Labs and vasopressors..new icu nurse needs advice

Specialties MICU

Published

What do you do if your pt has a picc line or central line and you need to get AM labs from the line but they are on high doses of levophed or any other vasopressor? Are you supposed to put all IV fluids on hold while you draw labs so they dont dilute the lab sample.. what if your pt is very sensitive to the vasopressor and drops their pressure right away? But what if you leave the pressors on will it mess up the lab results? Please help..I need advice.

Specializes in Critical Care.
getting an art stick (or any stick) of someone on pressors, especially more than 2 is nearly impossible. If you have enough pressors that you have no access left, then you need an a-line, period. I would check to see if anything can run together so you can have a free lumen. I usually have something else running (insulin gtt, heparin, fluids, etc) to where I can stop that instead of a critical gtt.

Getting an arterial stick or any stick on someone who is on pressors is done all the time. I really don't think it is "nearly impossible" at all.

And even if you have a free lumen on a central line you should be turning off all the gtts going into the line to prevent dilution or skewing of the results due to the solutions that are infusing.

An arterial line is best, of course, but if you don't have one you can still manage.

I do agree that patients on high dosages of pressors and those on vents who require multiple ABG's are best served by having an a-line. But we often have patients who are on low pressor gtt rates (and who will most likely soon be weaned off the pressor) and those who are vented (the ones who we think will be extubated quickly) that don't have a-lines.

Specializes in Critical Care.

If all your lumens are taken up by pressors, call the lab to draw from a peripheral.

Specializes in ICU, Education.

Can someone please explain how a pedal aline is ok, but not a brachial?????? In my 24 years of nursing I have never seen a pedal aline, and rightly so.... I think? Someone????

Specializes in Critical Care.
Can someone please explain how a pedal aline is ok, but not a brachial?????? In my 24 years of nursing I have never seen a pedal aline, and rightly so.... I think? Someone????

I'm not sure about your brachial a-line question (although I think it might be because the brachial artery divides into two terminal arteries which may be the major concern) but in my 30+ years of nursing I have seen pedal arterial lines numerous times. Always as a last resort after all other venues have been exhausted.

Amputations, anomalies, kidney transplants---all may render conventional sites useless.

Soooo....we go the pedal route.

Specializes in Med/Surg, Oncology, Tele, ICU.

i heart a-lines!!:p

Specializes in ICU,CCU, MICU, SICU, CVICU, CTSICU,ER.

agree with MrBubbles, advocate for your patient, get an A line. If your doc says no, go to the next doc AND the charge RN. If he doesn't want to do it go to your house super and raise hell (professionally of course) to get it. It is a matter of patient safety. But never interupt a vasoactive drip. Drawing from another lumen is a matter of contraversy as well-- some may argue the sample will draw back some concentration of drug infusing from the other lumen while just downstream within the vein and thereby adversely affecting the results. I only have opinion on this, not evidence. But when in doubt use an A line or do a peripheral stick. Would appreciate feedback on the downstream theory from this forum.

Specializes in ICU,CCU, MICU, SICU, CVICU, CTSICU,ER.
Can someone please explain how a pedal aline is ok, but not a brachial?????? In my 24 years of nursing I have never seen a pedal aline, and rightly so.... I think? Someone????

same here--never have seen it. It sounds strange. Assuming its an adult, does this patient have some weird anatomy that makes brachial A line impossible? Trauma? :confused:

Specializes in ICU, Psych.

I've had a few pedal A-lines. When you need a line, you need a line. We let our residents stick twice and then either an attending or one of the nurses with the A-Line cert do it.

We RARELY have RT do our gases. They do them a lot in ER and on the floors, but in our ICU- we do them. And if the pt is a hard venous stick- we do our AM labs (or any labs) arterial if we have to. We have a large population of control-freak Type-A nurses on the unit- so we do most stuff ourselves. I'm pretty sure we'd put in our own CVCs if we could!

I know this is really old...

But I have seen a handful of pedals and at least 2 brachials. Are they really that bad? Our anesthesia CC docs put alines in on any pt with a vaso active drip.

Specializes in ICU.
Thanks everyone for all your responses :yeah:. I definitely wish we had more a-lines in our icu, it would make things so much easier. I find that a lot of patients in our unit that are on multiple pressors do not have a-lines!!! I am not sure why and I will definitely try to advocate for one if possible.

sorry to say this, but at my last job was told that the reason we don't get more art lines is medicare has strict standards and won't pay.

I am happy to say that we had a new group of hospitalists that came in and but a quick end to this. They had attitude of "well of COURSE they need an art line, they are on pressors" LOVE LOVE LOVED it

Specializes in cardiology/oncology/MICU.
sorry to say this, but at my last job was told that the reason we don't get more art lines is medicare has strict standards and won't pay.

I am happy to say that we had a new group of hospitalists that came in and but a quick end to this. They had attitude of "well of COURSE they need an art line, they are on pressors" LOVE LOVE LOVED it

Medicare? An administration should not be allowed to dictate what is medically acceptable. It should be a standard of practice to have transduced blood pressures for anyone sick enough for pressors! I like the way your docs sound.:yeah:

Specializes in ICU.

In the ICU department I work in, all admitted patients, whether overnight post-op, short term, long term, on or off inotropes; everyone has an arterial line. Never ever interrupt your inotropes, except to wean them down, it's too risky for the patient. We always draw our blood for lab tests off the arterial line, unless it isn't aspirating. In this case, we draw off the central line or picc line if available, failing that, we do a peripheral stick.

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