Art Sticks

  1. Hey ya'll,

    I've been a NICU RN for a little over a year now. The one skill that I continue to have problems with is arterial sticks. I'm only running about 50/50 on those. Any advice for me out there?

    Thanks!
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    About Shenandoah

    Joined: Apr '03; Posts: 34; Likes: 2

    16 Comments

  3. by   lovemyjob
    1. dont give up too easily.
    2. feel, feel, and feel!! and then feel again!!! stick the needle in at a 45% angle below where you feel the pulse and aim for that. Be gentle b/c the more you poke around the more you cause the area to swell and then the less you are able to feel. I feel before I get my needle ready, feel some more after I have the needle in my hand, always keeping my eye on the spot I feel the pulse, then I stick, if I dont hit it fairly quickly, I feel again to reorient myself to where the pulse is.

    Also, go slowly, sometimes you can hit it, but not realize it because you are going too fast to catch the flash. Oh, also, whoever is p;ulling the syringe for you, make sure they pull slowly.... have several times had someone pull back too fast and collapse the vessle... or whatever it actually is that happens!

    Good luck!!

    Oh, and you cant get them all!! Sometimes we just dont have the touch at that particular moment!
  4. by   Gompers
    I have better luck with radial sticks, and I find that the artery almost always lines up perfectly with the index finger. Just draw a mental line down and you should be pretty close. I also change my angle of insertion - sometimes you'd think a kid would be shallow, other times deep, and find that it's completely opposite from what you thought! Go slow, definitely, that helps. We have someone hold the end of the butterfly up and they don't put the syringe on and pull back until we not only have bloodflow, but the tubing is starting to fill - that way we know we've got a good placement before we start putting pressure on the artery.

    Keep practicing - it takes awhile to do this! Many nurses are surprised that we even GET to do this - usually only docs are allowed to perform art sticks on adults. And here we're doing it on 500 gram babies!!!

    Have to say, though, it's one of my favorite challenges as a NICU nurse. LOVE to do art sticks!

    Now, IVs, that's another story...I can't thread a vein to save my life sometimes!
  5. by   Shenandoah
    Thanks, ya'll. Gompers, that's a great idea lining it up with the index finger. I'll definitely have to give that a try. I just don't do them often enough - I feel that every time is my first!

    Thanks again!
  6. by   Gompers
    Oh yeah, another thing we do...

    You know the plastic thing that covers the needle on the butterfly to protect it in the package? When you find the pulse, take that plastic sheath and press the end of it gently onto the spot you've got your eye on. It will leave a shallow, temporary impression in the skin that basically serves as a "bullseye" when you go to do your stick a few seconds later. We use betadine swabs for our sticks, and it pools in the indentation so then it's really easy to see!
  7. by   Love_2_Learn
    I once had a neonatologist teach us some tips on radial art sticks which I have found helpful. Along with feeling for the pulse, he taught us to look at the baby's inner wrist and notice they nearly always have two rather deep creases there. It's helpful to insert the needle into or just above the second crease. He also said that when remembering our anatomy & physiology books we can see that the artery is very close to the radial bone (another way of nature protecting us from bleeding to death...the bone helps protect the artery from injury) so we can expect the artery to be closer to the radial bone than it would be in the other direction. When you get blood to start flowing back hold your hand very steady but if the blood stops flowing as well you can gently raise the needle slightly in a more perpendicular way (like 50 degree angle) or pull back ever so gently to get the blood flowing better (since we more often find the needle goes in deeper or at a less than 45 degree angle while we are waiting for the specimen to be collected). He said to always use a new needle each attempt after applying betadine and letting it dry first and to hold pressure for a full five minutes after the needle is removed to avoid hematoma formation and the pain and injury associated with it. I sure do miss working with him!! I love a good neo who loves to teach!!

    I also love the tip about using the needle cover tip to mark your spot. I've seen people use their thumbnail for that purpose.... And like the other poster said, sometimes you would think a baby's artery would be deep when actually it's nearly at the surface.
  8. by   RainDreamer
    At the hospital I work at, RNs don't do art sticks. The only people that can do art sticks are the NNPs, neos, PAs, or the residents. I think some of our swat nurses, that are PICC certified, can also do art sticks .... but the majority of our RNs can't.

    Are we the only ones that can't do them??
  9. by   Love_2_Learn
    I forgot to add that if you hyperextend the baby's wrist it will often make the pulse more difficult to feel. It's very helpful to allow the baby to grasp the finger of your non-dominant hand and to hold the hand on the bed so that the wrist is kept in an even line with the wrist; this helps with feeling the pulse better and allows the baby a chance to grasp something which may help soothe them a little during the procedure. We try to swaddle, offer sucrose 2 minutes before the procedure if the baby is a candidate, keep lights low, etc. to help ease the pain associated with the needle stick.
  10. by   palesarah
    Quote from RainDreamer
    At the hospital I work at, RNs don't do art sticks. The only people that can do art sticks are the NNPs, neos, PAs, or the residents. I think some of our swat nurses, that are PICC certified, can also do art sticks .... but the majority of our RNs can't.

    Are we the only ones that can't do them??
    Nope, we don't do them either. None of our RNs do PICCs either.

    I'd like to learn both. Actually, I'll be happy when I can just go back to work- I've been on medical LOA for nearly 2 months now and am finally feeling well enough to be bored!
  11. by   Gompers
    Quote from RainDreamer
    At the hospital I work at, RNs don't do art sticks. The only people that can do art sticks are the NNPs, neos, PAs, or the residents. I think some of our swat nurses, that are PICC certified, can also do art sticks .... but the majority of our RNs can't.

    Are we the only ones that can't do them??

    I wish our RNs could do PICCs/PCVCs. About a dozen of our "best sticks" did take a class a few years ago, but it was for a very specific brand of catheters and about a week after the class, our unit decided to switch brands! Right now, only our NNPs and some of our fellows do them. Some of the fellows knew how from their residency, others have been taught by our own NNPs. I don't think it's a requirement for their fellowship, but my gosh it should be! If you're going to be a neonatalogist, you should know how to put a central line into a baby! Teaching hospitals can be so weird!

    Quote from Love_2_Learn
    It's very helpful to allow the baby to grasp the finger of your non-dominant hand and to hold the hand on the bed so that the wrist is kept in an even line with the wrist; this helps with feeling the pulse better and allows the baby a chance to grasp something which may help soothe them a little during the procedure. We try to swaddle, offer sucrose 2 minutes before the procedure if the baby is a candidate, keep lights low, etc. to help ease the pain associated with the needle stick.
    Great tips! We've found that art sticks have become a lot easier since we started using sucrose a few years ago...

    Quote from palesarah
    I'd like to learn both. Actually, I'll be happy when I can just go back to work- I've been on medical LOA for nearly 2 months now and am finally feeling well enough to be bored!
    Glad to hear you're feeling better and hope you can go back to work soon!
  12. by   lovemyjob
    The hospital I worked at PRN in another state did not allow us top do them. However RT's could, wich didnt make sense to me. It is so much easier and you dont use up nthe veins that could be used for PIVs or PICCs. When you have to to get something like chromosomes or a PTT it is nearly impossible to get 3+ ml of blood, especially if the kid is siock and the veins all blow. We have a andful of nurses who do PICCs. They are great at it. The neos or fellows dont do it. Our NNP's also do it.

    I really dont understand why nurses are unable to in certain states. It is relatively harmless, as long as you follow the protocol and hold pressure. We do not use any art except radial and pedal and post tibial. Md's or more expericed nurses can do others, b ut generally we dont. The risks are jsut too big.
  13. by   SteveNNP
    Where I work now only MD's, RT's and out transport team nurses do art sticks/Piccs/umbilical lines. I'm waiting until I start NNP school this fall to learn how to do these and more. I started one PICC with one of our transport nurses. It was challenging, but I'd like some more education before I do another...


    Stephen
  14. by   Gompers
    I've also worked in a NICU where only the docs and RT's could do art sticks. The thing with RT's is that most of them learn it in school and do it in adults -they're the ones often responsible for obtaining arterial blood gasses. Sometimes this carries over into the NICU, other times it remains a nursing or doctor responsiblity.

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