A peripheral arterial catheter is a small plastic catheter inserted through the skin into an artery in one of the limbs. Sometimes called a peripheral arterial line or PAL, this type of catheter is used in the NICU to take frequent blood samples without having to draw blood repeatedly via a needlestick. Peripheral arterial catheters in neonates can be necessary if the baby has a severe lung disease, is on a ventilator, has blood pressure issues, requires pressure monitoring, or is taking medication.
While the use of peripheral arterial catheters is fairly common, there are documented risks and complications with using them. There's always room for improving safety in the NICU, so here’s what staff and providers need to be mindful of.
How Peripheral Arterial Line Insertion in Neonates Works
Placing a PAL is a serious procedure and should only be performed by an experienced medical professional. First, the PAL is inserted using a cannula over a needle, typically a 24-gauge cannula for most neonates. The PAL can be inserted into the radial, posterior tibial, or dorsal pedal artery. The ulnar artery can be used as a last resort, but only if the radial artery on the same limb has not already been accessed.
When inserted, the cannula should be flushed with heparinized saline, then attached to a luer lock extension, three-way tap or t-connector with a septum for blood sampling, and transducer set. The cannula should then be secured with tape and the catheterized limb should be splinted with digits visible. If the cannula is inserted in the arm, the wrist should be held in gentle extension. If the cannula is inserted in the leg, the foot should be held in slight dorsiflexion. Once the transducer is calibrated and level with the right atrium, continuous blood pressure measurements can be taken via the PAL.
Fluid must always be running through arterial lines to reduce the risk of thrombus. Any unsuccessful attempts to place the PAL should be documented to prevent additional attempts from being performed on the same limb, which can potentially compromise or stop blood flow to the catheterized limb. This is the most significant sequelae of using PALs, but performing an Allen test before the PAL is placed can circumvent this risk. Other complications of peripheral arterial lines can include:
- Thromboembolism, vasospasm, thrombosis, or other circulation disorders
- Damage to the median or posterior tibial nerves
- Hematoma
- Aneurysm of the catheterized artery
PALs by nature have a greater risk for bleeding than standard IVs. The risk of complications is also higher in premature neonates, especially those with low birth weights, or when the catheter gauge is too large for the artery.
How the Hummi Blood Transfer Device Improves Peripheral Arterial Blood Sampling
The Hummi Micro-Draw Blood Transfer Device from Kentec Medical is specifically designed to improve on traditional peripheral arterial blood draw techniques in order to improve clinical outcomes.
The Hummi blood transfer device contains a blunt stainless tube and a Y-shaped hub with two separate micro-bore tubing extensions for collecting waste blood and sampling, respectively. When sampling, the Hummi Micro-Draw Blood Transfer Device is inserted through the split septum of the Micro-T connector directly into the base of an arterial catheter. The Hummi blunt tube comes to rest approximately 1-2mm from the opening of the catheter, bypassing the dead space in the T-connector and catheter hub entirely and allowing blood to flow directly from the catheter into the Hummi blood transfer device and extension lines.
When taking the blood directly from the peripheral catheter hub, the clearance volume required is very low, as only the catheter itself needs to be cleared. The Hummi Micro-Draw Blood Transfer Device draws no blood into the catheter hub or T-connector housing, allowing clearance of five times the catheter volume with only 0.1mL of blood movement into the Hummi device itself. The total discard volume of whole blood is approximately 0.12mL and no flushing after the draw is required, as the volume of blood in the catheter itself is easily flushed by the pump when flow is restarted in the line.
Other Clinical Advantages of the Hummi Micro-Draw Blood Transfer Device for Peripheral Arterial Draws
- No blood is aspirated during the sampling process when you use self-venting syringes. Vented syringes allow passive pressure to collect the blood, eliminating negative pressures as well as the risk of air embolism.
- No blood is drawn into the Micro-T connector or monitoring line, minimizing blood movement.
- The system is closed, keeping infection and blood exposure risk to a minimum.
- The device only requires one access point for both waste clearance and sample draws.
- Flushing after the draw is not required, as the pump will move the small amount of blood in the catheter back to the patient.
- Due to the low volume of blood movement and no flush requirement, the peripheral catheter will have a longer indwell life with fewer complications for the patient.
Improve the Safety of Your Blood Sampling Methods with Kentec Medical
Kentec Medical believes that high-quality tools like the Hummi Micro Draw are a critical part of ensuring that NICU staff and other healthcare providers have the equipment and support they need to improve patient health outcomes. We’re ready and able to help guide you through the process of getting Hummi products into your hospital so that you can focus on the work that really matters — saving lives. Contact us today to learn more.