Labs and vasopressors..new icu nurse needs advice

Inotropes/pressors = A line. this is standard practice in Australia also. I would only use CVC/Picc for bloods as a last resort and that is ususally a long term patient who is stable & not on haemodynamic support.
Remember any breaks into a CVC increases infection risks.
PS if using an A-line always check the flush bag before taking the blood incase someone as put up dextrose instead of saline.

I agree with everyone else to NEVER pause your pressors for labs. If all of your cvp lumens are occupied try a piv, as long as it has sufficient blood return. Or, just stick them. In reality, if your patient's BP is tenuous enough to be on pressors there should really be an a-line to draw off of. If their bp is stable with a low gtt rate of one pressor I wouldn't be too concerned with badgering the MD for an a-line. But, if they're on multiple pressors or high rates, there NEEDS to be an a-line to accurately titrate your gtts.

If you can't stop your fluids and you can't find a vein our RT's are great about grabbing a few cc's extra during a gas. You can get blood that way. I think in some states it's legal for RN's to art stick. I actually have the RT pull blood for me alot. Expecially with serial labs. It cuts down on a stick expecially with someone with bad veins and poor access.

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.

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

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.

I heart a-lines!!

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.