Confused patients and fem lines

[aCRNAhopeful]

So far during my short career as a cardiac nurse I have seen too many close calls with confused patients, whether its pump head post open heart or just plain dementia, and femoral lines. By close calls I mean out of no where going from calm and tranquil to trying to get out of bed and bending and squirming around while they still have a femoral sheath/femoral art line in, or by bucking around after you pull it to so that you lose control of the groin and they bleed alot. How often do you use fem lines in your facility? They seem like a huge risk and a sentinal event waiting to happen to me.

[OptimusPrime]

We very rarely use femoral A-lines. Infection being the biggest reason. Almost all of our post-op hearts have a radial A-line. But, occasionally they will come back with a femoral a-line. When this happens, most of the time it's fine, pt's wake up and it comes out after drips are off, or in AM. If the patient is confused, you can use some type of sedative, ie ativan, or Haldol/Diprivan, whatever your surgeons prefer. If the patient is off drips, just see how it correlates to your NIBP, then pull it (after ABG's of course).

For caths, as soon as ACT is under 250, it's coming out. until then, if they're trying to crawl out of bed or do reverse crunches, it's ativan and morphine until ACT is under 250.

[TakeBack]

Assess the need for the line. IABPs at my institution get a leg brace and 4 points if they are that agitated, until we can control them pharmacologically.

Fem A lines are a last resort of radial/brachial/axillary is impossible, and they should be out once you are comfortable w/ hemodynamics. I wouldn't leave a fem a line in just for ABGs unless you're checking q1hr or more frequent and have a bad pulm/vent issue.

Confused pts should get haldol over benzos; haldol addressed the psychosis better....ativan/midaz just makes a delirious sleeping pt, who will eventually wake up again, still delirious.