Source: Sharon Bord, MD, Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Maryland, USA

When monitoring patients, it is important to obtain values that are accurate and reliable. Blood pressure monitoring is one of the essential vital signs, and for a majority of patients, measuring it utilizing non-invasive techniques provides accurate values. However, there are situations in which the blood pressure requires more exact, specific, and reliable measurements. This can be achieved by intra-arterial blood pressure monitoring and requires arterial line placement. Arterial line placement refers to the insertion of a catheter, which is able to transduce blood pressure, into one of the major arteries (e.g., radial or femoral artery). Patients who potentially need arterial line placement include those with extreme low (such as in sepsis or cardiogenic shock) or high (as in cerebrovascular accident or hypertensive emergency) blood pressure measurements. Many of these patients are placed on vasoactive medications to either increase or decrease blood pressure. When the goal is to decrease a patient's blood pressure, it must be done gradually, which further necessitates close blood pressure monitoring. Arterial line placement is also ideal for patients who require frequent arterial blood gas monitoring.

1. Preparation for the procedure

1. Obtain the necessary supplies. This includes:
   1. Antiseptic skin prep pads, such as chlorhexidine pads
   2. A syringe (lidocaine 1%) with a needle attached
   3. Arterial line introducer kit. There are two different types of kits: an over-the- needle catheter kit and a kit with a guide wire
   4. Proper suture material (generally #0 silk) with a needle driver, pickups, and iris scissors
   5. Tape for patient positioning
   6. Gauze

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