Don't know if this is in the right spot or not, but:
I had a bit of a conflict with my charge nurse the other night. Had a trach'd and ventilated patient who was on sedation. His arterial line is pedal and has a long history of being positional/finicky. At one point during the night, his arterial line was reading 70s/80s systolic with a severely dampened waveform which I tried everything to fix but couldn't. His cuff pressure was reading 120s/110s systolic, however. He had strong pulses in all extremities, color was normal, and he would open his eyes to his name.
So my charge nurse comes to relieve me for lunch and I tell her what's going on. Okay. I come back about twenty minutes later and she's like "I turned off all of his sedation. His arterial line pressure is really low." I'm like "I know it's low but his waveform sucks." Well, his last cuff pressure was 100/something (MAP still well over 60). So the cuff pressure was "trending down." This is obviously where my minimal experience comes into play and I start to doubt myself. I was told to leave sedation off until his arterial pressure starts coming back up. By the time it's normal again, pt is very awake and extremely agitated. I spent the rest of the night chasing my tail trying to get him adequately sedated.
When I gave report the next morning, I explained what had happened without actually stating who had made what decisions. The oncoming nurse gave me crap. Was he hypotensive in his arterial line or his cuff? etc. etc. I wanted to tell her that it wasn't my decision to turn off sedation but didn't feel like it was my place because she was also orienting a new nurse to the unit, and I could have spoken up but I didn't.
My questions: was I appropriate in ignoring the arterial line pressure in favor of the cuff pressure? Also, are there any tips/tricks to getting a pedal line to work better? I'd changed the dressing, made sure the connections were good, tried to place a pressure dressing over the foot, re-positioned his leg...