art line capped..

NPOaftermidnight, MSN, RN, NP · Mar 15, 2015

I have never seen this done. Arterial lines should be transduced at all times. You need to know right away if the line becomes dislodged, or your patient could lose a good amount of blood. You also should never turn your art line alarm off on the monitor for the same reason.

Where did you send the patient to? If it was anywhere other than another ICU, they probably shouldn't have had an arterial line period. I am not criticizing you as I realize you didn't know any better, but what you are describing would get you into a lot of trouble at my hospital. And "the doctor told me to" is never a good defense. Definitely take some time to brush up on your hospital's policies so you know what is expected of you in the future.

Editorial Team / Admin · Mar 15, 2015

If the art line is no longer needed for hemodynamic monitoring, then it should be removed. Capping it off and leaving it in solely for the convenience of lab draws is not a valid reason to keep it in place, at least according to my facility's policy- infection risk, bleeding risk, etc. Also, the receiving floor may not accept patients with art lines, whether capped off or active hemodynamic monitoring. The only floors at my facility where patients are allowed to have art lines are the ICUs, step-down unit, PACU, and OR. Very rarely, a patient may have an art line in the ER, but they are getting very quickly transferred to an ICU or the OR for treatment and care. Just because someone tells you to do something doesn't mean it should be done- know your facility's policies and if in doubt, check with someone else.

shooklypeg · Mar 15, 2015

We are theatre where I have been employed for a considerable time previously and more laterally in er.the patient was going back to hdu.whilst the patient is in the dept he is at all times the responsibly of the consultant anaesthetist so generally u do what u are asked.

enuf_already · Mar 15, 2015

I assume you are not in the US so your practice may fall under totally different guidelines and chain of command than those of us in the US.

The problem I see with capping off an arterial line is that it could appear to someone as a peripheral line. If the line was used to give a medication IV push (into in artery in this case instead of a vein) the results could be lethal.

There have been many stories of wrong lines (feedings, etc) being hooked to invasive lines that have killed patients. So many of the accidents have taken place that manufacturers are now working on making lines that are incompatible with each other (in other words, someone shouldn't be able to hook a patient's tube feeding into their central line--or at least not without altering the connections).

LargeMarge · Mar 16, 2015

I agree you are only asking to be hung out to dry if using the "I was only doing what I was told" excuse and for your own protection find out the specific policy regarding what is allowed in what units. Doctors often have no idea about those things but you can bet they will always hold the nurse accountable. We were never allowed to send a patient out of the ICU to the floor with an A-line, cordis or any form of a stopcock in place. Too much risk for infection, bleeding out etc. and not fair to the nurse who might receive that patient on a unit with a lower level of care and no training on how to care for that line. At least now you know and can pass it on to the next nurse.

dah doh, BSN, RN · Mar 16, 2015

We don't have arterial lines outside of O.R., ICU, PACU, or other procedural areas. We never cap them off! What the patient could pull it out and they would bleed out!

shooklypeg · Mar 16, 2015

Whilst I was aware of most of what was discussed,I feel I have been caught out due to my previous experience.thanks for ur feedback.it's good to put things out there.

spacemonkey15 · Mar 16, 2015

We are theatre where I have been employed for a considerable time previously and more laterally in er.the patient was going back to hdu.whilst the patient is in the dept he is at all times the responsibly of the consultant anaesthetist so generally u do what u are asked.

Are you UK based by any chance? The language you're using makes it sound like you are.

As has been explained by a few posters here, it's best practice to transduce an A line whilst it remains in situ (you may even have a policy stating this), with monitor alarms on so that should the line become disconnected or pulled out you know about it pretty quickly.

Here.I.Stand, BSN, RN · Mar 16, 2015

I was taught that art lines are to be transduced at all times. Even if it quits working and reads 80/78 with a flat waveform, but we have more pressing priorities than pulling the line, we are NOT to shut off the alarms; we have to lower them. Reason for all of the above is that's the only way to know immediately if it becomes dislodged and the pt is bleeding.

Also, like enuf_already said, someone not familiar with them might think it's a PIV and give meds through it. That would be a bad day!!

Lab draws aren't an indication to leave an art line in. If their access is extremely poor, sometimes we'll get an order for a PICC line which can be used for lab draws in addition to meds; if they need an ABG, it's safer to stick them.

I know it puts us in a tough spot, but "I was just following orders" is never a viable excuse. We're supposed to know best practices--for our own safety, in addition to our pts' safety.

ICUNurseG · Mar 26, 2015

Never cap an arterial line. Where I work we at least leave it transduced and hooked to the monitor so it will alarm if it becomes dislodged. There have been cases of people exsanguinating from a disconnected art line. A good rule of thumb is if an invasive line on a patient isn't needed/functioning, remove it (with an order, of course). Why risk a complication if you don't need it in the first place?

Frequent ABGs (need for 4 in 24h, I believe) is an indication for an art line, but it still should be transduced. If it was being used for daily ABGs and not monitoring, then I'd say remove it and stick them.