? re: A-line policy

jwk · Oct 19, 2004

Our hospital is currently reviewing our policy on a-lines. It is recommended by AACN to insert a 19g needle to aspirate all of the air out of the line before priming the tubing. Is this a common practice? What is everyone doing? Thanks for the feedback.:)

Just flush the tubing using the valve - make sure you flush all the "joints" and stopcocks. It also helps flushing by gravity flow instead of doing it after pressurizing the bag. What are you sticking the needle into anyway? There is no injection port on an arterial line.

begalli · Oct 19, 2004

Are you sure the recommendation isn't for removing the air from the bag?

Most of us spike the bag, pull the spike out slightly, squeeze the air out of the bag and then securely insert the spike for good. Some use a needle to draw air from the bag before spiking.

Then I usually prime the tubing under pressure, it's faster.

ajithpaul · Oct 19, 2004

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our hospital is currently reviewing our policy on a-lines. it is recommended by aacn to insert a 19g needle to aspirate all of the air out of the line before priming the tubing. is this a common practice? what is everyone doing? thanks for the feedback.:)

we flush the tubing and connetors with flush solution .then we connect the tubing with the arterial cannula already inserted.air bubbles we aspirate through the port in the tubing and the aspirated blood we push gently through the central lines

jwk · Oct 19, 2004

Then I usually prime the tubing under pressure, it's faster.

It might be faster but you'll get rid of more bubbles doing it slowly without the high pressure.

zambezi, BSN, RN · Oct 19, 2004

Our policy is instill 1000u heparin in 500 NS (but we are going to premixed soon). Use the needle to get the air out of the iv bag. Spike the bag with the pressure tubing. Use the valve to flush the line, incuding stopcocks/joints. Our policy states to flush the line without the pressure bag inflated to diminish air bubbles in the line. Once the line is flushed, the pressure bag can be inflated to standard pressure, connected to the monitors and patient after insuring air is removed from lines...

begalli · Oct 19, 2004

It might be faster but you'll get rid of more bubbles doing it slowly without the high pressure.

Gosh, I'm so impatient.

I usually don't have problems with bubbles or dampened lines, but I guess I need to re-read our policy to see exactly what it says about this. I'm willing to bet that if I go by-the-book, it says to prime using gravity....it makes sense.

rnerin · Oct 20, 2004

Use the AACN guideline!

bluesky, BSN, RN · Oct 28, 2004

Have there been any evidence based studies that show that taking the 2 or 3 bubbles that may linger in the tubing actually significantly improves the waveform? I have a hard time beleiving this practice is worth the extra effort. We never do this at our hospital and our art lines always correlate. It would be difficult to argue that such a small volume of air would do any harm if it found it's way into the pt's blood stream.

jwk · Oct 30, 2004

Have there been any evidence based studies that show that taking the 2 or 3 bubbles that may linger in the tubing actually significantly improves the waveform? I have a hard time beleiving this practice is worth the extra effort. We never do this at our hospital and our art lines always correlate. It would be difficult to argue that such a small volume of air would do any harm if it found it's way into the pt's blood stream.

1) It depends on the size of the bubble. A couple of little "micro-bubbles" in the tubing probably wouldn't dampen the waveform much, but one larger one, say one that actually goes across the full diameter of the tubing, will dampen your waveform significantly.

2) The danger in having bubbles in the tubing is that when you flush the A-line, the bubbles can flow proximally back up the radial artery, up in the area of the aortic arch, and then up the vertebrals or carotids. Air in the cerebral circulation is not a good thing.

If you're not taking the time to get rid of the bubbles in your a-line tubing (which I'll bet is in your hospital's policies and procedures) you're engaging in a practice that's potentially dangerous for your patient and not in their best interests. Take the time to do it right. If you don't understand the reasons behind certain techniques and procedures, perhaps you shouldn't be doing them in the first place. Don't blow them off because YOU don't think it makes any difference and that it slows YOU down too much.

bluesky, BSN, RN · Oct 30, 2004

1) It depends on the size of the bubble. A couple of little "micro-bubbles" in the tubing probably wouldn't dampen the waveform much, but one larger one, say one that actually goes across the full diameter of the tubing, will dampen your waveform significantly.
2) The danger in having bubbles in the tubing is that when you flush the A-line, the bubbles can flow proximally back up the radial artery, up in the area of the aortic arch, and then up the vertebrals or carotids. Air in the cerebral circulation is not a good thing.
If you're not taking the time to get rid of the bubbles in your a-line tubing (which I'll bet is in your hospital's policies and procedures) you're engaging in a practice that's potentially dangerous for your patient and not in their best interests. Take the time to do it right. If you don't understand the reasons behind certain techniques and procedures, perhaps you shouldn't be doing them in the first place. Don't blow them off because YOU don't think it makes any difference and that it slows YOU down too much.

Listen, I didn't say don't get rid of big bubbles. I said the small bubbles that may remain after a good prime are not of consequence. I have a degree in physiology so beware of the ad-hominem statements you are making. A small bubble could not violate the laws of physics and move against the arterial pressure gradient.