hi my name is sallow Bhandari I'm an attending here at NYU Medical Center in Bellevue Hospital and I'm here with the video from AM core on how to set up an arterial transducer we oftentimes put in arterial lines but we leave up the are chilled transducer set up to our nurses however one of this videos to show you all how to do it yourself and so I'm here along with my partner dr. Brian Lynn ice able to say what's up Brian what's up Brian alrighty and and we'll go through the step one step at a time essentially this is a aseptic technique as soon as you start to poke the pressure bag however we're not going to do it just for video purposes so the first thing you want to do is get all your equipment ready there's Scentsy five things that you're gonna need you're gonna need pressure cable you're gonna need a transducer holder you're gonna need a pressure bag I'm going to need a bag of five hundred cc's of normal saline as well as your tubing and a transducer kit which should essentially come in one of these I've actually already opened it up for you and have it laid out but it's essentially everything that's in here and it comes with a packet that has certain caps in it as well which we'll go through in a bit so the first thing is understanding how all these tubing's are connected and how they all work so let's just go through that so you guys understand the big picture so first we're going to spike this bag of normal saline there's gonna be fluid that travels in this tubing all the way down all the way down up until this transducer right here and then it's gonna continue to fill this tubing it'll go into a syringe which is just an auxilary port to essentially remove blood and then it'll continue all the way down and go into the the patient over here which is on this end so in the old days or actually previously we used to not have such amazing setups that have this extra syringe here we'll talk about that a little bit later but just so you all know the lot of the older systems may actually have something that looks like this that from the transducer onwards is essentially just various stopcocks up until you get to the patient so don't worry if you don't have the syringe setup if you have the setup it's essentially fine it's the same principles and the same thing that you're going to do for that so what happens is this end is going to be connected into the patient's into the arterial line as soon as that pressure wave from the patient's artery goes into this into this port over here it's going to move this column of fluid that's in here a certain amount in certain pulsations that's can essentially get detected by this transducer right here and as soon as it detects that amount of movement it's going to send that and convert that into an electrical signal which will be outputted here and on to the monitor and that's what you're gonna see as air to your blood pressure so that's the overview that's a big picture now let's just break it down into each of the individual steps of what you're gonna do step one is is hooking up the pressure bags you're gonna take take off the little tab and spike your 500cc bag of normal saline you're gonna place it into your pressure bag just like this bring it out on the other side perfect and then you're gonna pump up your pressure bag make sure your stop the long arm of it is pointed out towards the atmosphere this allows all the air to go from here directly into the pressure bag whenever you have a stop always remember the long arm is pointed in the direction that is going to be off so if it's pointed that direction the atmosphere is off so all the pressure will go into the bag let's pump it up pump it up and essentially here's our gauge right over here there's a little bit delay in this gauge but it'll pop up in just a second and you'll see that we're gonna pump it up to a pressure there it goes just like that and you'll see we're gonna pump up to a pressure right at 300 millimeters of mercury and that's the ideal pressure that you want so as soon as you're there you're gonna take the stopcock and you're gonna turn it off just like this so we don't lose that pressure and we're gonna hook this up on to our IV pole so that is step one step number two now is hooking up placing everything on the IV pole and getting all the air out of the line so next thing we're gonna need our transducer holder we place this onto the IV pole just like that and we're now gonna take our set up and place it on to the transducer holder just like this the syringe fits very nicely right into the middle section it just literally slides in make sure you don't put it downwards like this you want to put it upwards so you can read all the numbers very clearly over here second thing you're gonna do is actually take your transducer and place that into its slot as well and slide that down make sure your cord is facing downwards over here so essentially you have a setup of the pressure bag with the tubing going down into the transducer and from the transducer you have a tubing going to the syringe and from the syringe you have the tubing that essentially goes to the patient and we'll decide hook this a little bit over here so you can see a little bit better perfect so next step is going to be getting all the air out of the actual IV lines so we're gonna do it in steps first we're gonna get the air out from the pressure bag all the way down to the transducer over here so we actually take this stopcock right here and take the stopcock and make sure that it's turned off upwards towards the patient this way all the fluid from the bag is going to be able to go out through this port right over here that actually has a little hole in it this blue tab allows the line to be open and allows actually fluid to flow so as soon as you pull on this you'll see fluid is ejected out of that port and perfect so as soon as all the bubbles are out of the out of the IV tubing you're done with that portion and you're gonna lock it in that direction now we're going to take out all the air from here all the way towards the end of the IV tubing that goes towards the patient and essentially you're gonna do the same thing we'll get a little basin just to make sure we are clean on this part and we'll do the same thing we'll pull on the tab and make sure that IV tubing is clear of any in all air bubbles and as soon as that's done boom we are done so now all the air bubbles are since you out of the IV tubing and now we're ready to connect it to our monitor so let's just go back here and essentially this port is gonna connect to our monitor Brian if you want to take a look at the monitor over here and let's just show that there are actually two ports right here that you can place this I'm gonna place it in one of the ports on the left side the right side is essentially for CVP monitoring oftentimes but you can use that as well but this is just what's done often times here at NYU take that put that back the other end essentially right here you're just gonna go and connect right onto the actual arterial transducer itself and that clicks in very easily and now our monitor is on so if this is actually connected appropriately if you take the part that goes into the patient which is right here and you wave it around you should see on the monitor a little bit of artifact that means everything hooked up and everything is connected correctly alrighty so that's the second part is getting all the air to the IV tubing last part is essentially going to be leveling the arterial line you want to zero it make sure it's zero to the atmospheric pressure so the way you're gonna do that is you're gonna expose this port right here the one that has a hole in it we're gonna expose that to the atmosphere first thing you want to do is take the stopcock and you want to turn it upwards so it's off to the patient again and then you're gonna unscrew unscrew this right here this cap and now you're essentially exposed to the atmosphere so as soon as you're exposed to the atmosphere you have to tell the computer that this is what I want in Xero to be so we're gonna come back up here Brian and we're gonna take a look at the screen and there's a button here that says zero all you're gonna do is press the zero button and two more options press pop-up and you press zero a B P or zero arterial blood pressure we're gonna press that again and essentially that is zeroing it for you perfect and we're right at zero excellent now I want you to notice one more thing over here on this side in terms of stopcock now in term instead of replacing this cap back on that we had before we're actually gonna change this and replace it with one of the caps that were in the packet insert that they gave us this cap right here looks the same from this side but it actually does not have a hole on that side unlike this cap which actually has a tiny little hole in it which allowed that fluid to escape before so we're going to take this one off and put this one back on so there's no more fluid or air that can actually get in or out of the system let's shut that off and this is the one that we're gonna actually replace back on after we have zeroed it and essentially you're now essentially have completed with the the setup procedure for the transitional end this end will now get connected to the RT R line and you're ready to transduce the pressures and that's it now a couple things just to note just to make sure we're all complete in terms of our understanding of everything is if you have this syringe option over here you can actually draw blood and I'm just going to show you very quickly how to do that you take a let's just take a little bit of orange juice over here we'll assume this is a the patient's blood because this is all I have right now this along with a bunch of tuna sandwiches in the fridge this is all we got right now so we'll just assume this is the patients blood and this is actually connected to the arterial line just so you can actually see the color in the tubing so let's say you want to draw some blood from a patient you click on the syringe and you pull it down blood gets drawn up into the sir and this is essentially what is wasted that's wasted and now this part right here can be accessed to actually withdraw the blood as soon as you withdraw the blood that you need whether it's an arterial sample or anything like that this you can let go of and now you're gonna take that waste that you had earlier and you're going to put it back inside the patient so you never really have to actually waste all that all that blood which is why the system is so great so that's essentially the advantage of having this system last thing is in terms of troubleshooting general troubleshooting techniques if you feel like you have a wave that is over damped and it's very flattened waves a couple things that you can do is just make sure that your bag is inflated correctly to up to 300 make sure this is leveled appropriately as well and also make sure that there's no air or kinks in the system as well oh and one more thing I forgot to mention when you actually set this up you always want to make sure you set it up at the level of the patient's FLE the static axis which is the intersection of their nipple and the fourth intercostal space which is sent to the fourth intercostal space and the mid axillary line that's essentially where you want to set this up on the patient's body using some older systems some people would actually tape the transducer to patients size but if you have this system it's probably much easier to keep it attached to the stand over here but you want to make sure that that height is correct so if you have a dampened wave gonna check your bag you're going to check make sure the height is okay on this make sure all the air bubbles are out as well and make sure there's no kinks in the tubing either if you have an under damped system or very large waves that are appearing a couple things that you can do essentially are also make sure there's no air bubbles in the systems and remove any sort of excess tubing sometimes extra tubing can cause that to happen but as long as those are as long as those are intact you should be good so those are all the basics all you need to know to set up transducers to do it yourself it's essentially the three steps the pressure bag getting the air out of the line and then zeroing the line and that's it it's not that hard do it next time your ship practice it and you can set up next time you have a patient hope you guys enjoy the video and I'll see you guys next time [Music]