Rash of A-line dislodgements

  1. We've had three, yes three, dislodged A-lines in the past week. Two of the patients were intubated the other not. No restlessness noted. Dressing charted as clean dry intact with arm board in place. No common clinician noted. Can't for the lift of me figure out why, any insight? A-lines are not sutured at our institution are A-lines sutured in your facility?
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    About kayern

    Joined: Jul '03; Posts: 244; Likes: 252
    Nurse Manager; from US
    Specialty: 21 year(s) of experience in Medical Surgical & Nursing Manaagement

    10 Comments

  3. by   cinja
    The non-suturing of the Art Line is your issue. Why do they not suture the art line?
  4. by   Snowbird17
    Our Intensivists always suture, never come out. Anesthesia never sutures, on occasion those will be pulled by patient or inadvertently with turning.

    I ditto the question of cinja, why are they not suturing?

    Just a random thought, but were the patients hypertensive? Maybe the added force contributed. But I have to think the lack of securing is the biggest factor.
  5. by   detroitdano
    If you aren't suturing it....duhhhhhh.

    Is it coming completely out of the insertion site, or is the tubing coming off? Maybe a new group of residents wimping out and not tightening it to the cannula with enough force? I've seen that more times than I care to remember
  6. by   gwapo
    Quote from detroitdano
    If you aren't suturing it....duhhhhhh.

    Is it coming completely out of the insertion site, or is the tubing coming off? Maybe a new group of residents wimping out and not tightening it to the cannula with enough force? I've seen that more times than I care to remember
    I have seen some patients come from OR with a 20g IV cath used as A line. It is not meant to stay after surgery i think. An anesthesia provider will probably not suture it because he only needs it intra op. when they get to you post op, you can pull it out, or if you want it to stay, have te surgeon or intensivist suture it.
  7. by   eCCU
    Have you tried Arterial line STAT LOCK device? We use then for all invasive lines, they don't require suturing but keep the line in place.
  8. by   kayern
    You hit the nail on the head......anesthesia does NOT suture. I thought about stat locking but if its done in the OR, will anesthesia use the device? Thanks
  9. by   Sun0408
    None of our A-lines are sutured, we also don't use stat locks. We really don't have a problem with them coming out. RT places them at the bedside and tapes them in place like we do a PIV then cover with an op-site. If they are placed in the OR by anesthesia they are still not sutured in place.
  10. by   knorrsrn
    In our hospital we run into the issue of anesthesia using IV catheters at times for a lines rather than catheter. As of them coming out it really depends on the patient and how agitated they are.
  11. by   focker14
    From an anesthesia point of view, No, most MDA/CRNA will not suture in the Aline as we only need it for the duration of the case. In addition, our patients are anesthetized so we do not have to worry about them moving around enough to dislodge it. We do tegaderm and tape the hell out it though..As a unit nurse I always wondered why they didn't suture them in, now being on the other side I see why...We do use 20g IV Caths at times however they typically are the type with a longer catheter. To my knowledge I don't know of any problem with those being placed as opposed to your common "radial" Aline Caths....
  12. by   juan de la cruz
    I've been a critical care NP since 2004 and have inserted probably over a thousand arterial lines. I've practiced in two different states with two different policies on arterial lines -- one place were we sutured them, the other where we didn't. To be honest, I don't see a difference in the incidence of arterial lines accidentally coming out...I would say however that since we cover all the ICU's in my current position, that the Neuro ICU is more notorious for this happening. Sutures only go through skin and can still rip off with any movement.

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