Leveling Art Line

And, as a theoretical question, if leveling to the A-line insertion site, I am assuming the pressure reading would be an accurate measurement of blood pressure AT THE INSERTION SITE. But, if leveled to the phlebo axis, the BP reading would be an artificial APPROXIMATION of central pressure due to the effects of atmospheric pressure on the transducer. Does that make sense? And, if so, why would we want an APPROXIMATION when we can have an ACTUAL?

Thanks all!

For swan/cvp/a-line you should level at the 4th ICS Mid-axillary line. You need to check your hospital policy on invasive monitoring. AACN Procedure Manual is also a good place to check.

Why would there be effects of atmospheric pressure if leveled at the 4ICS-MAL? That's why you zero the transducer. Atmospheric pressure isn't going to change from the 4ICS-MAL to the radial artery. I'm not sure I'm following you here.

Next time you have a pt with an a-line I want you to do a little experiment. Put the transducer next to the insertion site and move the arm really high in the air above the pt. Then look to see the pressure reading. Next hang the arm over the side of the bed so it is a low as it can go and look at the pressure reading.

When you see the readings I want you to think. Does my Central blood pressure really change that much just because I have raised or lowered one arm? Remember you are trying to find out about central blood pressure in order to check for organ perfusion.

Next level that a-line transducer to the phelbostatic axis (4ICS, MAL) like EVERY hemodynamic book, policy manual tells you to.

The very next thing you need to do is talk to the unit educator. Those experienced nurses that you have talked to, do not understand a-lines and some unit re-education is needed.

In support of the other nurses who have already posted, you need to look to the agency which is responsible for setting the gold standard of ICU care. That is the AACN. They set the standards we should practice by and their findings are evidenced based. I loved the AACN Practice book so much, I bought one for myself (not cheap) and have used it repeatedly over the years. This isn't a situation where you want to model improper practice, you want to use EBP.

4ICS-MAL!!!! Always always always. I feel you though, when I was new to the ICU, I looked up to the more experienced nurses and found a lot of inconsistency in practice. I look to policy and gold standard each and every time.

Good for you for questioning it!!!!

http://www.pacep.org go here

thanks acrnahopeful for posting this link... its a great refresher on cardiac for new sicu nurses like myself :)