Accidental arterial stick !!!

Specialties Emergency

Published

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.)

Specializes in Emergency & Trauma/Adult ICU.
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

OT, but ...

You are free to have whatever "policy" you wish. NO ONE is guaranteed to be successful in one stick. If you have poor venous access you may get stuck 4 times by the same person, a couple of times each by more than one staff member, or you may sign out without treatment.

You are free to "tolerate" whatever you wish.

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Specializes in Emergency Dept, M/S.

Sorry, Big-Chicken, but even the most seasoned nurses do not get every stick on the first try. And no, I don't "practice" on anyone. I start IVs and do phlebotomy. I'm human - sometimes I miss, most times I don't. But some patients have absolutely no veins that can be seen or felt. If I don't get it on the first try, I won't ALWAYS attempt another. If the pt is a difficult stick, I will call for backup. I'm not there to "punish" anyone. Remember also, a pt may be a very easy stick, but sometimes they jerk, flinch or pull back suddenly, and then the vein is blown. It is not always the fault of the RN or phlebotomist.

That being said, if you allow someone only one attempt and they don't get it, then you don't get your fluids or meds. It's absolutely your right to refuse, but then we cannot treat you the way the doctor decided was best, and they are not always happy with the pt when I have to go tell him/her that the pt refused to let me attempt another IV or blood draw.

And I know, patients "threaten" all the time with, "I know I'm a hard stick, and you better get me the first time, or else......" And it doesn't for one second affect how I will approach that pt for an IV.

I just stated what our ED policy is. You may know all of the above already but I'm just stating MHO.

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Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.

To the OP...yes, it happens. In my many years here starting IVs on little one's I think I've done it 5 times. First reaction : YIKES!! Whoa, let's send that blood for a quick ABG and confirm - yep. As others put so well...take out the catheter, hold pressure for 5 minutes or longer, pressure dressing.

It happens.

vamedic4

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Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.
OT, but ...

You are free to have whatever "policy" you wish. NO ONE is guaranteed to be successful in one stick. If you have poor venous access you may get stuck 4 times by the same person, a couple of times each by more than one staff member, or you may sign out without treatment.

You are free to "tolerate" whatever you wish.

OT as well...

While I certainly respect MLOS point of view and perspective, I also see part of what big chicken is saying. . Call someone better than you, because obviously you're not being effective. I realized long ago that I couldn't do every IV on every child I tried, so I enlisted help. The help of another experienced pair of eyes and hands makes for much lighter work, and they can see/feel things that perhaps you cannot. Teamwork.

:twocents:

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Specializes in Peds, ER/Trauma.

Call someone better than you, because obviously you're not being effective.

If a nurse misses an IV start, and another nurse gets it, that does NOT make the second nurse BETTER than the first......

I am pretty excellent at starting IV's- I can usually get one that others can't, but even the best aren't going to get every IV every time...... that doesn't mean that I'm "not effective" as a nurse. I'm a damn good nurse, but no one's perfect......:rolleyes:

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Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
Why is it such a problem to stick in the artery, besides the pain, I'm a nusing student.

The problem arises not from the stick, but if the line is left in place and used as a regular IV site to deliver meds. Phenergan is one med, that if given arterially, can cause significant damage to the limb the line is in.

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Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.
If a nurse misses an IV start, and another nurse gets it, that does NOT make the second nurse BETTER than the first......

I am pretty excellent at starting IV's- I can usually get one that others can't, but even the best aren't going to get every IV every time...... that doesn't mean that I'm "not effective" as a nurse. I'm a damn good nurse, but no one's perfect......:rolleyes:

My apologies, ...the correct word to use in that sentence would be "other"...not "better"....and it has nothing to do with you being effective as a nurse, just as an IV starter. Of course we can't be "on our game" and not miss any that we attempt (if only it could be that way - that'd be one less thing patients could complain about.:wink2:

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Specializes in Family Practice Clinic.

I work in a small rural ER. On my shift I am usually the last resort for hard sticks. There are some days that I can't hit the broad side of a barn, and others that I can close my eyes and hit everything. Luckily (knock on wood) I have not hit an artery :yeah: in my years as a nurse.

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Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

Hi,

do not worry about this, most people will do this at least once in their careers. Heck I did it the other day, and just like you couldnt feel it pulsating when I palpated it and it was very superficial so in I went, when i put the lock on to draw bloods I noticed it was arterial and took it out. No harm to the patient. Just learn from it. The only reall danger is if the patietn does not have adequate circulatio through their ulnar artery and you do damage to the radial or vise versa, but that would be unlikely if the IV is removed almost immediately and no drugs were pushed through it. I actually read an interesting article a while back and it talked about the fact that those superficial veins we sometimes use in the hand can actually be arterial in some patients, but it also discussed how easy it was missed that the IV was in an artery instead of a vein. I even had a doctor once put in a subclavian central line in the artery instead of the vein accidently, this was no picked up until the nurse had difficulty runing and IV through it and then the drips pulsating gave it away.

Anyway live and learn, but do not dwell.

Sweetooth

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Specializes in Infusion Nursing, Home Health Infusion.

started a few art lines myself ...remember that approx 10% of the population have abberant arteries (close to the surface and not typically deep) The most important thing is that you do not infuse irritating IVF AND MEDICATIONS THROUGH IT . That can permanently sclerose the artery and compromise blood flow to an area. also no one mentioned compartment syndrome which you can get with excessive fluid collection or blood in a confined space.. take it out and apply pressure and I always tell the pt they have an artery sitting on the surface and that it could be mistaken for a vein. By the way I love starting IVs and never mind going to our ER...something must be wrong in your system if you do no call an experienced IV nurse for the start, Never let your ego get in the way of what is right for the pt

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Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.
Sorry, Big-Chicken, but even the most seasoned nurses do not get every stick on the first try. And no, I don't "practice" on anyone. I start IVs and do phlebotomy. I'm human - sometimes I miss, most times I don't. But some patients have absolutely no veins that can be seen or felt. If I don't get it on the first try, I won't ALWAYS attempt another. If the pt is a difficult stick, I will call for backup. I'm not there to "punish" anyone. Remember also, a pt may be a very easy stick, but sometimes they jerk, flinch or pull back suddenly, and then the vein is blown. It is not always the fault of the RN or phlebotomist.

That being said, if you allow someone only one attempt and they don't get it, then you don't get your fluids or meds. It's absolutely your right to refuse, but then we cannot treat you the way the doctor decided was best, and they are not always happy with the pt when I have to go tell him/her that the pt refused to let me attempt another IV or blood draw.

And I know, patients "threaten" all the time with, "I know I'm a hard stick, and you better get me the first time, or else......" And it doesn't for one second affect how I will approach that pt for an IV.

I just stated what our ED policy is. You may know all of the above already but I'm just stating MHO.

I agree with red, I am one of the best stickers in the house, and Im a supervisor, but that doesnt mean Im going to get you first stick, and dont assume any nurse will, because they wont, and I wont put up with that type of attitude in my er, sign out if you dont like it, then you can explain to the doc why you sighned out. And yes I have stuck arteries on accident and on purpose, being an er and sicu supervisor I have put in a-lines, and technically yes its easier to cannulate an artery then a vein.:bow::nurse:

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