Death by Arterial Line?

Specialties CCU

Published

I was told when I was being precepted to NEVER silence the alarm on my arterial lines, no matter what, because if the line was to disconnect the patient could literally bleed to death through the line without any notice. Well, that scared me half to death so I have faithfully followed that advice.

I had a patient today who had an arterial line placed (on a previous shift) for lab draws because she was a "difficult stick." Well, It drew blood beautifully. However: 1) I could not get an accurate reading for the life of me (pitiful waveform) and neither could other nurses who tried 2) it alarmed constantly 3) she didn't require frequent labs 4) she wasn't a difficult stick!

But the night shift nurse who I gave report to was clearly frustrated with me for pulling it. She said I should have simply kept it all connected but taken it off the monitor entirely, for blood drawing purposes. Am I missing something here? She has about 8 years more experience than I do.

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I'm still a rookie (and a NICU nurse, not a CCU nurse - sorry for the intrusion) but I would be big time nervous if I left a line in a patient's artery with no monitoring/alarms. So I'm with you.

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Specializes in Cardiac.

If we're not using it, then I want it out. Not just because it's uncomfortable and the the pt may bleed from it, but because it's another place for an infection to develop. Not to mention I have to document it's existance every two hours with each assessment. I'm all about de-lining people!

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Specializes in NICU.

I would have wanted it out, too. If there isn't a good wave form with it, that makes me wonder how well it's positioned and I'd fear that it would cause circulation issues at some point. When we have a line like that in the NICU, first we'll try retaping and repositioning it. If that doesn't work, then we have the docs pull it. It's too much of a risk to leave a "bad" line in, even if it does draw blood okay.

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Specializes in Critical Care.

If you turn the alarms OFF, then a patient CAN bleed to death, because you have turned off the 'disconnect' alarm.

My first Nurse Manager considered an off art line alarm to be a 'final warning' reprimand.

But, you CAN widen the parameters so that the line doesn't 'alarm' for being dampened. For example, instead of setting the parameters at 90/160 for systolic, you can set it as 40/300.

This prevents the art line from constantly alarming because it is out of range, but leaves the 'disconnect' alarm on and intact. And then THAT allows the line to be used for serial abg/lab collection.

But I completely disagree with taking an art line 'off the monitor entirely'.

~faith,

Timothy.

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Specializes in Cardiac/CCU.

I agree with the other posters-pull it! If they really need something for frequent lab draws, then you're probably giving a lot of meds. How about a PICC line? Placing one of those makes much more sense-more comfortable for the pt, lasts much longer, good for giving meds and drawing blood. Costs are about the same as 4-6 regular IV sticks; and a nurse can place one at the bedside!

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If you turn the alarms OFF, then a patient CAN bleed to death, because you have turned off the 'disconnect' alarm.

My first Nurse Manager considered an off art line alarm to be a 'final warning' reprimand.

But, you CAN widen the parameters so that the line doesn't 'alarm' for being dampened. For example, instead of setting the parameters at 90/160 for systolic, you can set it as 40/300.

This prevents the art line from constantly alarming because it is out of range, but leaves the 'disconnect' alarm on and intact. And then THAT allows the line to be used for serial abg/lab collection.

But I completely disagree with taking an art line 'off the monitor entirely'.

~faith,

Timothy.

:yeahthat: we do this exactly.

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Had this exact situation at work happen a while back. Pts aline was off the monitor, but left in for lab draws. Nurse goes in the check on sleeping pt, notices something on the floor, looks down there is blood all over the floor. Long story short, the aline ended up unconnected, stat h/h checked, pt got 2 units of blood. We were told to not do this either, b/c it is totally a patient safety issue. If you don't need the aline for continuous bp monitoring of vasoactive meds, or a sick pt on the vent for frequeny lab draws/abgs, I agree with the other posters. Why keep an invasive line you don't need and put patient at risk for numerous complications, especially if is not reading right and the patient is not a hard stick so getting labs won't be an issue? I wouldn't feel bad about it. Ultimately, pulling it is not going to do patient any harm in this situation, whereas leaving it in with the monitor of very well could cause patient harm.

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Specializes in CVICU, Education Dept., FNP Student.

I would never leave a line in that isn't monitored...I'm with others who have posted-turn your alarms limits down, not off. If the patient had no other access I would have left it in, especially if it was a patient with a respiratory problem and we were checking ABG's. But I'd never leave in a line that I wasn't monitoring, even if it was incorrect.

Not to get all administrative......but, It is a National Patient Safety Goal to be able to hear the alarms at any place in the unit. Obviously a well founded goal.

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My first question is why on earth would you place an A-line simply for blood draws? You can't give meds through it and if you're not interested in obtaining blood gasses then it simply is the wrong choice. As far as what to do with it... I would widen the parameters assuming it had some sort of waveform. This way you solve the alarm issue, unless it becomes disconnected, in which case it should alarm. I would not have just pulled it without consulting with a midlevel. The line could be improved upon by using a longer cath placed over a wire.

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Specializes in Critical Care/ICU.

You know you could shut the alarms off for the sbp and dbp and set the alarm for the map.

Maps reflect a more accurate interpretation of bp. Unless the line is profoundly (flat) damped the maps are still amazingly constant because the measurement does not rely upon the waveform and the response of the monitoring equipment as the sbp and dbp does.

"In general, overdamping and underdamping affect mostly SBP and DBP. MAP is less sensitive to these sources of waveform distortion and is therefore less dependent on the dynamic response characteristics of the catheter system. When all steps have been taken to maximize the natural frequency of a system, yet the dynamic response test indicates overdamping or underdamping, then either MAP should be followed or an alternative method of monitoring (eg, oscillometric blood pressure monitoring) should be used."

http://ccn.aacnjournals.org/cgi/content/full/22/2/60 (from the journal, Critical Care Nurse, online articles/ceu's)

The only reason I would leave this art line is if the patient were intubated and needed frequent gases. It shouldn't be there if it's intended use is for routine labs - this patient would require a central line. At any rate I would not pull it without first having other access, be it a central line or another art line for the intubated patient or one recieving frequently titrated pressors.

Never, ever silence your alarms.

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Specializes in ICU, Education.

Yes, for dampened waveforms with inaccurate readings that draw well, I widen my parameters. I never shut off my alarms. It is NOT the same as turning your alarms off. I chart that the cuff pressure is being used and why In fact, i think it is safer to widen parameters on inaccurate alines when you are using the cuff bp, because it decreases the nuisance alarms that make people IGNORE alarms. Ignoring alarms is extremely dangerous and is my pet peeve!

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