Blanching arterial line???

[vrturner]

today, while flushing an arterial line, the patient had severe blanching going up his arm until the flush stopped. is that normal?

[Dinith88]

No....

[hypocaffeinemia, BSN, RN]

Sounds like your patient failed the Allen test. Essentially while you were flushing you were preventing blood flow via the radial art route and it appears the ulnar artery was quite insufficient.

[NurseKitten, MSN, RN]

Sounds like your patient failed the Allen test. Essentially while you were flushing you were preventing blood flow via the radial art route and it appears the ulnar artery was quite insufficient.

Yup. That's exactly what it sounds like. Might be interesting to see if whoever put that A-line in documented the Allen test prior to insertion.

[cardiacRN2006, ADN, RN]

Oh, I bet they documented it all right. Documented that it passed. I see it documented all the time on our ABGs, but never see anybody actually performing it.

I think I'll give a pop quiz to the next intern who attempts an Aline...

[hypocaffeinemia, BSN, RN]

Of course, even if the patient failed the initial Allen test (if it was actually done) it might be argued that one-time cannualization of the artery would be less traumatic and therefore less of a risk to the blood supply than numerous sticks every day to it would be. Not knowing the patient, I give the benefit of the doubt here!

[suanna]

Do you still use heparin in your pressure bags? It can be an irritant and cause arterial spasms in sensitive patients. Collateral circulation should still have preserved the perfusion but if the patients blood flow was better when they put in the line- (maybe they were hypertensive, had better cardiac function, better hydrated....) then the passed Allen Test could be moot. I think I would be asking the docs about getting rid of that line.

[cardiacRN2006, ADN, RN]

Does anybody still use heparinized flush bags anymore???

Unless this pt was a very, very difficult stick, I wouldn't ask the Dr if I could take out the line. I would call and inform him that I removed the line.

[PageRespiratory!]

today, while flushing an arterial line, the patient had severe blanching going up his arm until the flush stopped. is that normal?

>

where was the line placed? perhaps the modified allens test wasn't indicated. to me "up his arm" seems to indicate it was a brachial art line.

[dorimar, BSN, RN]

CardiacRN2006 stated,

"Unless this pt was a very, very difficult stick, I wouldn't ask the Dr if I could take out the line. I would call and inform him that I removed the line".

I concur 100%. Loss of limb is a heck of a price to pay for an aline.... A big price for the patient, and the nurses involved in his care .

[criticalHP, MSN, RN]

does anybody still use heparinized flush bags anymore???

unless this pt was a very, very difficult stick, i wouldn't ask the dr if i could take out the line. i would call and inform him that i removed the line.

yes, we use heparin flush bags. it is contraindicated in pts with sensitivity but it is recommended. here is a recent article from uptodate for reference. i can't paste the link but i'll provide the aurthors and topic reviewed.

arterial catheterizationauthors

gilles clermont, mdcm, msc

arthur c theodore, md

section editor

scott manaker, md, phd

deputy editor

kevin c wilson, md

last literature review version 17.2: may 2009 | this topic last updated: may 5, 2009 (more)

[cardiacRN2006, ADN, RN]

I see HIT all.the.time. And I mean all.the.time. We aren't going back in time to heparinized bags anytime soon.

Besides, saline works just fine.