IV in artery


Hi everyone. I was wondering how easy it is to have an accidental arterial stick instead of starting an intravenous line. Working in ER/ICU and in ER mostly fluids running by gravity. If in artery, you would be unable to run by gravity, correct ?? I know bright red blood but many of my patients are not oxygenating well to begin with, therefore, even ABG blood is dark. Thanks!


1,480 Posts

I've done that once. Before I did it I couldn't see any possible way someone could do that, but I did it. I'd say it's more likely working around the hand and wrist. If you're not sure (and this is very rare, I'd say) hook up the IV fluid with the roller wide open, take the bag and hold it several inches below the IV site and let the blood back up into the tubing several more inches.

Then raise the bag to above the level of your patient's heart and if the blood washes in, it's an IV and not an arterial line. If you just check for pulsatile blood you can get confused because some patient's venous pressure is so high that blood gushes out pretty briskly, even though it isn't pulsatile.


3 Posts

How did you know you were in an artery? Thanks for your reply!


1,480 Posts

How did you know you were in an artery? Thanks for your reply!

If I remember correctly, blood that was more red than usual ran up the tubing.


3 Posts

Thanks so much!!!


64 Posts

Some difficult sticks we would use sonosite and you can see those darn arteries can be mighty close to where you want to go.

8-ball, BSN

286 Posts

Specializes in ICU, and IR. Has 13 years experience.

I have seen itdone for sure. It actually turned out ok, the docs just found a way to make it an A-Line. Doesnt last as long that way but it worked for a quick OR case.

Buyer beware, BSN

1,137 Posts

Specializes in GENERAL. Has 40 years experience.

OP: Maybe 1:10, 000 people have a radial artery that is so close to the skin surface and inperceptibly pulsatile. (at least in my experience). Kind of rare.

So you canulate it and "uh-oh."

Now you've got youself an inadvertant a-line.

So much the better. (lemons to lemonaid moment)

Draw your blood, tape the thing down and call the physician telling he/ she that you have uncovered an interesting anatomical anomaly. How about that-fascinating!

Now if the patient is sick enough and needs frequent invasive BP readings, you've just done everyone a favor to include the patient, you and the doctor.

Truly a win, win, win situation.

Nothing is lost to this "Buyer beware" optimist is my middle name, kinda guy.

Oh, but I forgot, you still have to start the IV line.

Oh, well. :whistling:

Ruby Vee, BSN

67 Articles; 14,022 Posts

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

I've had a few inadvertent arterial sticks, but usually its the newer provider putting in a central line of dialysis cath. Doc put a dialysis cath in the femoral artery, and when we put the patient on dialysis, the numbers were really wonky. Finally a crusty old bat (not me, because I was still young and tender at that time) sent ABGs off that line, which confirmed arterial placement. We finished the run (only an hour left of an emergency run) and then let the doc take his own line out and hold pressure until the cows came home. (Literally -- we were outside the city limits in a brand new hospital and many of the windows had views of farm, fields, pasture and the cow path to the milking parlor.).

I also had a patient come back from surgery with a Cordis sticking out of his neck at an odd angle. "It doesn't work," anesthesia told me. "You can take it out." I had a funny feeling about it, so I hooked it to pressure tubing and yup, it was the artery. A caratid artery. The resident called anesthesia to come back and take out his own poorly placed line.

If it's not something spectacular like a big freaking hose in a central artery, it's not a big deal. You just hold pressure for a LONG time and try to find something good to watch on TV while you're holding the pressure.

EllaBella1, BSN

377 Posts

Specializes in ICU. Has 8 years experience.

I had an intensivist unintentionally place a central line in the femoral artery recently during a code situation. The patient survived the code and we ended up transducing it as an a-line, haha. But we knew because the blood was lighter and was pressurized.