Arterial Line Placement Procedure Note

Date/Time: [Procedure start date and time]

Location: [Care setting and bedside vs procedure suite]

Operator: [Operator name and credentials]

Procedure: [new placement / replacement] (If replacement, briefly state the specific reason such as malfunction, infection concern, or dislodgement.)

Indication

[Clinical indication for arterial line placement] (Concise reason for invasive monitoring and/or frequent arterial sampling. Include relevant risk considerations only if they influenced technique or site selection.)

Consent

[Consent status: obtained from patient / obtained from surrogate / not obtained] (If obtained: specify verbal vs written and confirm that risks, benefits, and alternatives were discussed and agreement given. If not obtained: document reason and that emergency/implied consent per policy was applied.)

Time-Out

Time-out performed immediately prior to the procedure: correct patient, correct procedure, [site and laterality], allergies reviewed, required equipment available. (If time-out was not performed, state the reason.)

Site Selection

Chosen site: [Vessel, laterality, and anatomic location]

Site rationale: [Rationale if higher-risk site used or initial site failed] (Include only if applicable; otherwise omit this line.)

Baseline distal perfusion: [Capillary refill, skin temperature, pulse oximetry waveform, palpable pulse, sensation] (Document findings; if not assessed, state not assessed and reason.)

Sterile Technique

• Hand hygiene performed: [yes / no]
• Skin antiseptic: [chlorhexidine-alcohol / povidone-iodine / other]; allowed to dry: [yes / no]
• Sterile gloves worn: [yes / no]
• Barrier precautions used: [cap, mask, sterile drape, eye protection] (List all used.)

(If any element was not performed, document not performed with brief reason. Do not use generic statements like "sterile technique used" alone.)

Anesthesia

[Local anesthesia used / not used] (If used: specify agent, concentration, and volume infiltrated. If not used: briefly document reason.)

Ultrasound

Ultrasound: [used / not used]

(If used: specify dynamic real-time guidance vs static pre-scan localization; document vessel assessment including patency and size; confirm sterile probe cover used; note whether images were saved. If not used: state "Ultrasound not used" with no additional detail required.)

Procedure Details

Positioning: [Patient and limb positioning]

Technique: [over-the-needle / Seldinger with guidewire]

Catheter: [Gauge and length]

Attempts: [Number of attempts] (If multiple sites attempted, list attempts per site.)

Hemostasis: [Hemostasis status]

Intra-procedure findings: [Clinically significant findings such as vasospasm or difficult anatomy / none]

Confirmation

• Pulsatile blood return observed: [yes / no]
• Arterial waveform on transducer: [present / absent]
• Pressure values consistent with arterial pressures: [yes / no]
• Transducer leveled and zeroed: [yes / no]
• Waveform quality issues: [none / troubleshooting performed and details]

(Document objective confirmation of arterial placement. Do not infer steps not explicitly performed.)

Securement and Dressing

• Securement method: [suture / sutureless device / adhesive]
• Dressing type: [transparent semipermeable / gauze] (If gauze, provide reason.)
• Stabilization: [arm board used / not used]

Post-Procedure Assessment and Complications

• Patient tolerance: [tolerated well / symptoms noted]
• Post-procedure distal perfusion: [Capillary refill, skin temperature, pulse oximetry waveform, palpable pulse, sensation]
• Immediate complications: [No immediate complications / complication type, management, and escalation]

(Complications must always have an explicit entry, even if none occurred.)

Plan

• [Ongoing arterial waveform monitoring]
• [Limb check frequency and parameters]
• [Dressing care]
• [Daily reassessment of line necessity]

Attestation

Operator: [Signature, name, credentials, date/time]

(Required sections—consent, time-out, sterile technique, ultrasound, confirmation, complications, and post-procedure perfusion—must not be left blank. If an element was not performed or not applicable, explicitly document with brief reason.)