[poppy07]

The arterial line set-ups we use have the 3-way stop-cock near the patient and a transducer with stop-cock at the hospital where I'm currently working. Most nurses put the needleless-access device/cap on the port nearest the patient for blood draws & ABG's. However, there have been several occasions that this port has been confused with a side-port on a CVP line, where medications CAN be given, thus, leading to administration of meds through the art-line inadvertently.

How do you guys cover your ports on the a-line to prevent this type of mistake? Is opening the a-line to air (with the original ventless cap) posing more risk for infection than the needleless-access device?

[mPathee]

Yikes!!! That sounds like a recipe for disaster. We have nice big, color-coded labels that go with all of our line kits (red for A-lines) and it is policy that they be in plain view on all of our lines so that nothing like that can happen. We aren't even using tape anymore. Also, we can only use the stopcocks on A-lines with the close ended caps, not the needless connectors. Hope this helps.

[poppy07]

I suggested that this be a policy to only use closed caps on a-lines, but the nursing supervisor says "there is increased risk for infection having the line open to air, laying the cap on the bed...etc" I wanted to find some research to prove otherwise, but am having a hard time.

[CVICURN2003]

For that very reason....I always put an "old" bullseye on my A line. You have to use a needle to access it. Because we never (unless mannitol or in a code) use real needles. So, it is another safety measure I personally use. I draw blood via vacutainer and
real needle from my aline. If your hospital policy does not allow that, I would place a bright colored sticker on it that says A-LINE near the stop-cock. I really like the red only for arterial lines and other color coded stickers that another poster said their hospital uses...that may even satisfy MY OCD tendancies.

[sarahrain]

I don't understand about how the mistake can take place.. about wrongly assumed that the art-line is CVL...

The CVL and Art-line normally is inserted in different part of the body. Example the common practice are - sub-clavian CVL and radial art-line.

CVL ports are well visualized. 3 way Stop-cock used is either blue (indicate vein) or while (from the transducer set) connected directly to one of the safesite at the port.

Art-line will be connected to red-lined-extension-tubing with red3 way stop-cock at distal or the set from transducer.

[cardiacRN2006]

I don't get it either??!!

There's only one possible place to infuse on my A-line set-up (at the actual transducer) and it's not only clearly labeled with the RED arterial sticker and red stopcock, but it's next to my vamp.

In addition, not only is our CVP port clearly labeled, but it doesn't have a vamp on it. So, I can honestly say I've never been confused by the two.

[PageRespiratory!]

It does'nt matter how many lines a Pt has, I was always taught you should never trust the label, always trace the line with your fingers and pull the flush valve while watchng the tracing on the moniter, this guarantees you have the correct line.

[yeSICU]

We use VAMPS in my unit which I love! It is a closed system device. You don't even have to waste. First thing I do is string one up when they get back from OR with an A-line. Makes labs/gasses so quick and easy. Decreases contamination and there is no way to confuse the line, although I think with conscientious nursing this should not be happening anyway...

[calla2114]

We use the exact same tubings for CVP's and A lines. We do not have red caps to put on the A lines...we have the stickers though. Generally our CVP's have lately been running through a power port on PICC lines..or like a pp said in the subclavian..our A lines are almost always radial..though last week I did have a brachial A line. I trace all my lines at the begining of my shift and label them all!!!

[Morettia2]

Ahh how ironic I just saw this post.

My pt. came from the cath lab right smack in the middle of shift change at 1900. I knew the pt. was comming from the cath lab with an 6fr. arterial sheath in the right groin. No prob. I pull Arterial sheaths all the time on my floor.

Recieve the pt. check the groin, and I go to draw the blood from the sheath for labs and an ACT. I notice that there is no cap, nothing cap wise or even a flush attached to the sheath, which is odd b/c there is always a cap on the top port and every sheath we have has one, and the side port always has a flush attached or a cap. A flush is usually attached b/c if the stopcock accidentally opens during transport as long as the top port cap is inplace and the flush is in the side port, there would be no open ports for the blood to come rushing out if the stopcock were to open.

So anyway I knew if I were to turn the stopcock that blood would be spirting from the 2 ports b/c both ports are uncapped. I get a cap , draw my labs, do my ACT call the cath lab and ask for the nurse who took care of the pt. in the holding area. The pt. was trying to get up and walk with the femoral sheath sutured in,I had to explain that the pt. had an arterial sheath in place and blah blah blah, drew a picture and what not pt. understood, and I put an imoblizer on the leg per MD's orders to stop the pt. from bending the leg untill I could pull the sheath.

So I call the cath lab and talk to the Nurse. She tells me, she is new, "oh I just threw it out after I did the ACT before we sent the pt to you r floor.." Ok she's new, I know how it is being new I am only 11 months in to my first year.

I explained to her that the cap ALWAYS need to remain in place, not in a mean way b/c I can't be mean if I tried. She was so upset, I said to her, "It happens, don't freak, the cath lab is a crazy busy place, you are new. If the cap is off with both ports exposed and the pt. is moving or squerming the leg with the sheath sutured into place during transport to the floor and transfer into the bed the stopcock can be affected and open and the pt. can bleed from both ports at the end of the line. If the cap is in place at the end of the line, and the pt. were to bleed b/c the stopcock was affected by movement it would only come out of one of the ports if no flush was attached, it would still be a mess but something that I can handle quickly. So don't freak, just remember for next time not to throw the cap away, let's put it this way we should only have access to one port and the other to be capped. And if you do throw the cap away just grab a new one. It happens."

She said, "thank you so much for being so understanding and explaining the situation to me and for being so nice, I did this the other day and another nurse on your floor ripped into me after the pt. got to your floor and didn't explain why, she just was screaming at me for being so stupid and didn;t tell me what I did wrong, but now I know what I did and now I know that the cap needs to stay on"

I said, "welcome to nursing, and if someone ripps into you don;t take it personal, eventough we do, ask them what happened and if they don't want to tell you, then you ask to speak to the charge nurse.." I said "Good Luck and if you ever have any problems with the night shift nurses on my floor giving you crap, ask to talk to the charge nurse or to me, I am one of the night shift nurses on this floor. I deal with the crap all the time and have become pretty good at defusing these situations." She laughed and said "thanks so much and I will ALWAYS remember to keep the cap in place and not throw it out"