Leveling of A/L in Side-Lying Pt?

[All4Seasons]

Hello,

In your practise,from where do you level the arterial line when the patient is side lying (let's say at 25-45 degrees with HOB elevated 30-45 degrees)? Do you reposition your patients supine with HOB

I see that in a 2004 'Critical Care Nurse' article,the author says that (in reference to pulmonary catheter leveling):

Q: Are pulmonary artery pressures measured in patients who are positioned on the side (lateral or side-lying position) accurate?

Monitoring pulmonary artery pressures in patients who are in lateral or side-lying positions (eg, 20°, 30°, 45° to the side) is generally not recommended. Most research results are conflicting and inconclusive because of the lack of a standardized point of reference for leveling and zeroing in patients in side-lying positions.11–18 The only lateral position for which measurements of pulmonary artery pressure seem to be accurate is with patients lying on the side in a 90° lateral position with the backrest flat.3 The landmarks for leveling and zeroing with patients in the right and left lateral positions areas follows: (a) right lateral position (at 90° with backrest flat)—the intersection of the fourth intercostal space and the midsternum; (b) left lateral position (at 90° with backrest flat)—the intersection of the fourth intercostal space and the left parasternal border. Because most critically ill patients who require monitoring of pulmonary artery pressure are rarely positioned in a 90° side-lying position, until external landmarks for the correct reference location in 20° to 45° side-lying positions are determined by further research, pulmonary artery pressure should not be monitored while patients are lying on the side."

[meandragonbrett]

Phlebostatic axis is all you need to be concerned with when measuring arterial pressure.

[Chisca, RN]

I always thought arterial lines were leveled to the tip of the catheter.

[fiveofpeep]

I only precepted in the PACU but the nurses always taped the a line apparatus directly to the patient's gown near the phlebostatic axis. It worked pretty well especially for PACU patients who are being moved so often to check dressings or tx to own bed.

[Chisca, RN]

Meandragonbrett is right, it is the phlebostatic axis as the correct point. Zeroing to the tip of the catheter will give you the pressure in the arterial tree. What you are concerned with is the pressure at the aortic root.

[NotReady4PrimeTime, RN]

When I'm leveling my transducers for a patient who is side-lying, I visualize where their heart is in reference to their back or chest then level to where the right atrium would be. Same with EVDs... level to where the third ventricle is in relation to the patient's position... since they're lying on their tragus. The bridge of the nose is a good reference for that one.