Arterial line

Indications: Hemodynamic monitoring in specific circumstances including - Expected significant blood loss (multilevel spine, trauma, major ortho surg) - Clinically unstable patients (severe or labile hypertension or hypotension with concern for sepsis, cardiogenic shock, ect) - Surgical need for tight BP control (neurosurgical/vascular procedures; CNS aneurysm coiling, carotid surg) - Measurement of MAP crucial to derive cerebral perfusion pressure or coronary perfusion pressure (CPP): Neurosurgery, cardiac, beach-chair, semi-Fowler's ENT

Frequent blood sampling for blood gas analysis &/or diagnostic tests to guide intraoperative management (electrolytes, iCal, Lactic acid, Hb, coagulation studies, TEG, ACT, PTH, ect)

Unable to obtain a non-invasive blood pressure or NIBP ineffective/impractical - Morbidly obese patients where NIBP cuff pressures are unreliable - Significant concern for NlBP cuff trauma; patient with very low PLT count or high INR - Cases where arm positioning make cuff potentially traumatic to med nerve (thoracotomy)