Art lines in the ED

bill4745, RN · May 22, 2007

Philadelphia suburbs, 36,000/year, community hospital. We never do invasive monitoring lines (art,cvp) even though our monitors are capable. ANyone that sick goes to ICU.

CraigB-RN, MSN, RN · May 22, 2007

Philadelphia suburbs, 36,000/year, community hospital. We never do invasive monitoring lines (art,cvp) even though our monitors are capable. ANyone that sick goes to ICU.

That only works when you can get your patients right up to the ICU. What about the stroke alert patient with the BP of 210/100. How do you safely and acuratly titrate the nitropriside and esmolol? I know it can be done, and I did it for years with nothing but a manual BP cuff.

Set up your compentcies, Use graphics to present the waveforms, fake a set-up for people to play with. Just be creative. Competencies can actually be fun.

CVICURN2003 · May 22, 2007

Our ED sees about 32,000 a year with medium-low acuity (no trauma, STEMIs, Brain attacks, unless come POV), and we rarely board patients. In our state, maintaining an art line is an advisory statement, and must have documented competency for the RN. RNs in the larger facilities do this all the time, and there is a validation, however some of the local small hospitals do not start art lines in the ED.
I'm wondering what is happening around the country/world for similar sized EDs.
Thanks!

They get sent ASAP to the unit where we (Anestheia or Intensivist) inset A line. I have only seen a handful put in in the ED and those were full blown arrests.

nuangel1, BSN, RN · May 22, 2007

i work at a hospital ed visits avg 47,000 /yr no invasive lines for us .off to the icu or transfer for them.

scattycarrot, BSN, RN · May 22, 2007

My experience is from England but you did say you wanted to hear from all over the world!

We frequently insert invasive monitoring...art lines and central lines in the ED. Where I worked we often did all of that before we transferred the patient. The more stable the patient though the more likely they would be transferred without invasive monitoring and it would be done on the unit.

NURSJADED · May 22, 2007

i work at a hospital ed visits avg 47,000 /yr no invasive lines for us .off to the icu or transfer for them.

Which is really too bad. You have the Doc's down there to do it. I dread when we get a patient into ICU who's got order for gtts, ABTS, IVF, blood transfusions, stat and one angiocath in the only accessible vein. That means we have to call the admitting, get an order for a central line, call the surgeon, hope it won't be too many hours before they get there. Anesthesia will sometimes put them in, depends on which group we have in-house at the time. For Art lines, sometimes RT can do them, depends on who's working and how long it takes to get an order. It just seems to me, it would be easier if they're that sick, put the line in while they're in the ER and you have a Doc right there to do it. Am I wrong?

scattycarrot, BSN, RN · May 23, 2007

No, your right. Which is why its done in the ER where I worked. Effective use of man power....for a change!

Jen2 · May 23, 2007

Level 1 Trauma center 35,000-45,00 patients a year. We do A-lines and central lines on a daily basis.

debi1rn · May 24, 2007

In that situation where it just causes you more work, I can see your frustration. It's really a delay in care. All of that chasing should happen in the ICU, or they should just let your docs do it.

Thanks for your response!

debi1rn · May 24, 2007

Thank you for your responses! This will really help us make decisions at our facility.

Thank you to the UK! That was great!

Deb

nuangel1, BSN, RN · May 24, 2007

Which is really too bad. You have the Doc's down there to do it. I dread when we get a patient into ICU who's got order for gtts, ABTS, IVF, blood transfusions, stat and one angiocath in the only accessible vein. That means we have to call the admitting, get an order for a central line, call the surgeon, hope it won't be too many hours before they get there. Anesthesia will sometimes put them in, depends on which group we have in-house at the time. For Art lines, sometimes RT can do them, depends on who's working and how long it takes to get an order. It just seems to me, it would be easier if they're that sick, put the line in while they're in the ER and you have a Doc right there to do it. Am I wrong?

in our case yes .we hav 18 beds in our main dept and 8 fast trac beds the tfastrac is run by 2 pa's then the dr is available for consult especially on pts that need to go to the main dept ie cp sob some abd pains etc .the main er has 1 dr and 1 pa for the 18 plus pts .that does not leave our md free to do art lines swans etc be available for titration etc if pt is that sick they should be in icu's .we have 2 which are run by intensivist who is avail 24/7 let him do it.