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.)
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.)
I've done this twice in 18 years - both times in an ambulance. Both times it made a huge mess.
You did fine with what you did. Crazy things like this happen!
I was in on a code once where, during the IV attempts, we managed to get bilaterals at the same time. Cool, eh? Well, everyone is doing their thing and someone notices blood backing up into one of the lines. It gets pointed out and we watch it as it pulses up the line slowly, matching the compressions. CPR gets held for a second or two, and the blood goes down...start back up, and it starts pulsing up.
There's that momentary silence, and finally all that is said is by the doc running it to the medic doing CPR..."Awesome compressions, dude!" Thankfully, we had been using the other line for meds. D/C'd it, no harm, no foul.
Happened once to a friend of mine starting an IV, in ICU. She did the logical thing; hooked it up to a pressure line and explained to the MD that he didn't need to start an A-line. No problem.
LOL! I did this too when I first started... was in a 90-something little old lady's right arm... going for what I thought was a vein on the... medial side of the arm. Wasn't even a large vessel but it was laying like a vein I've stuck many other people with. Bright red blood into the tubes... oops! I don't think a whole lot more damage is done with an accidental art-stick than with intentional drawing ABGs (except for the fact that the tourniquet is on and the tubes are drawing the blood out instead of letting it flow naturally via art-pressure)... I just held pressure for awhile, let the doc know it was unintentionally drawn from an artery... I know my eyes got really big but doc said no harm done. Definitely is a shocker when it happens!
Happened once to a friend of mine starting an IV, in ICU. She did the logical thing; hooked it up to a pressure line and explained to the MD that he didn't need to start an A-line. No problem.
OK, I have a possibly VERY stupid question (mostly because I've never taken care of a pt with an art-line)...
Wouldn't the cath be facing the wrong way? I know arteries are bigger than veins, maybe this wouldn't matter, but in theory, I would think that veins are bringing blood back to heart, arteries distribute blood throughout the body? Am I wrong?
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.
As a patient, there is no way in h*** I'm going to allow staff to stick me 4+ times. That's MY policy! You get one shot with me. If you are unsuccessful, call someone in with more experience. No one is practicing on me! I'm not criticising anyone, just saying what I will tolerate as a patient.
An art line will point in the same direction an IV would- towards the heart.
It's not a big deal if you accidentally put the IV in an artery- just get your blood, remove the IV, and apply pressure.
I myself have purposely done radial arterial sticks to draw labs on patients who we couldn't get a venous draw on. It's no different than if I were drawing ABG's......
If you were to look at a persons antecube under ultrasound, you would really be shooked that more people do not accidently hit the artery when attempting AC sticks. My friend hit the artery one time a few years ago, and I had to laugh the ER Dr ended nup tranducing it to an a line
OK, I have a possibly VERY stupid question (mostly because I've never taken care of a pt with an art-line)...
Wouldn't the cath be facing the wrong way? I know arteries are bigger than veins, maybe this wouldn't matter, but in theory, I would think that veins are bringing blood back to heart, arteries distribute blood throughout the body? Am I wrong?
As someone else said, Arterial line position is toward the heart. The catheter does not occlude the vessel, it merely rests in it. The arterial set up has a pressure bag, which should be at 300 mm pressure, is used to force the solution (either 0.9 Saline or Heparinized saline) through the catheter, which in addition to stopping it from clotting off also helps to keep the catheter straight.
One thing to learn is that there are no stupid questions, especially in nursing. One of the things I like about ICU is because nurses frequently ask questions of each other. They know what the consequences are if there is an error.
As a patient, there is no way in h*** I'm going to allow staff to stick me 4+ times. That's MY policy! You get one shot with me. If you are unsuccessful, call someone in with more experience. No one is practicing on me! I'm not criticising anyone, just saying what I will tolerate as a patient.
Big Chicken
I hit the thank you button when I meant to hit the quote button.
They may not be practicing, sometimes the patient just has lousy veins.
Even the best IV starter in the world may not get it on the first try and may not even be able to get it at all.
Thankfully, we had been using the other line for meds. D/C'd it, no harm, no foul.
chip193
272 Posts
I've done this twice in 18 years - both times in an ambulance. Both times it made a huge mess.
You did fine with what you did. Crazy things like this happen!