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May I ask my STUPID questions here?

NICU   (11,379 Views 17 Comments)
by superwee superwee (New Member) New Member

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Why can't you infuse glucose into a peripheral arterial line?

I should know this, I know. I've tried to google it and can't figure it out. Does it mess up the BP reading?

Thanks!

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medchick has 3 years experience and specializes in nicu.

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IT depends on the dextrose level in the IV fluid. Usually anything above 12.5% needs to go into a central line. It was explained to me that the higher concentrations are more thicker and more damaging to the peripheral veins than central ones. It is better to put it through a PICC or UVC.

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I don't know of any physiologic contra-indication to infusing D5 or D10 thru an art line. To my knowledge, it is simply a matter of practicality. Since labs will be drawn thru the art line, it is best to avoid dextrose infusions that could affect lab values such as blood glucose. Also, many peripheral arterial lines will not "accept" high volume infusions without blanching or dampening the wave form, so another IV site will be needed for the baby's maintenance fluids. Beter to run the dextrose there, and avoid "contaminating" the art line (both in the infection-control sense and in terms of affecting lab values.)

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CritterLover is a BSN, RN and specializes in ER, ICU, Infusion.

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why can't you infuse glucose into a peripheral arterial line?

i should know this, i know. i've tried to google it and can't figure it out. does it mess up the bp reading?

thanks!

well, i don't do babies......but i do know iv therapy.

assuming that babies are the same as adults in this respect (and i don't know why they wouldn't be):

it is very dangerous to administer any medication through an arterial line.

arteries have a thick layer of muscle, and are prone to spasms.

foreign substances, such as medications, tend to cause those arteries to spasm. this can lead to an infarct (tissue death) to the distal tissues.

there are some medications that are safe (or relativly safe) to infuse into an artery. dilute heparin is one of them. some forms of chemo are also administered intra-arterially (ia), though there may be a risk-benefit trade off here. contrast and ntg are also given ia in the cath lab, though in this case, and spasm would most likely be noticed by the cardiologist.

so anyway, it is a safety issue. i know of patients that died due to meds infused via the pulmonary artery port of a pulmonary artery catheter (swan line) due to a pulmonary artery spasm that infarcted a lung.

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Thank you! I guess I'd just always assumed dextrose was one of those "safeish" meds to be put through an arterial line. He who assumes...well, you know!

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RainDreamer has 13 years experience as a BSN, RN and specializes in NICU.

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it is very dangerous to administer any medication through an arterial line.

is this just in regards to a peripheral art line?

it's not too uncommon for us to administer some meds through a uac, especially abx.

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Is this just in regards to a peripheral art line?

It's not too uncommon for us to administer some meds through a UAC, especially abx.

Yes, peripheral art line. That's why I'm confused-- why is it okay through an umbilical artery, but not peripheral artery?

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RainDreamer has 13 years experience as a BSN, RN and specializes in NICU.

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Yes, peripheral art line. That's why I'm confused-- why is it okay through an umbilical artery, but not peripheral artery?

I guess because the UA is a central line? Kinda like how we can only give D12.5 and above in a central (venous) line, but anything peripheral has to be a dextrose of 12.5 or less. Maybe? I don't know.

As far as your question about dextrose though, I've never seen it run through an art line. We just use our art lines for just that, art lines .... so we can monitor BP and so we can draw blood. We just infuse 1/2 NS c heparin at 1 cc/hr. Sometimes I've seen them run abx through the art lines, but that's usually only if they have to push the line in and therefore they want abx run through for infection control.

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CritterLover is a BSN, RN and specializes in ER, ICU, Infusion.

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is this just in regards to a peripheral art line?

it's not too uncommon for us to administer some meds through a uac, especially abx.

i'm really not sure, since i don't take care of the little ones.

since the pulmonary artery in adults is a pretty large artery, i don't think size is an issue. i also know of a case where a picc was inadvertantly placed into the arterial system, and tpn was infused through it. pt died due to complications of this event. so, it definitly isn't size related.

does the ua "serve" anything? if it were to spasm from the medications, would anything be adversly affected?? i'm thinking that while you might lose the line, you wouldn't have any other complications due to ua spasms, and that is why it is safe to administer meds through it. i'm not certain, though; i'll have to look it up when i get to work and see if i find anything.

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medchick has 3 years experience and specializes in nicu.

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No; I mean why can't you infuse like, D10 into a peripheral ARTERIAL line? THanks, though!

Sorry, I missed the arterial part. My bad.

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SteveNNP has 9 years experience as a MSN, NP and specializes in Neonatal ICU (Cardiothoracic).

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Yes, peripheral art line. That's why I'm confused-- why is it okay through an umbilical artery, but not peripheral artery?

We RARELY run anything but 1/2NS/Hep 0.5u/1cc through our UACs. I've only given 2 things through them..... PRBCs and UAC fluids with calcium added.(the baby had no other access) The risk of air embolus and thrombus formation is just too great to run anything through them. The arteries are very sensitive to irritants (read: drugs) They can clamp down in a heartbeat, and then you have black legs/toes/butts. We NEVER push UAC's in once the sterile field is broken. Whoever is doing that needs to review their infection control/procedure notes. No amount of abx running through the catheter will kill the bacteria tracked into the baby on the outside of the catheter when it's pushed into the pt. You can only pull back on the UA, not advance it once your sterile field is broken. (sorry,,,, can you tell that I'm on my soapbox? :>P)

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