Peripheral Arterial Lines

[donnuchi]

What type of method do you use to draw blood from a peripheral arterial line? Do you use the "drip" method or do you draw back with a syringe? Is there any evidence-based research on this? Thanks!

[KK7724]

We first use betadine to clean the hub. Then let it dry. After that, ETOH to wipe the hub off. Then clamp off your fluids...then using a 25 gauge needle, let about 4-5 drops fall onto a 2x2, then collect your gas or lab. Afterwards, un-clamp and let your fluids run back through....you can squeeze the yellow apparatus on your transducer to kind of flush a little bit extra through.

There is big debate over a lot of nurses in our unit that say "NEVER EVER flush a PAL"...but you can in fact, slowly and carefully flush if you have blood backed up into the line. You do not want to be calling your Dr to tell him you screwed up the art line and have to pull it--at least not at our facility because ours are not in-house!

~Kristina, RN, BSN~

[nell]

Why allow the blood to drip out and risk possible exposure? Why not draw back your discard?

All of the hospitals I have worked at in this part of the country use the 3-drop method to clear the line. Our policy gives the reason as "Amount of blood discarded is minimal". Most of the smaller NICUs follow the lead of the three large teaching hospitals in the area.

We clean the hub with ChloraPrep instead of Betadine now.

Our policy doesn't specifically forbid flushing a PAL, but it is understood that it is done only to save a line.

I just reviewed our policy and see that 0.1ml of Lidocaine can be administered into a PAL if heat to the affected extremety doesn't relieve a spasm.

Nell

[nekhismom]

I've never seen the drip method! We pull back on all of our lines slowly with a 3ml syringe. We then obtain enough blood for the sample, and we give back the "waste" that we pulled off. All of our art lines have heparin in them anyway, and the blood draw is so fast that our policy says it is safe to re-administer the blood we drew off. We do have to open our lines, though, because we don't have a closed system for any IV or art lines.

[Mags4711, RN]

We have a two stopcock set-up after the transducer, that is them connected to the T-connector. We run our art lines on pumps to deliver 1 cc per hr to keep it open and for pressure on the transducer. We have 10cc flush syringes on the farthest stopcock from the patient (and we use this as a closed system to draw waste, and therefore we can give it back), the second (closest) stopcock is where we draw our samples, SLOWLY. We do not have to use a certain size syringe, we use whatever is appropriate.