Accidental arterial stick !!!

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I have posted this in General Nursing, I am in a panic over here....

RN 1yr now, work in a VERY BUSY ER.

Last night, needed blds & iv line on pt (obese)

Left arm option only (rt arm shunt)

AC not an option (badly scarred, keloids etc..)

Can't feel/find anything on forearm or hand, but I feel (what I thought was nice vein) on radial area.

OK, so I stick w/a 20g & rcvd. an immed. flashback. Started to think I might have hit an artery by the color, but thought "no way could this be an artery so close to the surface" & continued to fill my tubes & secure iv lock & flushed w/10cc ns.

(Shoot, i should have realized by the mess I made & the pt's pain reaction!)

NOW I see pulsating in line, I'm quietly freaking out inside & bring dr. over & YEP....it's an artery!!!!

I remove & apply pressure apprx 5min.

Now I ask you......anyone....what, if any, damage I may have done?

I have started sooo many lines & have never come across an artery so close the surface.

(By the way, dr went for an left EJ & it blew, so no iv lock.)

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Specializes in Emergency.

Just my humble opinion: You will be fine. No damage. Life is good. Sent the blood to the lab - d/c the line - don't give any drugs.

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Specializes in Emergency/Trauma/Education.

Been there, helped hold the arm while it was done. It's certainly an "OMG!" moment. But it sounds like you handled it. There are some that wouldn't have noticed the pulsating and then put it all together. Good job for the catch! :wink2:

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I have accidently gotten an artery when doing a phlebotomy. I could tell by how bright red the blood was and it was pulsing into the tube. No ill effects, just a good tight bandage to stop the bleeding afterward.

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Specializes in Emergency Dept, M/S.

I think you did the right thing, and I'm a new ED nurse, and I would think I would have done the same thing by having the Dr. verify it was an artery.

What makes me really mad is when I see the seasoned RN's in our dept purposely do arterial sticks just to get labs, because we are a huge ED and don't like calling the IV team for anything. Our policy states we get 2 chances at an IV, and 2 chances at phlebotomy (though we normally draw the labs off the catheter for labs before we run fluids). And then you're supposed to call in another RN or dr. who also gets 2 chances for each, and then policy says IV team. If someone even looks like a hard stick, lots of nurses will go right for an artery and not say anything, or document as a venous stick.

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Specializes in Cardiac/ED.

I used to work for a blood bank and we would occasionaly get an artery during a donation...just d/c and hold the pressure and elevate.

p2

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OK.. this may sound silly, but I am a nursing student who is learning. Why is it a big deal to take blood from an artery?? Is it because they can bleed out? Please explain. Thanks!

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Specializes in ER.

I've done this before too...it's not a big deal. I just explained to the patient that the line was "not in the right place" and removed it held pressure, but only after I got my blood :) I've had a doctor put a central line in the femoral artery too! The pt's BP was only 70's over palp so he missed the pulsating, but fortunately I noticed it when I was cleaning up the site and changing out the hubs. I went and told him and he was like "nuh huh" until he came and looked and then promptly removed the line. It happens, especially in the ER, not really a huge deal though.

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Specializes in Cardiac/ED.

As I understand it...and I am sure I will be corrected if wrong. The main concern is that once the arterial stick has been made that if the artery is damaged that a potential for loss of limb is present. Thats why an Allens test must be done before drawing from a radial artery to verify collateral circulation. I once was working as a phlebotomist and nicked an artery during a routine lab draw, a day and half later the patient was in the ED as the swelling and bruising continued to worsen even with direct pressure and elevation. I felt terrible about it especially since I heard that the patients arm really hurt. The results can be slightly different as well but my understanding is that the difference is not significant as nurses draw from art lines all the time for blood draws.

With the above scenario, with the line being put in the femoral artery, you are correct a bleed out could occur and could harder to detect as the blood would probably go into the thigh which if I remember correctly could potentially hold up to 2 liters of blood.

Just remember that it happens all the time, keep calm (don't freak your patient out) D/C what your doing and apply pressure, elevate and re-assess.

P2

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Specializes in med/surg/tele/neuro/rehab/corrections.

May I ask a question too? I was just helping a nurse the other night in the ER and she was looking for an artery to stick. Stuck- and it turned out to be venous so d/c'd and looked again. (I can't remember all the details)

Why would one intentionally stick in an artery?

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Specializes in ER.

to obtain an arterial blood gas (ABG) to determine how well, or how poorly in some instances a pt is oxygenating.

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Specializes in Trauma ICU, Surgical ICU, Medical ICU.

You have to stick an artery for an ABG, ARTERIAL blood gas. I work in a MICU and we stick arteries all the time. No biggie! I'd personally rather go for an artery because its so much easier to feel for.

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