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?

[psychnurse7]

I have been a nurse for 16 years and have never seen this happen. The same exact thing you just described happened to me a few hours ago. I used to work in ER so IVs come natural, I stuck the IV in the AC like many of us have done over and over. When I took the needle off when usually blood would just pour out, it shot out, I totally thought arterial too. The color was normal. I freaked out and called the house manager who told me if it had been arterial it would have blown with a flush and caused him severe pain, which it did not, the patient actually bragged on how well I did. Hung 2 different antibiotics back to back and though they ran fine severely pulsated. She said with his history of polio, and seizures something about compensating and pressure causing that. She said her daughters veins are the same way and she also has a seizure history. She lead me not to worry but reading these comments now I'm worried. The next shift is on and now I'm worried about what could happen until I come back on the next shift

[psychnurse7]

GrnTea you made me feel better making me think my house manager was right. Thank you

[Guest838984]

You def hit an artery. It doesn't always have to pulsate up into the tubing or bag. I've seen quite a few in my ER. Sometimes it's hard to tell cuz it won't pulsate so obviously but yes you hit an artery mam and I'm not too sure about the ABX part. I can't say I would know what would happen or if it's bad

[travelingrn2001, ASN, BSN]

I only have personal experience to add. I once received a patient shortly after cardiac arrest. Sepsis was the original diagnosis. The intensivist placed an emergent femoral central line, blood return was dark and appeared routine. Usual medications and treatment continued (levo, neo, abx, propofol , crystalloids etc) throughout the day. Later in the day when rechecking labs the patient had stabilized more and I noticed the blood in the tubing was pulsatile. Hooked it up to a transducer and obtained an arterial tracing.

I called the intensivist, lines changed, femoral arterial line removed, incident report filed.

A few days later the patient left ICU and I lost track of the patient. I don't know of any terrible complications but it has made me more alert to a central line placed on a hypotensive, hypoxic patient emergently.

[cardiacqueen]

If the blood was pulsing strongly up the tubing, then I would feel pretty certain yes, you hit an artery. I have had an inadvertent arterial puncture once, in a patient with a very thin arm, while aiming for the basilic v. I didn't even get to the point of flushing it...as soon as I removed the needle from the angiocath I could tell the blood flow from the hub was pulsatile - and strong! Both the patient and I were wide-eyed! Removed the line, applied pressure and started over.

I have noticed that sometimes with a particularly patent IV that a small amount of blood (maybe a few inches max) has backed up into the tubing if the IV is infusing at a really slow rate, or if I stop the pump for a few minutes to take a blood pressure or something. In this case, the pressure in the vein is greater than the pressure being exerted by the fluid in the tubing (especially if you have a BP cuff squeezing the arm :)).

Bottom line, if you suspect arterial puncture I would err on the side of caution and remove the catheter. Part of your medication "rights" is "right route."

[NurseStorm, BSN, RN]

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.

Just stating we were taught to perform venipuncture.. (not art access though)

*edit* Quite surprised this is not standard.

[Mcpatty55]

I think I did the very same thing yesterday; someone asked me to start one on an elderly, dehydrated lady who I haven't cared for, so I wasn't familiar with her. I found a big "vein" at the distal wrist, and threaded fairly easily. The blood was pulsating in the connector up the tubing, and the NS wouldn't drip. The blood also was a brighter red than normal, so I concluded that I was in the artery and dc'd it. They ended up having an IV nurse come in and do it.

[SBJustBreathe, ASN, RN]

This did happen to me once. Nice big juicy vein, easy stick. But when I tried to run my meds the pump kept beeping occlusion. I unhooked it, flushed, but if I released the flush it pushed back. Bright red blood. It was an artery. Pulled it out and started over. Lesson learned. Palpate to feel a pulse if you're not sure because sometimes those arteries look like big beautiful veins, but they're not.

As as far as running meds through doing damage, I'm not sure. I suppose it would depend on what's running, how much, etc.

But bottom line is, your medication is ordered IV and that's how it should be given.