art lines

There are lots of ill patients at the Austin, and giving anaesthesia to an ill patient always equals to an art line. Am I right? probably not.

There only several conditions in which an art line is absolutely mandatory, meaning you would put your heart and souls into getting one and will resort to desperate and brutal means of acquiring one and may even cancel the case if there is no art line.

These are in no particular order:

1.Liver transplants
2.Cerebral aneurysm surgery
3.Elective cardiac surgery
4.Carotid endarterectomies under GA
5.Carcinoid tumor resection and Pheochromocytoma resection.
6.Big people where a BP cuff wont fit.
7.Burn victims.

There's a whole list of situations where it will be nice to have one, but it will do jack shit for for patients.
There's an even bigger list where we put one as a safety blanket.

There's also a list of surgeries where we have no business doing an art line until (ironically) the patient is safe:

1.Hypotensive shock
2.In an actively bleeding patient
3.In a hypoxic patient
4. In an obtunded patient with raised ICP.
5. In awake, poor frightened patients going for cardiac surgery.

In bleeding patients, shocked, hyotensive patients we should try to keep them alive. When, a second pair of hands arrive, then second pair should help us keep the patient alive. When a third pair of hands arrive, that third pair should help keep patients alive.

There are thousands of things to check:
-enough crystalloids
-enough colloids
-do we need blood
-do we need products
-acidotic? -do we need a NaHCO3 solution to catch up?-no we dont an art line to dram blood sample!
-are we behind calcium
-does someone need to start an antifibrolytic
-is it time to organize the level one?
-is the patient freezing? can we do more-ask surgeon to apply warm packs? increase bair hugger temp, wrap his whole neck and head up, blah, blah,blah

our first duty is to the patient. when we sort out all this, then we can then make our monitering screen look pretty with an art line waveform. And it DOES look impressive, regardless of the sorry state of the patients BP!


What do we do when (gasp!) we dont have an art line?
use the NIBP cuff, ECG, watch the etCO2 to gauge cardiac output, watch urine output, CVP, pulse oxi waveform, and yes i know its crude and unscientific, but, believe it or not, we can actually PALPATE the brachial an carotid pulse and resusitate accordingly.

I am not against artlines, and would have hundreds. Its just that there's a time and place for everything.