What are the standards for your unit? most places I have worked if you had pressors running you had an art line for continuous monitoring. Where I work now they run pressors with q5-10 minuted cuff bp's. It drives me nuts watching the continuous stimulation these critical babies are getting from this type of monitoring.
All input appreciated.
May 17, '07
We like to have an arterial line, but sometimes we can't get one on the kid, so we use cuff pressures. Sometimes you have to make due with what you have.
May 17, '07
Q10-15min cuff pressures?? Are you kidding me!! What about a kid w/PPHN? The less stimulation the better, I am sure they are sedated, and in that case I would definately want an a-line for continuous pressure monitoring, not to mention the fact that you are doing frequent blood gases AND the PO2 reading is critical! We do cuff pressures Q 2 hours to check correlation of the A-line reading. They can't get a UAC or peripheral arterial line in?
May 17, '07
Sometimes they can't get an A line in. If you're in a teaching hospital and your resident has blown every possible route leaving little for the fellow or attending, then cuff BPs are your only option. And yes, it is a PITA.
May 17, '07
We have art lines as much as possible. With regards to the using up routes, we have a 2strikes policy. If the more juniors don't get it after 2goes it moves up in seniority. Usually in the really sick ones they just start with the consultant/senior registrar doing the femoral (if UAC/radial has been tried previously).
May 22, '07
Thanks everyone. I too, am used to having A lines with sick kids. This was new to me. This place will have a < 30 weeker on vent with pressors and not attempt a UAC or peripheral A line. It's very frustrating seeing the hamburger heels after working in a unit where we did very few heel sticks.
May 22, '07
I've never taken care of a kid on pressors with no A line. I guess it could happen though as sometimes it takes a while to get an A line in, but usually one of our neos can get it. But I agree that would stink with having to get continuous cuff pressures.
May 23, '07
I've had to do serial pressures on a kid who kept clotting off his A-lines (can we say black fingers and toes all around? this is after clotting his UAC as well) It's a pain, but it's what you have to do sometimes. Definitely not routine practice here... I've maybe had to do it 2-3 times in 2 years...
May 23, '07
I think it is unacceptable to not even try....
Those poor heels
May 17, '07We like to have an arterial line, but sometimes we can't get one on the kid, so we use cuff pressures. Sometimes you have to make due with what you have.
May 17, '07We have art lines as much as possible. With regards to the using up routes, we have a 2strikes policy. If the more juniors don't get it after 2goes it moves up in seniority. Usually in the really sick ones they just start with the consultant/senior registrar doing the femoral (if UAC/radial has been tried previously).
May 22, '07I've never taken care of a kid on pressors with no A line. I guess it could happen though as sometimes it takes a while to get an A line in, but usually one of our neos can get it. But I agree that would stink with having to get continuous cuff pressures.
May 23, '07I've had to do serial pressures on a kid who kept clotting off his A-lines (can we say black fingers and toes all around? this is after clotting his UAC as well) It's a pain, but it's what you have to do sometimes. Definitely not routine practice here... I've maybe had to do it 2-3 times in 2 years...
