IV in an artery

[jrmarr]

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?

[Rob72, ASN, RN]

IVRUS said:

I agree with the statement that nurses aren't taught this in school... Many RN's are just expected to put all the pieces together and come up with a clear picture of what to do, this doesn't happen.

Additionally though, one must always be mindful that there are Aberrant arteries, with approx 1 out of 10 people having one... This is an artery that is NOT deep, but rather superficially located and in an unusual spot.

Absolutely, what I was specifically commenting on was cath length, and what made me cringe was the OP saying, "I shot for blue...".

Palpate, palpate, palpate. I've cared for two patients who had distal amputations because the brachial artery was blown during an attempt for the brachial aspect of the cephalic vein. What we feel is far more important in site selection than what we see.

[Merced]

I'd like to thank the OP for starting this informative discussion. It took guts - I like that

[nurseprnRN, BSN, RN]

"I've noticed that with patients with respiratory troubles, copd especially, the blood return is increased and can cause blood to back up like that. not sure what is the scientific explanation for this."

increased venous pressure in copd is mostly a result of increased pulmonary artery pressures, caused by loss of pulmonary capillary bed due to the loss of alveoli that happens in longstanding copd-- the same amount of blood has to go through fewer capillaries, so its pressure is higher. this translates (working backwards) into increased right heart pressures and then increased venous pressures. you've heard of cor pulmonale? that's latin for, roughly translated, what happens to the heart when the lungs are chronically bad-- increased right ventricular size (and failure).

you can also see this in the jugular veins, which will be distended at higher sitting postures than in normal folks. (you also see jugular venous distension, jvd, in congestive heart failure, but for a little different reason-- the right side is backed up and congested because the left heart is failing to move blood out arterially.) you also see liver enlargement, for the same reason-- backed-up venous flow, and the liver sees a lot of venous flow.

[SleepynurseRN]

Ooops..I meant catheter length, not guage size. My bad. Thanks for pointing that out.

[SleepynurseRN]

Rob72 said:

Veins are generally 2-3 millimeters below the surface, arteries more in the 3-6mm range, cath length makes no diifference.

What disturbs me is that, no, nurses are not taught how to perform venipuncture or art access, overall. Repeatedly this is referred to as a "lower level" skill, learned OJT.

At this point, the "proof-test" is to put a towel nearby, and disconnect the hub. Venous will ooze, art will spurt.

Ooops..I meant catheter length, not guage size. My bad. Thanks for pointing that out.

[ERRNinNC]

It may or may not have been in an artery. Someone earlier asked if the patient was puny..there have been times in the past that on a thinner patient or someone with a very strong or bounding pulse that I have put in an IV into the basilic vein and saw what I thought was pulsation. We have an ultrasound machine for ultrasound guided placement that I used and you can compress using the probe over your IV site. If you see compression where your IV is you're in a vein, if not then you're in the artery and you need to pull the IV. So it could happen. Just like others have said, if you aren't sure ask someone else or pull it. Better safe than sorry.

[kannette23]

I will probably get dinged for this but don't care. First, if ever in doubt then DO NOT follow through. If you suspected you were in the artery then it is your obligation as a prudent nurse to discontinue that line for patient safety. If many feel they are not trained as a RN or even LVN for that matter re IV starts then take it upon yourself to get the additional proper training....don't start IV's if you have doubts about proper techniques or abilities. I start many IV lines and there are many factors re the return. Was pressure still applied when attaching the adaptor device? If so, there would have been a return, esp if in a larger vein such as the ceph. I've started lines that would produce a back flow even when holding pressure while attaching the male adaptor. Regardless...that line should have been taken out if there was a doubt. I'd find IV classes at your facility or in your area to get additional training as it can only benefit you and your patients. Remember, just because there is an order doesn't mean you have to follow through with that order if you fear for pt safety....because in court you say it was the MD who wrote the order but that doesn't matter because you carried out the order.

[Guttercat, ASN, RN]

Great thread!

[beckster_01, BSN, RN]

This may be obvious, but when I was first starting to place IV's I forgot to remove the tourniquet before saline locking the IV (hello mess). I was pretty confused when the blood returned into the SL after I flushed it until the patient complained about the tourniquet

[psu_213, BSN, RN]

nurse2033 said:

Drugs that enter the bloodstream do their job whether in a vein or artery.

No, drugs should not be passed through an A line. There was a situation a few years back when and IV was accidentally inserted into an artery (thus not really an IV!), phenergan was given through the line, the arm became gangrenous quickly and an amputation was needed. I'm not sure what other meds would do but I don't want to be the one to find out.

It is true that the insertion itself probably did not do damage, but you need to take it out and go somewhere else.

[6spdftwtm]

I was in a situation several years ago where I was convinced I had started an A-line on a young guy. He was ~18 y/o muscular, fit guy, in ER for intense abd pain and being a little....shall we say dramatic. Either way, tensing abd muscles, or rather tensing muscles all over. Elevated BP (2º pain or drama - I couldn't tell) and tensing all his muscles, he was able to produce a pulsating venous return. Mind you it wasn't very forceful, but it was certainly pulsating and it was certainly a vein (since I D/C'ed mine thinking I had hit artery)....another person stuck a different vein with same results. It's not something you'd routinely see, but it happens.

[Epic_RN]

I have really enjoyed this thread, especially Grntea's explanation regarding COPD and cor pulmonale. Personally, at my school we were trained in IVs and blood draws, part of our skills checklist and skills sign off. I am very thankful, I would NOT have liked to place my first IV on the job! We practiced on each other which really helped with the anxiety of learning a new skill as we were all new to it (except for the LVN to RN students who had IV cert). Our school also offers IV certification classes -- had I not been trained in IVs, this is something I would have done while preparing to take NCLEX. Just my