Labs and vasopressors..new icu nurse needs advice

Pedal? People place Alines in the feet? Did you mean femoral?

And if the doc isn't comfortable placing the a-line, in our facility, respiratory can do it with an order, and if all else fails, call anesthesia!

Yes I meant pedal. We do also use fem lines. Last resort seems to be a brachial, but only for use in the OR. At my hospital brachial a-lines must be DCed by an MD upon arrival to the ICU. An MD told me this is because of a higher incidence of amputation with brachial lines.

Had a guy with an axillary a-line this week - haven't seen that very often.

I've had axiallary and brachial, but never, ever a pedal.

That's interesting. I've never seen or heard of a patient needing an amputation because of a brachial a line.

I agree an A line is best, but in the real world..at least my unit,it isnt always there. Usually on a patient that has one or two pressors and are only expeted to have them for a short time, the docs wont place an aline if the cuff pressures are pretty accurate and consistent. Patients that are on presors long term, or whose pressures just arent picking up well with the cuff, or if they are on lots of pressors (like those that are on everything in the book and then some), they usually get an aline. However, these patients always have a PICC or a centrl line,so i try to place as many as i can into one or two ports, and try to reserve at least one port for antibiotics, IV push meds, and lab draws.

The brachial artery is a terminal artery, which is why there's a higher incidence of complications with it.

Complications of A-lines increase something like 7% for each day it's in.

I have always been told you have to stop everything infusing through any central line to draw off of it. If you have pressors going and no a-line you're gonna have to stick for your blood.