Peripheral Arterial Lines

Policy says to do the drip method to avoid any chance of collapsing the artery. Many nurses do the drawback method anyways.

Our policy says to use the drip method. I've seen nurses use the draw back method, which I don't like because it requires you to clear the line with a fair amount of flush afterward.

Drip. I've tried the pull back, but it's spasmed the artery.

Do you know of any evidenced-based research on this or is this "just what we do"?

We draw back slowly.

Drip only. Can't afford to lose lines.

Okay, wow, we must be doing something totally different.

We draw back on our lines, and only use the drip method when a line is really bad, on it's last legs. I dont know how everyone else's tubing is set up - but we use a T-connector right at the hub of the IV, and we use that port right by the skin. We clamp the line, draw back 0.5ml of blood/saline (and discard) to clear the hub, and then draw our samples with 1ml syringes. Once in a while we'll have some spasms, but then we just go really slow, and let it pass. I've never had an artery just completely collapse on me.

I've seen some trying to pull the blood back from the other end of the T-connector is, like where the flush and connection to the transducer is. Then I've seen a lot of problems, and then you do need an awful lot of flush to clear the line. When we draw from the hub by the skin, it takes less than 0.5ml to clear the hub of blood after a draw.

Are we the only ones who don't routinely use the drip method? I like that everything is contained when using syringes. No mess, no chance of contamination.

We've never had a bad incident with using this type of method. If a line is so sensitive that we have to use the drip method, it's usually pulled and replaced within the day.

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We also use a t-connector with a port right at the hub.

We clamp the t-connector, stick a 25 ga needle into the hub and drip 3 drops before connecting the syringe to the needle hub. After the draw, we withdraw the needle and unclamp the t-connector - no flushing.

I have drawn 8ml from a PAL at one time using 5ml and 3ml syringes (3 Kg kid that needed fancy metabolic tests).

I've rarely had problems with spasms and never clotted one by drawing.

Nell

Why allow the blood to drip out and risk possible exposure? Why not draw back your discard?

We'd get written up if we used a sharp to draw off the line...we have to use needle-less systems on all our lines!

I've had slow lines that we leave about 1/2ml deadspace and let it pulse back for a bit then they usually draw after that...I'd be afraid that open lines would open them up to getting contaminated. No problems though with you guys?

We first use betadine to clean the hub. Then let it dry. After that, ETOH to wipe the hub off. Then clamp off your fluids...then using a 25 gauge needle, let about 4-5 drops fall onto a 2x2, then collect your gas or lab. Afterwards, un-clamp and let your fluids run back through....you can squeeze the yellow apparatus on your transducer to kind of flush a little bit extra through.

There is big debate over a lot of nurses in our unit that say "NEVER EVER flush a PAL"...but you can in fact, slowly and carefully flush if you have blood backed up into the line. You do not want to be calling your Dr to tell him you screwed up the art line and have to pull it--at least not at our facility because ours are not in-house!

~Kristina, RN, BSN~