS probe in a sterile manner with the ultrasound probe cover
Remove air pockets around the probe and secure with rubber bands
Determine orientation of the probe
Scan the wrist looking for calcification, kinking and pulsatility
Have an assistant adjust the gain and depth
Anaesthetise the skin
Insert the angiocatheter at a 45-60° angle to the skin
Slide or tilt the probe towards the needle until you can visualise the tip
As you advance the needle towards the artery, tilt the probe in the direction of the needle’s trajectory
Insert into the artery and observe for flushback
Flatten the catheter and ensure with ultrasound that the needle tip is still within the artery
Slide the catheter over the needle into the atrterial lumen
Apply pressure proximal to the needle and attach the catheter to the transducer
Apply a sterile dressing

Tegtmeyer, K., Brady, G., Lai, S., Hodo, R., Braner, D., 2006. Placement of an Arterial Line. New England Journal of Medicine 354, e13. https://doi.org/10.1056/NEJMvcm044149
Ailon, J., Mourad, O., Chien, V., Saun, T., Dev, S.P., 2014. Ultrasound-Guided Insertion of a Radial Arterial Catheter. New England Journal of Medicine 371, e21. https://doi.org/10.1056/NEJMvcm1213181