Miller麻醉学关于桡动脉穿刺的操作

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1、Ｍiller麻醉学关于桡动脉穿刺的操作：Percutaneousradialarterycannulation.(A)Thewristispositionedandthearteryidentifiedbypalpation.(Thecatheter-over-needleassemblyisintroducedthroughtheskinandadvancedtowardtheartery.(C)Entryoftheneedletipintothearteryisidentifiedbytheflashofarterialbloodinthe

2、needlehubreservoir.(D)Needle-catheterassemblyisadvancedatalowerangletoassureentryofthecathetertipintothevessel.(E)Ifbloodflowcontinuesintotheneedlereservoir,thecatheterisadvancedgentlyovertheneedleintotheartery.(F)Thecatheterisattachedtopressuremonitoringtubingwhilemaintaini

3、ngproximalocclusivepressureontheartery.Seetextforgreaterdetail.Salvagingarterialcannulation.(A)Whenbloodflowintotheneedlereservoirceases,theneedletiphasexitedthevessellumen.(Theneedletipiswithdrawnseveralmillimeterssothatthecathetertipbecomestheleadingedgeoftheneedle-cathete

4、rassemblyandarterialbloodflowreappearsinthecollectionreservoir.(C)Whenarterialbloodflowisreestablished,thecatheterisadvancedintothearteriallumen.Salvagingarterialcannulation(II).(A)Whenbloodflowintotheneedlereservoirceases,boththeneedletipandcathetertipmayhaveexitedthevessel

5、lumen.(Theneedletipiswithdrawnseveralmillimeterssothatthecathetertipbecomestheleadingedgeoftheneedle-catheterassembly.(C)Ifarterialbloodflowdoesnotreappearinthecollectionreservoir,theentireneedlecatheterassemblyisnowwithdrawn,allowingthecathetertiptoreenterthevesselasthelead

6、ingedge.Thisisconfirmedbythereappearanceofarterialbloodflowinthecollectionreservoir.(D)Whenarterialbloodflowhasbeenreestablished,thecatheterisadvancedintothearteriallumen.Usingaguidewiretoaidarterialcannulation.(A)Acathetermaynotthreadintoatortuousartery.(Theneedleisremovedf

7、romthecatheter,andaguidewireisadvancedthroughthecatheterintotheartery.(C)Thecatheterisadvancedovertheguidewireintothearte-riallumen.Arterialcannulationusinganintegratedneedle–guide-wire–catheterassembly.(A)Thearteryisidentifiedbyaflashofarterialbloodintothecollectionreservoi

8、rastheneedletipentersthevessel.(Theguidewireisadvancedthroughtheneedleintot