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Discussion

Art line question

First and foremost, I don't like art lines. I find them in patients coming from PACU with no real need for them in the first place in almost every instance.

That said, I had a patient last week with an art line that was frequently moving and had significantly elevated pressures. I zeroed the art line myself as well as 2 other RN's, both of which were more experienced than I am. The pressures on the art line weren't correlating with pressures taken from the cuff, as in they were reading 200-220's while his SBP's were running 150-160 for the most part. I couldn't find the culprit and neither could the other RN's that looked into it. The thing I should have done is discontinue the art line altogether because there was no order for it from the MD in the first place. The much more experienced ICU nurse said "not to worry about it".

When I gave report to the day shift RN, I commented that the pressures weren't correlating and that I should have just had the PACU RN pull it prior to bringing the patient to our floor. The day shift RN went to management and evidently complained that I just increased the parameters up to 250 (which I didn't increase that high). It appears management wants to talk to me about this and I feel like I may have done wrong by not either discontinuing the line in the first place or not demanding the MD put in an order. That said, I did seek additional input and attempted to troubleshoot the problem as to why the pressures were reading so high.

Long story short-can anyone explain why it would seem art pressures would seem to be substantially different when everything is positioned correctly? I can see variance of 10-20 with no issue, but I'm talking pressure differences in 50-60. I will tell them I attempted to troubleshoot the culprit with other RN's, but what else could I have done differently in the future (short of just pulling the stinking line in the first place)?

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    If the patient has Subclavian Steele syndrome, which is a false low on the affected side, usually the right arm, the NIBP will not correlate with the ABP.

    In the future ask the patient if there is a difference in the BP or is it the same in both arms.

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    It would be impossible to answer this questions without being there. Was there a proper waveform with diacritic notch? Were you able to draw back any blood? What was the difference between the systolic and diastolic - a dampened waveform will often give you absurdly narrow pulse pressures like 200/190.

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    It would be impossible to answer this questions without being there. Was there a proper waveform with diacritic notch? Were you able to draw back any blood? What was the difference between the systolic and diastolic - a dampened waveform will often give you absurdly narrow pulse pressures like 200/190.

    Excactly. If you did have a good waveform, dicrotic notch, and were able to draw blood and flush appropriately, it is likely that the art line is more accurate than the cuff.

    A better method that will keep you out of trouble than just "not worrying about it" would be to call the provider, explain to them what's happening, get their recommendation, and then chart the heck out it. Sometimes they'll want to come look at it, sometimes they'll say just pull it, sometimes they'll replace it. If you don't think the patient needs it, tell them, but they're the ones that need to make the call on that.

    You were obviously trying to do the right thing by asking your more experienced peers and attempting to troubleshoot it. However, the above approach is the right one, not just changing parameters. Health care providers are always very quick to discredit numbers that look bad, but you always have to have a legitimate reason to discredit your information, not just the fact that the numbers seem extreme. If your only reason for not believing your ABP is that it's not correlating with the NIBP, that's not good enough to throw it out. It needs further investigation.

    Hope this helps.

    p.s. Art lines are your friend. When working correctly, they are a better indicator of minute to minute blood pressure than NIBP. You can also get unlimited ABGs and any labs for that matter with no patient poking. Reconsider the art line. Like that boy who you hated at first, but eventually won you over, you may end up falling for the art line.

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    I agree with Mully. Art lines are awesome once you get comfortable troubleshooting them. Also call the physician with anything weird, it covers you and it is their patient too, most likely the will want to know about anything strange happening with the patient. I have never been yelled up for updating a physician. (We have awesome docs, though).

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