Labs and vasopressors..new icu nurse needs advice

[icu26RN]

What do you do if your pt has a picc line or central line and you need to get AM labs from the line but they are on high doses of levophed or any other vasopressor? Are you supposed to put all IV fluids on hold while you draw labs so they dont dilute the lab sample.. what if your pt is very sensitive to the vasopressor and drops their pressure right away? But what if you leave the pressors on will it mess up the lab results? Please help..I need advice.

[MrBubbles]

Yes I meant pedal. We do also use fem lines. Last resort seems to be a brachial, but only for use in the OR. At my hospital brachial a-lines must be DCed by an MD upon arrival to the ICU. An MD told me this is because of a higher incidence of amputation with brachial lines.

[ghillbert, MSN, NP]

Had a guy with an axillary a-line this week - haven't seen that very often.

[cardiacRN2006, ADN, RN]

I've had axiallary and brachial, but never, ever a pedal.

[sicushells, RN]

Yes I meant pedal. We do also use fem lines. Last resort seems to be a brachial, but only for use in the OR. At my hospital brachial a-lines must be DCed by an MD upon arrival to the ICU. An MD told me this is because of a higher incidence of amputation with brachial lines.

That's interesting. I've never seen or heard of a patient needing an amputation because of a brachial a line.

[Mommy_of_3_in_AL..RN]

I agree an A line is best, but in the real world..at least my unit,it isnt always there. Usually on a patient that has one or two pressors and are only expeted to have them for a short time, the docs wont place an aline if the cuff pressures are pretty accurate and consistent. Patients that are on presors long term, or whose pressures just arent picking up well with the cuff, or if they are on lots of pressors (like those that are on everything in the book and then some), they usually get an aline. However, these patients always have a PICC or a centrl line,so i try to place as many as i can into one or two ports, and try to reserve at least one port for antibiotics, IV push meds, and lab draws.

[NurseKitten, MSN, RN]

The brachial artery is a terminal artery, which is why there's a higher incidence of complications with it.

Complications of A-lines increase something like 7% for each day it's in.

[diosadelsol, ADN, BSN, MSN, RN, APRN, CRNA]

I have always been told you have to stop everything infusing through any central line to draw off of it. If you have pressors going and no a-line you're gonna have to stick for your blood.

[icu26RN]

Thanks everyone for all your responses . I definitely wish we had more a-lines in our icu, it would make things so much easier. I find that a lot of patients in our unit that are on multiple pressors do not have a-lines!!! I am not sure why and I will definitely try to advocate for one if possible.

[chani]

Inotropes/pressors = A line. this is standard practice in Australia also. I would only use CVC/Picc for bloods as a last resort and that is ususally a long term patient who is stable & not on haemodynamic support.

Remember any breaks into a CVC increases infection risks.

PS if using an A-line always check the flush bag before taking the blood incase someone as put up dextrose instead of saline.

[RN Joe 86]

I agree with everyone else to NEVER pause your pressors for labs. If all of your cvp lumens are occupied try a piv, as long as it has sufficient blood return. Or, just stick them. In reality, if your patient's BP is tenuous enough to be on pressors there should really be an a-line to draw off of. If their bp is stable with a low gtt rate of one pressor I wouldn't be too concerned with badgering the MD for an a-line. But, if they're on multiple pressors or high rates, there NEEDS to be an a-line to accurately titrate your gtts.

[whooha]

If you can't stop your fluids and you can't find a vein our RT's are great about grabbing a few cc's extra during a gas. You can get blood that way. I think in some states it's legal for RN's to art stick. I actually have the RT pull blood for me alot. Expecially with serial labs. It cuts down on a stick expecially with someone with bad veins and poor access.

[PiPhi2004]

getting an art stick (or any stick) of someone on pressors, especially more than 2 is nearly impossible. If you have enough pressors that you have no access left, then you need an a-line, period. I would check to see if anything can run together so you can have a free lumen. I usually have something else running (insulin gtt, heparin, fluids, etc) to where I can stop that instead of a critical gtt.