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?

[hypocaffeinemia, BSN, 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.

This. I've never had an art line go non-patent on me yet provided adequate flushing with saline routinely.

[PICNICRN, BSN, RN]

We use 0.5:1 or 1:1 Heparin in our kids still... we tried to switch to plain NS and started having clotting issues and these little patient's arteries are too precious to take the chance of clotting off a good aline.

As for blanching, sometimes we will notice a little blanching around the site when drawing/flushing- usually you can feel the spasm too... for this we will add Papaverine to the bag and the blanching goes away. I don't want to say that blanching in our population is "normal" but it is not all too uncommon.

Now as for blanching that goes all the way up the arm like you described- I'd say the thing has to go! And fast!

[criticalHP, MSN, 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.

Then I'd say someone is not doing a very good job of checking pt records for prior exposure--HIT occurs as a result of exposure. It can, as you know, happen from a first time use of a flush bag but it isn't usual to have an a-line long enough in our facility. If they need it long term, say prolonged vent wean longer than a few days it is converted to ns. But as you can see from the current evidence it is recommended regardless of how often you see HIT.

[TakeBack]

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.

Curious if you're in CT surg; there's some evidence that the high heparin doses intraop cause false positive antiplatelet antibodies.....are you seeing HIT or HITT?

[cardiacRN2006, ADN, RN]

Then I'd say someone is not doing a very good job of checking pt records for prior exposure--HIT occurs as a result of exposure. It can, as you know, happen from a first time use of a flush bag but it isn't usual to have an a-line long enough in our facility. If they need it long term, say prolonged vent wean longer than a few days it is converted to ns. But as you can see from the current evidence it is recommended regardless of how often you see HIT.

Lol, my pts are crawling in off the street...they don't have medical records. They are getting it after a few days of picc flushes.

I see you posted one article that says it's recommended. I bet I can find 10 that says it's not. I really don't care though. We use saline, it works fine and doesn't endanger anyone's life.

[criticalHP, MSN, RN]

Lol, my pts are crawling in off the street...they don't have medical records. They are getting it after a few days of picc flushes.

I see you posted one article that says it's recommended. I bet I can find 10 that says it's not. I really don't care though. We use saline, it works fine and doesn't endanger anyone's life.

Lets see them...and lets keep this professional please.

[hypocaffeinemia, BSN, RN]

Crit Care Resusc. 2006 Sep;8(3):205-8.

BACKGROUND: Heparin is used as a flush solution for intravenous and intra-arterial lines, but has a number of drug interactions, as well as potentially serious side effects. METHODS: We compared the function of arterial lines for both monitoring and blood sampling when flushed with either normal saline or saline containing heparin (1 unit/mL). Sixty-five patients were recruited at this mixed medical and surgical Level 2 intensive care unit. Patients were randomised to receive either normal saline (NS) or heparinised saline (HS) (3 mL/hour as a continuous flush). Each patient's nurse was asked to score the function of the line at the end of each nursing shift. RESULTS: 35 patients were recruited in the NS group and 30 in the HS group. Mean study duration was 5.8 and 6.6 days for the NS and HS groups, respectively. The scores for the intravascular line for each patient were summed, and the percentage of the total possible score was calculated. Mean percentage scores were 83% (NS group) and 82% (HS group). Comparison using the central limit theorem showed no difference between the groups at the 95% confidence interval (-6% to 10%). CONCLUSIONS: Heparin as a continuous flush at 3 units/hour does not improve the function of arterial lines compared with a continuous normal-saline flush.

Intensive Care Med. 2008 Feb;34(2):339-43. Epub 2007 Oct 16.

OBJECTIVES: The objectives were to analyze the effectiveness of heparinized solution vs. saline solution for the maintenance of arterial catheters and to detect changes in the activated partial thromboplastin time (aPTT) and platelet count in the samples extracted from both groups of arterial catheters. DESIGN: Randomized, double blind, placebo-controlled clinical trial. SETTING: Intensive Care Unit of a third-level hospital in Terrassa, Barcelona, Spain. PATIENTS: One hundred and thirty-three patients were included in the trial. The selection criteria were: adults, informed consent, not receiving either full-dose anticoagulant or fibrinolytic treatment, and no thrombocytopenia. INTERVENTIONS: Sixty-five patients received heparinized solution (1 IU/ml) and 68 received saline solution. MEASUREMENTS: Arterial catheter functionality was compared in the groups every 8 h and at catheter removal. Patency, reliability of arterial pressure, and curve quality were used to evaluate the functionality of the catheters. Blood was drawn, discarding 7.5 ml, from the arterial catheter and from the venouscatheter simultaneously for coagulation tests. RESULTS: The median duration of catheters being in place was 5.1 days (IQR = 8.1) in the heparin group, and 5.4 (IQR = 7.3) in the saline group (p = 0.7). Kaplan-Meier curves showed no differences between groups (p = 0.6). The number of manipulations required to maintain the patency of the arterial catheters was 35% vs. 40% (p = 0.5). The heparin group had a significantly longer aPTT (2.1 +/- .3 vs. 1.25 +/- 0.3, p = 0.001). CONCLUSIONS: The use of heparinized solution for arterial catheter maintenance doesnot appear to be justified. It did not increase the duration of the catheters, nor did it improve their functionality significantly. On the other hand, heparin Na altered aPTT significantly.