Death by Arterial Line?

[MarySunshine]

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.

[endorphinrush]

Thanks for the congrats!

The problem with PICC lines is that I work in the NICU. Our PICCs are so tiny, and babies' blood pressure is so low, that drawing back isn't very easy nor is it recommended on a regular basis. The only time we ever do it is when we are drawing blood cultures off the line to r/o infection. If we have a baby with a Broviac, we'll do our blood draws off that because they're much larger and have good blood return. Another reason we prefer arterial lines is that the docs much prefer ABGs to VBGs, especially in really sick babies on high ventilator support. Also, in a very sick baby their cuff blood pressure is sometimes undetectable, and having continuous BP monitoring helps us titrate our pressors.

One more reason in the NICU - we either do capillary heelsticks or arterial punctures to get our labs. Trying to draw venous blood often "ruins" the kids' veins. So either their heels look like hamburger meat from the cap sticks, or we have to do an art stick instead. This is why we'll leave in a line that provides blood return even if the wave form is dampening.

Totally off topic, I sure do miss peds. I cross trained to NICU but PICU was my "home." :) Level I trauma could be a great challenge and a lot of fun to do. I hear what you are saying about the picc's being too small. In your case, yea, definitely. I know the AACN says its acceptable for A lines for blood draws but we'd still use a PICC in my hospital. Or a midline but those don't "draw" for very long.

[Reggie686]

I think that any line that could potentially injure a patient should come out; in this case, a line that is not functioning properly with circulation, clotting issues as well as potential risks if alarms are turned off. Widening out alarm limits is similar to shutting them off; a lot of bleeding could happen before you notice by an alarm.

[ZASHAGALKA, RN]

I think that any line that could potentially injure a patient should come out; in this case, a line that is not functioning properly with circulation, clotting issues as well as potential risks if alarms are turned off. Widening out alarm limits is similar to shutting them off; a lot of bleeding could happen before you notice by an alarm.

If you widen out the bp parameters, the disconnect alarm is still intact, and it will alarm timely if disconnected.

How many times have you guys accidentally tripped that alarm when zeroing or drawing labs because you forgot to set the 3 min silence?

It IS a timely alarm. I wouldn't downplay it's absolute importance with an arterial line. It is sentinally important.

Eveything in medicine is risk/benefit. You have to weigh the risks to the benefits of avoiding future sticks. Every arterial stick now required because that line is d/c'd also carries a risk of permanent damage to an artery.

~faith,

Timothy.

[MurseNeutron]

that had to be one of the hugest risk infections ever! sounds like some people need to practice there blood drawing skills, lol. laaaaaaaazzzzzzzzzzzzzzzyyyyyyyyyyyyyyyyyyyyyyyy.

especially if the patient wasn't ventilated, lordy....

[nrsang97, BSN, RN]

Had a issue today with a art line myself. Went to start a new peripheral IV, ( pt has multi iv's and Nicardipine drip and no Central line). I went to the arm with the A-line and pt restraint was wet and it wasn't earlier. I immediately took off the restraint to see the site. The aides were stocking drawers in the room. I asked one to go get me some 4x4's and my preceptor. My pt A-line was cracked. There was a hole in the catheter. My preceptor stayed with the pt while I went to get one of the intensivets team docs. The fellow came over and took a look and we immediately went over wire and repaired the line. I can see why it is so impotrant to set those alarms. BUT THIS ALARM DIDN"T GO OFF. It was me just starting a IV because one had gone bad. What would have happened if I didn't keep up with my restraint checks? So I am all about alarms. I am one that will go investigate any alarm going off, you need to assess when the alarms are chiming.

As for leaving the line just to draw blood and not connected to the transducer is very dangerous.

I also had a A-line that I looked and noticed that it was backed up with blood and had a dampened wave. We checked all the connections and a connection was loose. Alarm didn't go off. So I ALWAYS make sure my alarms are set.

[BackPackerRN]

"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. "

I agree with a lot of what has been said. Keeping a line for frequent ABG's (have you seen an arterial site after multiple sticks-soon you can't find the artery anymore) is definetly a reason to keep a dampened art line. Widening the alarm parameters is the way to go. Disconneting it from the monitor is waiting for trouble, I've had my own experiences where pt's would have bled out if it were not for the alarm.

But one thing I must say about the nurse you gave report to. Even though she may have more experience than you, stick by what you know. Always put the patient first. Don't let the fact that she has more experience than you waver your confidence in what you know to be right.

[NURSJADED]

A little off topic, but not too much. I'm a firm believer that its not the lines themselves that cause infection but the fact that nurses are not cleansing the ports before IV pushes and IV tubing not being changed per protocol.

For example: Pt A's IV tubing is laying under his back, his pad is soaked with urine but the nurse just whips that tubing out and pushes that Digoxin with nary an alcohol swab in site. Urine being the least offensive of the "fluids" that the tubing has laid in all day. ::::shiver::::