arterial stab policy on your units?

NicuGal, MSN, RN · Mar 5, 2011

We do almost all of our labs from heelsticks. We do art sticks when we need over 2ml or the kid has bad heels. Art sticks are also done for all SWU's. We never do venous sticks.

Nurses can't do art sticks where I work anymore....they said we were taking all the experience from the residents...nevermind that we almost always got them on the first stick!

NICU_babyRN, BSN, RN · Mar 5, 2011

We do heel sticks for 95% of our labs, then venous. We only do art sticks at time of admission since we need a bit of blood at that time and that's if no lines are being inserted. art sticks are a last resort for us!

rockabye · Mar 5, 2011

Heelsticks are the norm. Arterial sticks are generally reserved for lots of labwork, central sticks, or if the patient is not a good heelstick (older babies usually). In fact, our unit rarely uses venous stick. I am not sure if this is due to lack of education or just not being comfortable with venous sticks. Nurses are only allowed to use the radial or posterior tibial arteries for arterial sticks.

walkingrock, ADN · Mar 6, 2011

Art sticks or venous sticks (more likely will be a art stick) when we do blood cultures or have a lot of blood to draw, otherwise heelsticks. We only do radial art sticks (RN's); RT's don't do them on our babies, they only do art sticks on adults.

walkingrock, ADN · Mar 6, 2011

What is SWU?

babyNP., APRN · Mar 6, 2011

septic work up :) I assume

Love_2_Learn · Mar 6, 2011

Our docs prefer venous samples, especially if we are getting a CBC. I will do a heel stick for capillary blood gas and labs; as long as the heel bleeds well and no squeezing is necessary, the potassium level will be normal. We use arterial sticks for ABGs and labs if labs are needed at the same time. Often we use them for when we have to get a lot of blood which is often on admission. If the baby is a potential for a PICC line we choose which antecubital vein to leave alone and write that on the kardex so no one will stick that arm in that area for labs in case it is needed later to place a PICC. Where I worked before the only time we could stick an artery was if a blood gas was ordered. At both places we only stick radials and posterior tibials. Where I work now I see more nurses using arteries as a second choice for labs (rather than a heel stick) when a venous sample is not successfully drawn... especially when CBC is ordered. There is a difference in the results of the hct when drawn from heel versus vein/artery blood so that's why our docs like CBCs done venously/arterially. I know from experience that arterial sticks are painful and can cause long term damage to the nerve which runs along side the radial artery. I do my best to avoid them when I can for that reason.

Mags4711, RN · Mar 7, 2011

If you've ever had an art stick, you'd understand why I am about to say what I'm going to say. I HATE THEM!!!!! Lots of our RN's will do them to get "larger" samples of blood (and not even try a venous). It makes me nutty! To me an arterial poke is a last resort, or it sure as snot should be. The pain is *incredible* and yes, you run the risk of losing that artery. I also only occasionally see anyone doing the Allen's test. Which should be an absolute MUST.

Sure, I understand that sometimes, you simply have to get an arterial sample. But I do think they are performed too often.

BabyLady, BSN, RN · Mar 8, 2011

hi!
Just wondering what you all do out there! The nurses on my unit do art stabs ALL the time. It's done for routine bloodwork because its generally quicker than cap or venous bloodwork. The previous unit i worked on, we RARELY did art stabs, they were almost frowned upon. I was under the impression that repeated art stabs (esp the radial arteries) can cause a ton of pain and possible long term damage to the . Personally, I try and do cap bloodwork unless i have a significant amount of bloodwork ordered and then at that point I would go venous. Anyways let me know what you all are doing!

You are absolutely correct. Doing an art stick for routine labs is L-A-Z-Y nursing.

I work in a Level III unit and our policy is very strict:

NO ONE accesses an art line except for NNP's and respiratory therapy.

Period.

It is painful, it is cruel and no facility should permit the policy.

No need, whatsoever.