Quote from GreyGull
I do both so I still try to put myself and the patient in the best position possible.
Placing the line in a position that can create discomfort for the patient may shorten the life of that line and will have to be replaced in the ICUs which then can tie up the bedside RN working to start one on another site. Thus, be careful with hyperextension.
The Modified Allen's test can not predict the extent of damage on pre-existing disease processes. That is what you the clinician will have to assess for risk vs benefit with this knowledge. You can document or use whatever test or information you are comfortable with depending on when you assess the patient also. However, if you do not make some attempt to prove adequate patency of both arteries, good luck pulling up enough studies to prove or disprove your point when something does go wrong. Hopefully the bedside clinicians recognize problems which you may not always see in the short time the patient is in the OR and remove the line.
1. The vast majority of art lines done by anesthesia are done while the patient is sedated on the OR table or just after induction. So patient comfort is not exactly easiest to confirm at that time and really not our top priority while inserting the art line since the patient rarely feels/remembers anything of the artline insertion in the OR.
The wrist is either placed in a preformed splint or just left on the armboard in the normal position after the artline is secured. We don't leave the wrist/thumb taped to the armboard after the arterial line is placed. So, the point of over hyperextension is a mute.
2. Most people place the pulse ox on the same hand as the arterial line which seems to be more than adequate for the vast majority of us that work in anesthesia. I have never heard of anesthetic provider having any trouble using this method.
3. Most of the techniques you describe of getting in a comfortable position, pulling up a chair, etc. will not work in the OR. An anesthesia provider needs to be competent putting in arterial lines in awkward positions such as bending over while under the drapes in low light positions. Our jobs as anesthesia providers is to ensure safety of the patient and to keep the surgery going, so our comfort is often a very low priority.
4. Modified Allen's test has shown not to be adequate and provides absolutely no protection for you should it go to court either if something goes wrong. Anesthesia providers not using an inadequate test is just an extension of EBP.
5. Since the OP was asking on CRNA forum what their advice is on doing arterial lines why not let the anesthesia providers providers give them the information that is going to be most helpful to him/her in the OR.