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Have you ever had a baby in the neonatal unit? That no matter how hard you try, you just can't insert a UAC. You have two options. You could either perform repeated frequent capillary blood gas monitoring and noninvasive BP monitoring. But this is not ideal in a critically unwell neonate. You could also insert a peripheral outline which will allow more adequate monitoring of their physiology. This is a tricky procedure and has risks of complication. So you only ever do it under senior supervision. I'm Doctor Matthew Sayers, a consultant, pediatrician with over 10 years experience in pediatrics and I have inserted a number of peripheral arterial lines with varying degrees of success. In this video, I will share my tips and experience from successful and unsuccessful peripheral arterial lines. In this video, we will focus only on radial peripheral arterial lines and neonates as this is what I have experience in. Thanks to all guidelines and documents are available in the video description and also on the Ola Medical app. An arterial line is generally required in babies that are critically unwell and require continuous monitoring of their arterial BP. For example, a baby with severe persistent pulmonary hypertension of the newborn. It is also required for babies that have persistent hypotension requiring AA troops. It's required for babies that will require frequent sampling for their oxygenation and ventilation. For example, a baby on high frequency oscillating ventilation. Finally, it is indicated for babies that require an exchange transfusion as the arterial line is vital in removing blood from the baby. Mentioned, umbilical arterial lines are often easier to put in than peripheral art lines. However, if these are unsuccessful or contraindicated, a peripheral outline should be attempted for babies that require single or infrequent um blood gas sampling. Capillary sampling should be used. I have linked my video on capillary blood gas sampling at the top of this video. Arterial lines are contraindicated. If there is poor collateral circulation in that artery, if there are signs of poor circulation, there has been a recent attempt in that artery or if there are severe limb abnormalities, always perform Alan's test before performing a peripheral arterial line. Uncontrolled coagulopathy is also a contraindication. A N TT is required when inserting and also when accessing an arterial line. This video by Neo Sim shows you the correct technique for accessing an arterial line in a baby. The modified Allen test is performed by lifting the baby's hand upwards, occluding both the radial and ulnar artery and applying blanching pressure to the hand release the ulnar artery and observe the hand to see if the blanched area returns to its normal color within 10 seconds. If it does not do not perform uh radial artery cannulation in that arm. Firstly, prepare your equipment, you will need at least a size yellow cannula 24 gauge chloraprep applicator, a dressing and steri strip set to secure a flushed extension set, a three way T with an arterial line connector and a saline flush, attach your arterial connector port to your three way tap and flush all lumens position the patient's arm with the wrist extended gently, palpate the radial pulse in premature babies. It may be useful to place a transilluminating vein finder device under the wrist to assist with visualization of the artery, clean the area and allow it to dry. Slowly, advance the tip of the cannula through the skin, advance at a 45 degree angle slowly until flashback is obtained. Slowly advance the plastic cannula tubing over the needle. It should advance easily and the needle can be removed. Pulsatile bleeding from the cannula will occur if successful, quickly attach the extension set and slowly flush with saline. It should flush easily. But if done too quickly, it can cause blanching of the hand which should be avoided. Secure the cannula with steri strips and a dressing and flush again. Attach the flushed three way T to the extension set and attach this to a transducer. Make sure you prescribe a heparinized saline infusion to avoid blood clots developing in the arterial line. Always make sure. The arterial line is appropriately labeled to avoid accidental injection of fluid or medication. This procedure has a number of complications and should only be performed after senior discussion. The main complications are thrombosis, thromboembolism and vasospasm which can lead to necrosis, gangrene and autoamputation of the extremities. A large hematoma infection, local aneurysm tendon or nerve damage can occur if you have any doubt about an arterial line, take it out of you if the line isn't beating back well, or the BP tracing isn't working first check. Distal perfusion is ok. Reposition the hand and um check that there are no visible clots within the transducer, flush the line and consider removing the dressing to ensure it's not kinked. If the line remains persistently problematic, it is better to remove it before more severe complications occur. If you do, if the baby suddenly develops severely reduced perfusion, this to lead to the arterial line, virtually remove the arterial line immediately and contact a senior name NATO, raise the affected limb and put a warm compress on the contralateral limb to promote uh reflex vasodilation. Perform an urgent Doppler ultrasound to identify the cause if this persists, consider antic coagulating and using low molecular weight. Heparin. Discuss with the hematologist and vascular surgeon before doing this. Thanks so much for watching. 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