Setting up arterial lines

merlee · Jul 3, 2011

Check the procedure manual. It's been MANY years since I was around those, but we left air in the chamber to see the dripping, too.

I think it would be very difficult to get an embolus from air in the chamber unless the bag was upside down AND the pressure was still on for more than a few moments.

Best wishes!

allnurses Guide · Jul 3, 2011

Excerpt from attached article:

"Air-free priming starts with removal of all air from the flush solution to prevent air from going into the solution as a result of the pressure applied by the external pressure cuff. Then, the entire tubing system should be flushed. Stopcocks, Luer-Lok interconnections, and the transducer are common locations of air entrapment27 and deserve special attention throughout priming and use of the catheter system."

monitoring ABP.pdf

GilaRRT · Jul 3, 2011

You should remove the air and you are correct about the waveform and assessing the fast flush. In addition, air emboli are more of a concern with art lines and critical patients.

MunoRN, RN · Jul 4, 2011

We "double spike" the bag and squeeze out the air, but we don't completely fill the drip chamber and you don't need to. In order for the air in the drip chamber to reach the patient when the bag empties, it would have to have enough air behind it to make it through the tubing and reach the patient, which is about 15-20cc if you have a VAMP inline as well. If there's no extra air in the bag, then you don't have enough air to push drip chamber air to the patient.

Pressure tubing is made specifically for that purpose, so if having air in the drip chamber was an absolute no-no then they wouldn't even make it with a drip chamber. You do need to follow a couple of rules: The drip chamber should be at least half full, and you do need to make sure it can't become inverted. If you never look at the drip chamber then it doesn't really hurt to fill it all the way up with NS, but along with waveform and fast flush rebound waveform, I find the flow through the drip chamber when flushing to be a useful way of troubleshooting an art line.

mwboswell · Jul 4, 2011

Am I wrong about this? It concerns me because in one trauma I was working, the arterial line chamber actually emptied somehow, which put the pt at big risk for an embolus if someone flushed the line.
I'm new here and don't want to make waves, but I think a policy change might be needed. What do you guys think?

JennyAS...

Regardless of right or wrong ways to do this, FIRST go check your nursing policy manual at the hospital.

You need to make sure you follow the policy on how to do this because if you deviate from the policy you're essentially making your self open to liability should a problem occur as a result of not following policy.

If you find the policy is written wrong and is not consistent with contemporary nursing practice, I would find some citations/references (nursing texts, peer-reviewed nursing manuals etc) and present those to your department manager to see about maybe a need to re-write the policy.

But first and foremost, protect your license and make sure you actually read the policy at your facility so at least you have some protection. I've seen it time and time again, over my 15 years, a surprising number of nurses have never even looked up their hospital policies on even routine nursing procedures - not all hospitals do them the same!

Would be very intersted to hear back on this bulletin board what you find out!

Good luck.

JennyAS, BSN, RN · Jul 4, 2011

There is no hospital policy written to detail the exact step-by-step process they want us to use to prime an arterial line. I just wanted to get a poll as to how nurses around the board tend to prime their art lines.

APRN., DNP, RN, APRN, NP · Jul 4, 2011

Get the air out of everything. Anything and everything in that bag has the potential to mainline into the patient.

Let's say you are changing the sheets, or transferring the patient to a different mattress, or emergently moving the patient to surgery or what-have-you. What happens to ANY air in the bag if the bag gets taken down off of the pole and laid down on it's side on the mattress beside the patient?? (Any takers?)

Add a tug or two on the pig-tail and say hello to an air embolus if there's air in the drip chamber, or in the bag.

Esme12, ASN, BSN, RN · Jul 4, 2011

I have moved from one part of the country to another. There are HUGE variances as to procedures on how to do things properly.....what is correct at one facility is forbidden at another and in true nurse form the nurse who doesn't do it "Our way" is somehow lacking, uneducated, or inexperienced. So just becasue it is different doesn't mean it isn't safe. :rolleyes:

I have done it both ways depending on department and facility preference. In CTPACU or cath lab we always removed ALL the air to prevent possible "air embolisim". In neuro ICU or MICU not so much. In Pedi all air was meticulously removed from everything including IV lines.

You need to check with your educator to see what the policy is......the staff my not know where it is but if Joint Commision comes through trust me they have a policy. When I moved from the midwest to the east coast there were MANY MANY things that were different here than back home........but were equally effective and safe.

Something as simple as a patient gown got me one of my biggest reprimands. :bugeyes:

I was in the trauma room with some other nurses being shown post mortem care (we didn't do post mortem care where I came from....they stayed in the room after they were bathed,with a sheet over the head until the funeral home or coroner came we assured there were ID bands on the patient and belongings but no tying no toe tags). One of the nurses told me to get a Johnnie. I asked "A Johnnie?" and the nurse replied "A Johnnie....you do know what a Johnnie is don't you?:cool:" I mean you did come with experience didn't you????":uhoh3: I thought "Ok...a Johnnie" where I come from the male member is a Johnson and the bathroom is a John........so......even though I thought it was crazy I brought in A BEDSIDE COMMODE! :eek: What they could possibly want a bedside commode for a dead person was beyond me but I'm a team player sooooooooo........ :smokin: Needless to say it wasn't well recieved and even got me pulled in the office to question my abilities......true story:cool:. One I never quite lived down either:o.

Moral of the story being there are many way to do something that are safe and correct right down as to how to dress the A-line or secure the PA line that are unique to each facility. Be careful of sacrificing all the sacred cows in your first few weeks of employment. YOU may not be familiar with how they do it but it doesn't make it unsafe....go straight to the educator or manager and ask them for the policies.....they're there......good luck.:)

mwboswell · Jul 5, 2011

I have moved from one part of the country to another. There are HUGE variances as to procedures on how to do things properly.....what is correct at one facility is forbidden at another and in true nurse form the nurse who doesn't do it "Our way" is somehow lacking, uneducated, or inexperienced. So just becasue it is different doesn't mean it isn't safe.
I have done it both ways depending on department and facility preference. In CTPACU or cath lab we always removed ALL the air to prevent possible "air embolisim". In neuro ICU or MICU not so much. In Pedi all air was meticulously removed from everything including IV lines.
You need to check with your educator to see what the policy is......the staff my not know where it is but if Joint Commision comes through trust me they have a policy. When I moved from the midwest to the east coast there were MANY MANY things that were different here than back home........but were equally effective and safe.
Something as simple as a patient gown got me one of my biggest reprimands.
I was in the trauma room with some other nurses being shown post mortem care (we didn't do post mortem care where I came from....they stayed in the room after they were bathed,with a sheet over the head until the funeral home or coroner came we assured there were ID bands on the patient and belongings but no tying no toe tags). One of the nurses told me to get a Johnnie. I asked "A Johnnie?" and the nurse replied "A Johnnie....you do know what a Johnnie is don't you?:cool:" I mean you did come with experience didn't you????":uhoh3: I thought "Ok...a Johnnie" where I come from the male member is a Johnson and the bathroom is a John........so......even though I thought it was crazy I brought in A BEDSIDE COMMODE! What they could possibly want a bedside commode for a dead person was beyond me but I'm a team player sooooooooo........ Needless to say it wasn't well recieved and even got me pulled in the office to question my abilities......true story:cool:. One I never quite lived down either:o.
Moral of the story being there are many way to do something that are safe and correct right down as to how to dress the A-line or secure the PA line that are unique to each facility. Be careful of sacrificing all the sacred cows in your first few weeks of employment. YOU may not be familiar with how they do it but it doesn't make it unsafe....go straight to the educator or manager and ask them for the policies.....they're there......good luck.:)

A "Johnnie"...OMG I hadn't heard that since I did a travel job in an ICU back in 2000 in Rhode Island!!!!

Thanks for the memories!