Arterial Line Tubing Change

Specialties Critical

Published

This question came up recently on my unit and I'm curious if anyone has any resource material to back up their position other than "this is how I was taught to do it!"

Let's say your patient has an arterial line and the tubing is due to be changed. You get a new bag of fluids in a pressure bag, a new pressure tubing primed, and then you:

A. Disconnect the old tubing at the hub of the catheter while applying pressure just above the insertion site to keep blood from spilling out of the exposed catheter. This is correct because you are changing the entire tubing down to the hub to limit the risk of bloodborne pathogens growing in the outdated tubing.

OR

B. Twist the valve closed on the extension tubing nearest to the hub and change the tubing only above that on/off valve. This is correct because it limits exposure of the catheter insertion site to potential infection and prevents unnecessary bleeding.

Love to hear y'all's thoughts. Everyone in my unit feels very strongly about their personal position but I can't find anything to back up either side. Thanks!

 

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Specializes in Critical Care.

A. The whole point is to reduce infection, right? If you do it this way you'll know all about the days old caked on blood sitting on that hub. Pressure, disconnect, scrub, connect new tubing.

I've seen it done the other way and it's easier for sure but it's hard to argue it's better. The rationale doesn't even make sense - if you want to limit exposure of the insertion site then why change any dressings ever? You scrub the insertion site the same way you would a central line. And if you're exsanguinating the patient you're doing it wrong.

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Thanks for your comment! What I find fascinating is that no one I've talked to is sheepishly claiming they disconnect it at the valve because they're lazy- they insist that's how they were taught to do it! It seems like both methods are just confidently passed down from preceptors and then each nurse just keeps doing it one way or the other for their careers. We don't have a policy on it and I can't find anything on my old nursing books. Thanks for contributing!

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Specializes in ICU | Critical Care | CCRN.

Interesting ?

Have you had an opportunity to look intomyoir hospital's policy? 

 

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

Our tubing is changed every three days, down to the first hub only because the central line dressing is only changed every seven days. The chlorhexidine impregnated dressings are very expensive and they're not supposed to be disturbed between changes. The thought is that the site is kept sterile because of the chlorhexidine patch. And the arterial line setups are much less likely to become a contamination site since we're not infusing anything into an arterial line, only drawing off. At least that's how I was taught. 

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inflating a bp cuff proximal to the cathether is a lot easier than trying to just pressure point occlude arterial flow. Frees up a pair of hands too...

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Thanks everybody. My hospital doesn't have a policy on this (or most things.)

I've been trying out changing it down to the hub lately and it seems to work okay even if it makes a mess. It's definitely tricky on combative patients who are trying to arm wrestle you the whole time. They don't suture the a-lines at my hospital so it certainly makes the dressing changes scarier but I haven't lost a line yet. Thanks again for all the input, I'll try that BP cuff trick next time.

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Specializes in MICU, STICU, CTICU, CCRN-CSC-CMC.

I've seen it done both ways. 

 

At my previous hospital we took ABG/blood samples the old fashioned way (10 ml syringe at the pigtail, and drawing off the stopcock). This would lead me to want to change the entire tubing. The stopcock where the blood draws are done are absolutely DISGUSTING and a pool for microorganisms.... Now, where I am at now has what we call a "vamp" or a blood saver that draws the blood up, and then you can close it off and get your sample from injection sites on the tubing further away from the stopcock. With this method, I could see changing the tubing up to the stopcock because the stopcocks remain clean and unused during blood draws. We are also 800+ days out from any catheter/central line acquired infection in my unit, so I suppose if that counts for anything...

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