Invasive monitoring in ASC

[Alison Kirkpatrick RN]

I work in a freestanding ASC for the VA. We have acquired a new orthopedic surgeon who will be doing shoulder arthroscopies with rotator cuff repairs, distal clavicle resections, and acromioplasties to be done in beach chair position. Our chief of anesthesia is insisting on placing arterial lines for these cases that will be done as outpatients and discharged home same day. Anyone else have any experience with this? I have worked Preop/PACU/OR both in the hospital and freestanding ASC's and have NEVER in over 25 years had a patient for an outpatient surgery that needed an arterial line let alone was discharged home same day after a surgery. His plan is to start them in preop, and have the nurses pull them in PACU. We don't even have a Phase I/II PACU, it's all in the same room. We have argued with management and lost, so it is going to happen whether we like it or not. 

[offlabel]

Intra-operative beach chair position is associated with devastating neurologic injury because of improper interpretation of the NIBP readings...ie the blood pressure in the arm was way higher than the blood pressure in the head, not a concern in supine patients. VA patients especially can carry co morbidities like peripheral vascular dz/ carotid and/or vertebral artery stenosis that make this an especially important consideration. The a lines are not needed once the patient is awake so you can pull them almost immediately after admission to the PACU. While there are work arounds, like just using a cerebral oximeter that are a lot easier and probably just as effective, an a line is the gold standard....I agree, tho, it is a bit overkill in every single patient...this surgeon has either been badly burned or knows someone who has been. It's just a matter of pulling the catheter and holding pressure for a couple of minutes...not worth the fight IMO...

[LovingLife123]

Is there a reason you don’t feel like you can pull an art line and send the patient home?  It’s not really anything that needs super monitored once you pull it and make sure there’s no hematoma.  
 

Hold pressure above the insertion site for 5 minutes, check, place a 4X4 and tegaderm and it’s done.  

[Alison Kirkpatrick RN]

A multitude of reasons. The patient will be in an ultra-sling, so they will be limited and will have to use the non-operative side to do everything. If you have a patient with mobility issues every time they go to stand up, they will use that side to push out of the chair. We also do a fairly large population of ASA 3's that are on thinners. I don't have a problem as a skill set, I have cared for patients with them before, but never in a freestanding ASC. It would be different in a hospital setting. I understand the applicability I just personally think its overkill for the most part.