Arterial Line: Radial Approach
[Right / Left] radial arterial line placement [with ultrasound guidance]
[indication] requiring continuous arterial pressure monitoring for [hemodynamic instability / vasopressor titration / frequent arterial blood gas sampling / anticipated major surgery].
[Informed consent was obtained from the [patient / patient's surrogate] after discussion of risks, benefits, and alternatives / The procedure was emergent, and consent was implied].
[***, MD/DO]
Local: [X] mL 1% lidocaine without epinephrine
The radial artery was [palpable / identified by ultrasound] at the [right / left] wrist. Pulsatile arterial blood return was obtained, and a sharp arterial waveform was confirmed on the bedside monitor after catheter placement. Distal hand perfusion was intact after the procedure.
A time-out was completed confirming the patient, procedure, and side. A modified Allen test showed color return to the palm within [X] seconds after release of ulnar compression, confirming adequate ulnar collateral circulation.
The [right / left] wrist was positioned in extension over a rolled towel and secured with tape. The wrist was prepped with chlorhexidine and draped in sterile fashion. Sterile gloves were worn. The skin and subcutaneous tissue overlying the radial artery were infiltrated with [X] mL of 1% lidocaine, taking care to avoid intra-arterial injection.
The radial artery was [palpated / visualized with ultrasound in the transverse plane]. A [20 / 22]-gauge arterial catheter was advanced at a 30–45 degree angle toward the arterial pulsation until a pulsatile flash was seen in the hub. The catheter was advanced [over the needle / over the integrated guidewire] into the arterial lumen, and the needle was removed. Pulsatile arterial blood flow was confirmed.
The catheter was connected to pressurized arterial line tubing. A sharp arterial waveform was confirmed on the bedside monitor, and the transducer was zeroed at the phlebostatic axis. The catheter was secured with [a sutureless securement device / suture], and a transparent sterile dressing was applied.
[20 / 22]-gauge arterial catheter, [right / left] radial artery, secured with [a sutureless securement device / suture], transduced and zeroed at the phlebostatic axis
Minimal
None
None
The patient tolerated the procedure well. Continuous arterial pressure monitoring was initiated. Distal hand perfusion will be monitored [per nursing protocol].
Epic SmartPhrase Version
PROCEDURE: [Right / Left] radial arterial line placement [with ultrasound guidance]
INDICATION: *** requiring continuous arterial pressure monitoring for ***.
CONSENT: [Informed consent obtained from the [patient / surrogate] after discussion of risks, benefits, and alternatives / Emergent, consent implied].
PERFORMED BY: ***, MD/DO
ANESTHESIA: Local: *** mL 1% lidocaine without epinephrine
FINDINGS: Radial artery identified by [palpation / ultrasound] at the *** wrist. Pulsatile return and sharp arterial waveform confirmed on monitor. Distal hand perfusion intact after placement.
PROCEDURE DETAILS:
Time-out completed. Modified Allen test with color return in *** seconds, adequate ulnar collateral circulation. Wrist positioned in extension over rolled towel. Prepped with chlorhexidine and draped in sterile fashion.
Skin anesthetized with *** mL 1% lidocaine. Radial artery identified by [palpation / ultrasound]. *** gauge arterial catheter advanced at 30–45 degrees with pulsatile flash in hub. Catheter advanced into arterial lumen, needle removed. Connected to pressurized tubing. Sharp arterial waveform confirmed on monitor. Transducer zeroed to phlebostatic axis. Catheter secured, transparent sterile dressing applied.
DEVICE PLACED: *** gauge arterial catheter, *** radial artery, secured with ***, transduced and zeroed
EBL: Minimal
SPECIMENS: None
COMPLICATIONS: None
POST-PROCEDURE PLAN: Tolerated well. Continuous arterial pressure monitoring initiated. Distal hand perfusion to be monitored.
Signed: .ME, .MYDEGREE
.TODAYVariants
Failed Allen Test: Alternate Site
Modified Allen test demonstrated delayed color return beyond 5 seconds, suggesting inadequate collateral ulnar circulation. To avoid hand ischemia, the [contralateral radial / femoral] artery was accessed using the same technique.
Femoral Arterial Line
Given [inability to access radial artery / bilateral radial access failure / hemodynamic instability requiring larger vessel], the right common femoral artery was accessed. The right groin was prepped and draped. The femoral artery was palpated medial to the femoral nerve and lateral to the femoral vein and accessed with a [20-gauge] arterial catheter at a 45-degree angle with pulsatile blood return. The catheter was connected to pressurized tubing and waveform confirmed. Catheter secured with suture and sterile dressing applied. Distal pulses were confirmed following placement.
Charting Tips
- Document the modified Allen test result and time to color return. Note: the Allen test has limited sensitivity (66-78%) and a normal result does not guarantee safe radial cannulation, nor does an abnormal result contraindicate it. Most ischemic complications occur in the absence of a documented abnormal Allen test. Document distal perfusion after line placement as the more clinically relevant assessment.
- Document distal hand perfusion assessment after the procedure (capillary refill, color, sensation). Hand ischemia is the most feared complication and documentation of a normal post-procedure exam is critical.
Documentation & Reimbursement Considerations
- Primary service: Report Arterial Line: Radial Approach as the primary service when it is the definitive operation performed.
- Percutaneous arterial catheter placement is a single service (0.98 wRVU, 0-day global) covering radial, brachial, and femoral arterial lines. Site does not change the code.
- 0-day global: no bundled postoperative period. A separate E/M can be billed the same day if a significant, separately identifiable service is documented.
- Arterial line placement is frequently bundled by payers when billed on the same day as a major surgical procedure. In the ICU/bedside setting it is separately billable. Document the clinical indication (hemodynamic monitoring, frequent ABGs) explicitly.
- Ultrasound guidance for vascular access (0.29 wRVU) is separately billable when documented with real-time imaging and a permanent record. Use the vascular access guidance service, not the soft tissue needle guidance service. Ultrasound is increasingly expected for non-radial sites and strongly preferred for all sites.
- Daily management of an arterial line does not generate a separate procedure charge. Ongoing monitoring is captured in the critical care or E/M billing for that encounter.