Arterial puncture and cannulation, also known as arterial line placement or “a-line,” is commonly performed to allow for continuous blood pressure measurement and frequent arterial blood gas sampling. Generic arterial line kits include separate needle and wire components, as would be used to place a central line. However, the following guide covers fundamental knowledge for the commonly utilized all-in-one (Seldinger type) radial artery kit.. This protocol covers the task of arterial line placement by a Nurse Practitioner (NP).

The purpose of this standardized procedure is to allow the Nurse Practitioner to safely insert the arterial catheter when needed. An arterial catheter may be needed in routine (preoperative placement, non-urgent placement for titrating vasoactive agents more effectively in a stable patient, etc., and urgent case scenarios. The goal of arterial line placement is to provide a means of monitoring a patient’s blood pressure moment-to-moment and to have access to the arterial blood supply for laboratory analysis.

Learning Sequence Builds Confidence

The learner practices the procedure in the ‘guided mode’ (ghosted hints, narrative from tutor) as often as they like. 

When the learner is confident that they can accurately demonstrate the procedure without error, the learner plays the level in the ‘expert mode’ (no hints or coaching narration) - which they can repeat as often as they wish. 

Finally, when the learner is confident that they have mastered the procedure - they take a one-time ‘exam’ attempt which results in their grade for that procedure.


Guided Mode - ghosted hints show step-by-step positions, learner can 'see through' the patient to verify placement.

Oculus Quest Hand Tracking - learner uses natural hand movements to interact (no need to memorize buttons & controls).

Oculus Quest Affordability & Ease of Use - next generation game development processes allow the untethered, mobile VR to present effective visual and interaction fidelity at 1/4 of the cost of desktop VR.

Physiology Engine - real-world patient & case data informs the simulation.

Feedback - Cloud-based enterprise incorporates real-time data acquisition that allows learner to track progress and mastery, and provides detailed insights for debrief with faculty.

Support - Enterprise incorporates Knowledge Base (with tutorial videos & FAQ) - combined with help desk support staff for learners and staff.


Arterial Line Checklist

  1. Wash hands and don personal protective equipment.

  2. Assess the external anatomy of the selected insertion site. If using ultrasound, evaluate the site using ultrasound prior to starting procedure.

  3. Perform the Allen Test to assess for patients at higher risk of ischemic complications from prolonged arterial cannulation.

  4. Obtain a prepackaged radial artery catheterization kit. Typically, the kit should include iodine or chlorhexidine solution, dorsal wrist extensor splint, 1% lidocaine for local anesthesia, 4×4 gauze squares, adhesive tape, nylon suture (3-0 or 4-0), needle driver, catheter-over-the-needle, and compatible spring wire guide.

  5. Extend the patient’s wrist to identify the radial artery insertion site. Secure arm and hand with tape if needed.

  6. Palpate the radial artery to determine its location.

  7. Clean the skin with an antiseptic solution, arrange sterile drape, and inject anesthetic.

  8. Prepare patient for puncture.

  9. Stabilize artery by pulling skin taut.

  10. Puncture skin at 45-60 degree angle for radial artery; 90 degrees for femoral artery.

  11. Advance catheter when flash of blood is observed in catheter.

  12. Cleanse area of any blood and allow site to dry.

  13. Secure arterial line with tape or steri-strips and cover with a Tegaderm dressing.

  14. Secure I.V. tubing to prevent it from being caught and pulling on arterial catheter.

  15. Properly dispose of the I.V. sharps and other used materials.