Aline insertion

[kurlykay]

I work in the ICU. I took care of a patient that was a RRT and transferred down to our unit because the floor could no longer get a blood pressure via cuff. The patient was alert and talking but had nausea and vomiting. When I got on shift she had been on the unit for about 2 hours and Levophed and Dopamine were both maxed. The nightshift was getting only mean pressures and they were all over the place. I called the doc and asked for an aline and he agreed. To make a long story short, multiple attempts for an aline were made by 2 different anesthesiologists (with doppler and sonosite) and 2 different cardiologists attempted groin lines and all line ended up being venous. Finally after 5 hours an interventional radiologist got the aline in the groin using ultrasound. (By this time the patient was intubated and on levophed, dopamine, and vasopressin maxed.) The patient's SBP was 179!

What would prevent the docs from getting the aline? I know it can be difficult to get an aline on people with very low BPs, but I've never seen so much difficulty. Especially when she did have a very good BP in the end. Has anyone else had this happen and what was the cause determined to be?

[TazziRN, RN]

This is just a guess, but I have seen people in the ER who were bottoming out and their bodies were so stressed they were shutting down, but once they were intubated everything came back up. It's like being paralyzed and intubated took the work away from the body and it was able to relax a little.

[CC-RN-EMTP]

In my ICU we start our own a-lines and my experience is that when the patient is on significant amounts of vasopressors (esp. Levo) it becomes much harder to get a line due to vasoconstriction and the vasospasm that can occur when you try to advance the guidewire/cannula.

CC