How to measure blood pressure using an arterial catheter: a systematic 5-step approach

Abstract

Arterial blood pressure (BP) is a fundamental cardiovascular variable, is routinely measured in perioperative and intensive care medicine, and has a significant impact on patient management. The clinical reference method for BP monitoring in high-risk surgical patients and critically ill patients is continuous invasive BP measurement using an arterial catheter. A key prerequisite for correct invasive BP monitoring using an arterial catheter is an in-depth understanding of the measurement principle, of BP waveform quality criteria, and of common pitfalls that can falsify BP readings. Here, we describe how to place an arterial catheter, correctly measure BP, and identify and solve common pitfalls. We focus on 5 important steps, namely (1) how to choose the catheter insertion site, (2) how to choose the type of arterial catheter, (3) how to place the arterial catheter, (4) how to level and zero the transducer, and (5) how to check the quality of the BP waveform.

Cardiac output estimation using pulse wave analysis—physiology, algorithms, and technologies: a narrative review

“…6 Although invasive AP monitoring with an arterial catheter is the reference method to record the AP waveform, measurements can be invalidated by artifacts, including underdamping and overdamping. 72,73 Underdamping and especially overdamping may lead to the impossibility to correctly perform PWA, since many PWA algorithms rely on the correct identification of the dicrotic notch that is necessary to distinguish the systolic and the diastolic parts of the AP waveform. Most PWA devices do not automatically detect and correct inappropriate AP waveform readings.…”

Pressão arterial invasiva: conhecimento teórico dos profissionais de enfermagem de uma unidade de terapia intensiva adulto

“…Em sua totalidade, os profissionais declararam não ter recebido treinamento no setor/instituição sobre a medida da PAI, dado relevante, uma vez que 80,6% afirmaram realizar este procedimento no setor, e o mesmo ter sido instituído na rotina do setor há um ano. Este dado merece atenção, pois, para que se assegure o rigor técnico-cientifico necessário à monitorização da PAI, é fundamental o entendimento profundo do princípio de medição e dos critérios de qualidade da onda de pressão (SAUGEL B, et al, 2020).…”

Management of sepsis and septic shock in the emergency department

“…In case of vasopressors administration, invasive arterial blood pressure monitoring is suggested, albeit neither arterial catheter nor central venous catheter (CVC) placement should delay NE administration. Under these conditions, vasopressor treatment can be initiated on a peripheral venous line with non-invasive BP monitoring, and it should be shifted, as soon as possible, to CVC administration accompanied by invasive arterial pressure monitoring [ 41 , 54 ]. As basic hemodynamic monitoring is not able to detect the effects of fluid challenge on CO [ 55 , 56 ], methods for continuous CO monitoring are recommended to track changes in CO both during tests of preload responsiveness [ 22 , 57 , 58 ] and fluid challenge [ 23 , 59 ].…”