Labs and vasopressors..new icu nurse needs advice

meandragonbrett · Jun 15, 2009

Leave your pressors running. Draw the blood from a different lumen.

Mommy_of_3_in_AL..RN · Jun 18, 2009

yup..never turn off the pressors, even for a minute..ive seen too many BPs bottom out, quickly! If you have a lumen with nothing going to it, use that one..flush well, draw the labs then flush and clamp. If all your lumens are in use, look to see what is going into what..if they just have fluids going into one, its ok to turn those fluids off a minute to get your labs. If each lumen has a different pressor going to it, look to see if those pressors are compatible at the Y site and run them all into one lumen if compatible..that frees up a lumen.

Atlas09 · Jun 20, 2009

If your patient is on high dose pressors you should have an A-line to draw labs off of period. Titrating high dose pressors without an A-line is just plain dangerous. I've titrated one low dose pressor off of a cuff before, but nothing that I felt was a high dose or anyone on more than one gtt.

geekgolightly, BSN, RN · Jun 21, 2009

If your patient is on high dose pressors you should have an A-line to draw labs off of period. Titrating high dose pressors without an A-line is just plain dangerous. I've titrated one low dose pressor off of a cuff before, but nothing that I felt was a high dose or anyone on more than one gtt.

And if you can't get an order for that (which has happened to me before, unfortunately), lab needs to draw directly from a vein. If you have anything running in any of the lumens, it will affect your lab results.

jangraciemom · Jun 21, 2009

Exactly what i was thinking if the blood pressure is that labile on multiple drips an arterial line is essential. Don't stop the pressors.

Atlas09 · Jun 21, 2009

And if you can't get an order for that (which has happened to me before, unfortunately), lab needs to draw directly from a vein. If you have anything running in any of the lumens, it will affect your lab results.

It will indeed affect that lab results, if you can't turn all of the things running off, you need a peripheral stick or an A-line.

allnurses Guide · Jun 21, 2009

God no, don't interrupt your inotropes! If you've ever had an IV pump fail, you will have seen the impressive speed with which BP can plummet when inotropes are interrupted.

As per other posters, get labs from art line, different lumen, or from a peripheral stick.

cardiacRN2006, ADN, RN · Jun 25, 2009

And if you can't get an order for that (which has happened to me before, unfortunately), lab needs to draw directly from a vein. If you have anything running in any of the lumens, it will affect your lab results.

Or just draw it yourself. I've found it much easier and faster. Drawing blood is easy.

However, it's just plain dangerous to not have an Aline here. I've never had a Dr say no to placing an Aline for a pt on pressors.

MrBubbles · Jun 27, 2009

YOU MUST HAVE AN A-LINE! Any MD who does not say yes needs to be slapped, then call his upper to ask for an a-line. YOU MUST BE A PATIENT ADVOCATE! When the Dr. says no to an a-line when pressors are being run that is when you step up as the patient advocate and say "You are giving me an a-line!" If he can't get it on the R radius, then he needs to try the L radius, if that doesn't work, go to the R pedal, then the L pedal. Bottom line it needs to get done. Don't take no for an answer here. Now I say this because it sounds like you had multiple pressors running. And remember, anytime you access a central line/PICC, you have to stop everything running and pull up some waste. Look up your hospital's protocol on this. And always flush after getting your sample. And turn everything back on. And I'm with the others, don't turn off pressors.

cardiacRN2006, ADN, RN · Jun 27, 2009

Pedal? People place Alines in the feet? Did you mean femoral?

NurseKitten, MSN, RN · Jun 27, 2009

And if the doc isn't comfortable placing the a-line, in our facility, respiratory can do it with an order, and if all else fails, call anesthesia!