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Discussion

IV in an artery

Hello, I had something happen today that is bothering me....I was starting an IV on an elderly gentalman....this man had very bad veins and not many choice places left to start an IV due to several infiltrations. Any way I finally found a place one the interior forearm. The thing that bothers me is that once I got the flash and hooked up the tubing I notice that the blood was pulsing up the lines....it was actually pulsing like an artery. What are the chances that I inserted the line into an arterty...I was aiming at blue. After I flushed it it immediately pulsed back into the lines. Secondly what happens if antibiotics are run there if it is in an artery?

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Uh, it sounds like the odds were 100% that you were in an artery. Drugs that enter the bloodstream do their job whether in a vein or artery. You probably did no injury but next time, if you suspect you are in an artery, you should pull it, apply pressure and try again.

Did you stop it? If abx go into an artery they are going to go into the hand muscles and most likely do some damage. You would have to have a pressure bag with a lot of pressure in order to prevent blood from filling the bag immediately if you actually hit an artery... how far up the tubing did it go? weird.

That happened to me one time, but in my case, the blood went all the way up to the hanging bottle - fast! so there was no question it was an artery.

So I removed it, of course, applied some pressure to prevent hematoma, then started over & found a vein.

QUESTION: I am unclear whether you left that line in: it certainly sounds like an artery (just smaller than the one I got into).

I would imagine the main potential problems would be: bleeding, & the person not getting the medicine ordered iv.

I wonder why we don't learn about that; you are now the 3rd nurse who I have heard of, doing this --- so I think it is not too rare :uhoh3:

jrmarr said:
Hello, I had something happen today that is bothering me....I was starting an IV on an elderly gentalman....this man had very bad veins and not many choice places left to start an IV due to several infiltrations. Any way I finally found a place one the interior forearm. The thing that bothers me is that once I got the flash and hooked up the tubing I notice that the blood was pulsing up the lines....it was actually pulsing like an artery. What are the chances that I inserted the line into an arterty...I was aiming at blue. After I flushed it it immediately pulsed back into the lines. Secondly what happens if antibiotics are run there if it is in an artery?

I don't think antibiotics can run in if it's in an artery.

For art lines you need to have IV fluids run in with a pressure bag usually set at 300.

I would think that you would know if you hit an artery. . .

ksRgonnabN19 said:
Did you stop it? If abx go into an artery they are going to go into the hand muscles and most likely do some damage. You would have to have a pressure bag with a lot of pressure in order to prevent blood from filling the bag immediately if you actually hit an artery... how far up the tubing did it go? weird.

Doesn't it partially depend on the patients blood pressure? ?

jrmarr said:
I noticed that the blood was pulsing up the lines....it was actually pulsing like an artery. What are the chances that I inserted the line into an arterty...I was aiming at blue. After I flushed it it immediately pulsed back into the lines. Secondly what happens if antibiotics are run there if it is in an artery?

Ever hear the phrase, "if it walks like a duck ..." That applies here -- if it pulses like an artery ... it's likely an artery. It happens - especially when you're aiming for the basilic vein.

So since you noticed the pulsing ... I'm hoping that you removed the line, obtained other access, and did not administer the abx, right?

the tiniest bit of pressure against a non-pressurized system is going to make fluid move the other way..hence the reason when you give IV push meds you don't have to push very hard...

Sure it could damage. Think... where did you want that abx to go? You wanted it to circulate via the venous to system circulation. By entering the forearm (if you hit an artery) you send the abx to the hand. The vessels there/tissue/muscle can't take that. That is if the pressure forward was not too strong. I guess as others have said you'd have seen it backflow up your lines.

With something like this, ask your charge nurse ASAP.. Call someone in the room with you.. Meds and IV's should go in the vein.

Just to echo what others said...yes, you were in an artery. Please tell us you took it out immediately and held good pressure and found another site. In all my years of starting IV's, I have only hit an artery once and it scared me to death when I hooked it up and saw what was happening! Too bad he didn't need an arterial line.

Agree with another post...if you are not sure, please ask someone immediately.

I hope you took that line out ASAP after suspecting you hit an artery. Giving medications that way most certainly can do damage. I took care of a patient once who in the past had emergency meds given via an IV that turned out to be in an artery... she lost her hand.

  • Experts

Actually this happens more frequently than most people would believe, especially in pediatrics. Scalp IVs are notoriously prone to be arterial and when a nurse is learning to insert scalp IVs they're taught to palpate for a pulse along the path of the vessel they're thinking of using, plus to watch for pulsatility in the tubing.

I've lost count of the number of times an attempt at central line placement results in giving us a second arterial line. There are a couple of giveaways, the pulsatility being one and the colour of the blood in the flashback being another. Without transducing the line, one way to assess would be to run a gas on the blood. PO2 greater than about 60 would suggest arterial.

In an emergency, drugs CAN and probably should be given into an artery. Dead is dead, losing a limb isn't. Some neonatal units give all their antibiotics arterially. But realistically, the line should be D/C'd if it's suspicious.

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