Saline infusion vs. pressure bag for Arterial Sheath Patency

[tonyrn21]

Colleagues,

Our Interventional Radiology department is bringing us patients post arteriogram with an arterial sheath in place. I'm concerned because they are using infusion pumps with normal saline going into the side port to maintain patency. My experience with side ports is that we hook them to a pressure bag with either NS or Heparinized saline so that we can maintain patency, monitor their blood pressures and get an immediate alarm in the event of a dislodgement or other complications.

I have never heard of using an infusion pump with NS to maintain introducer patency nor was I able to find any supporting evidence that endorses this practice.

Is this common practice in Interventional Radiology? If so, where can I find supporting evidence or education info?

Any feedback would be greatly appreciated. Thanks and Happy New Year!

[ED Nurse, RN]

I would personally ask the IR physician- I mean I typically ask the docs as a teaching moment for myself when I don't know the rationale behind something.

[MunoRN, RN]

I would personally ask the IR physician- I mean I typically ask the docs as a teaching moment for myself when I don't know the rationale behind something.

Every IR doc I know if would tell you to ask a nurse. IR docs don't generally or really ever deal with transduced lines, only an anesthesiologist, an intensivist, or an interventional cardiologist would understand the issue well enough to discuss it, this is primarily a nursing related question.

[MunoRN, RN]

In general, all arterial access should be continuously transduced primarily for safety reasons; to have an alarm for if the line should become dislodged, disconnected, etc. When hooking up a NS infusion to line, you would need to close off the 3-way to the transducer or split the connection between the two which would take away the ability of the monitor to alarm properly. In theory, a pump would be more effective at maintaining patency due to it's pulsatile flow, but the transducer still continuously flushes the line, with the added advantage of having some warning that the patient might be bleeding out.

[OhioCCRN, MSN, NP]

I would be uncomfortable with an arterial line not connected to a transducer. As Muno notes, it also warns us when the line is disconnected ( holy mother of bleeders)

[nrsang97, BSN, RN]

Transducer with pressure bag.

[VANurse2010]

Any arterial line need to be transducer with a pressurized fluid. It is a major safety hazard not to do so. You should file incident reports for any arterial line that isn't transduced.

[Horseshoe, BSN, RN]

I treated patients post cath lab with arterial sheaths for a decade. We ALWAYS used a pressurized set up connected to the transducer as already noted. As it has been several years since I cared for a patient of this kind, I would be very interested to see if things have changed, or to hear the rationale for the setup you have described.

[tonyrn21]

My thoughts exactly. This is something our IVR department is doing and there is no evidence I was able to find that supports this practice.

[mighty-mouse]

Is there a chance that maybe it's a venous sheath? At times ours come out with an art line as well as a venous sheath. If it's venous it would be appropriate to hook up to NS via pump usually kvo

[tonyrn21]

No. Its arterial. That's the issue. Our IVR Team is using this practice without supporting evidence.

[ProgressiveActivist, BSN, RN]

If the sheath is not going to be pulled, write the occurrence report as a deviation from policy and standards of care.

Cite hospital policy.

Recommend education for all IR staff.

Recommend that IR stocks pressure bags and transducer tubing.