Holding with art line

babyNP., APRN · May 5, 2016

Well... what happens when the baby is in the incubator and you are charting at a computer and don't notice the blood because the isolette cover is on until the alarm starts dinging? How is that any different?

I think it's a good idea to have more than one set of hands to hand a baby with a lot of lines or on a ventilator, but just because the kid has an arterial line shouldn't be an absolute indication not to hold.

MNNICU, RN · May 6, 2016

Right I'm not sure if this is just something that older nurses started (who can be incredibly opinionated) and then everyone followed suite or what?? My gut is usually if the doctor or practitioner says it's ok and you have adequate help its fine. Whenever I hand babies who have UVCs to parents I always tell them if they see blood or feel something wet to hit the call light right away so I can check. I figure it's the same. I have never seen a baby that has an art line and one a vent be taken out on our unit. Our practitioners consider that a little too unstable but we have babies that are vented held all of the time if they are stable and the parents are comfortable.

BittyBabyGrower, MSN, RN · May 6, 2016

Our attendings feel if the baby has an art line they are not stable enough to be held. We really warn parents about UVC's. They can not hand the baby to

anyone else without assistance since we have had several dislodged in this way. Nothing like a freaked out parent covered in blood with a silently freaked out nurse trying to grab the belly to stop the blood flow. Ugh.

MNNICU, RN · May 7, 2016

Glad to know we aren't the only ones. The nurses are super uncomfortable with it. And their mindset is it doesn't matter if the doctor is comfortable with it or not we are the ones handing the babies over and we are the ones responsible for their well being when the doctors aren't there. I have mixed feelings for sure but I just don't think I am comfortable with it a whole lot unless it may be their only chance to hold or something .

sailornurse · May 7, 2016

Right I'm not sure if this is just something that older nurses started (who can be incredibly opinionated) and then everyone followed suite or what??.

OK I'm an opinionated older nurse what's your problem with us? Did you ask any of the more experienced season nurses? perhaps it's a policy or it could be a throwback to a policy from the past.

Coffee Nurse, BSN, RN · May 7, 2016

Your monitor should certainly be telling you when a line is dislodged to the point of letting blood flow well before your MAP drops, that's one of the points of transducing an art line. I think my hangup would be less about the safety of transferring/holding with an art line in place and more about whether the baby is stable enough to be held if they're needing an art line? That's a judgment call that needs to be made by the doctor and nurse together, it can't be a unilateral decision.

MNNICU, RN · May 7, 2016

OK I'm an opinionated older nurse what's your problem with us? Did you ask any of the more experienced season nurses? perhaps it's a policy or it could be a throwback to a policy from the past.

I don't mean they are just opinionated I mean they will yell at you in front of other people and be totally rude about it. Opinionated is a nice term for some of the people I work with. Hence why I am caught in between because either the doctor is mad at me for not listening to him or the nurses are making a scene because I did something they didn't agree with. Either way it's a lose lose for me. And I will need help with moving the baby so I would need to ask another nurse who would give me an ear full I am sure.

BittyBabyGrower, MSN, RN · May 8, 2016

Do you have a practice council or educator/CNS at least to consult with? This sounds like something that needs to be run past them. Like some of us said, we really only use art lines on sicker kids where holding is contraindicated. Do a lot of your kids have lines? Pretty much as soon as they are stable or the line has been in 10 days, it is pulled.

MNNICU, RN · May 9, 2016

Do you have a practice council or educator/CNS at least to consult with? This sounds like something that needs to be run past them. Like some of us said, we really only use art lines on sicker kids where holding is contraindicated. Do a lot of your kids have lines? Pretty much as soon as they are stable or the line has been in 10 days, it is pulled.

yes we pull them ASAP as well we recently had a baby that ended up with an art line for blood sugars of all things because they couldn't get a UVC or peripheral and the blood sugars were literally so low the meter couldn't pick it up. We had to use a super concentrated dextrose gel just to get a reading of 12 while they were scrambling trying to get in a line. They decided to leave the line for a few hours while the sugars were stabilizing in hopes the extra fluids would help the baby perfuse and they could get a PIV. He was totally stable otherwise and the mom wanted to hold and our neonatologist said it was fine but one of our senior nurses told

me not to listen to him and that the baby shouldn't be held with an art line. Thankfully one of our absolute amazing NNPs came in an hour later and got a scalp PIV and at that point the sugars were in the 70s so the art line was pulled and I had no problem letting mom hold. Thankfully it became a non issue but this is the third baby that neonatologist has told parents they can hold with an art line.

Mindylane · May 20, 2016

Our hospital's policy is that if a baby has a UVC, they cannot be held.