Standard practice for arterial line pulls

Specialties Cardiac

Published

I'm trying to collect info on how many practice line pulls are considered adequate to consider someone competent to do them on their own. Our cath Recovery requires 10 but this is not possible for our new ICU staff based on pt volume and staffing I'm wondering what other hospitals are doing.

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one observed pull and you're good to go. it's not brain surgery

And if you're really trying to thoroughly assess "competence" then maybe key points could be covered in a formal or informal written test on best practice for skills specific to your clinical setting

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Specializes in Public Health, TB.

If you are talking about femoral arterial line pulls, our cardiac recovery unit requires 3 observed. I think new ICU staff even goes to cardiac recovery to get their 3 pulls done/ observed.

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Specializes in Cath Lab/ ICU.

Send staff down to the lab and they will get all their pulls in one day. We've really backed off from closure devices lately...

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Specializes in Cardiac Critical Care.

We have a 6wk orientation, I think I watched one, pulled the 2nd. Prob did about 20 on orientation, however we are not allowed to pull without another RN in the room until we hit 6months... however many that may be.

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Specializes in Cardiac Surgical ICU.

Most new ICU staff hires have at least an 8 to 12 week orientation (based on previous experience). During orientation most nurses should be able to experience removing arterial lines. On my unit (Cardiac Surgical ICU), pulling arterial lines is necessary for patients to be able to transfer to the telemetry or Cardiac Surgical Step Down Unit. In my institution there is not a competency for removing arterial lines. I believe the most important thing to remember is to hold adequate pressure for at least 5 to 10 minutes depending on the location (i.e. if the patient has a femoral arterial line pressure will be need to held for a longer period of time). This will also depend on the patient's anticoagulation status (i.e. are they on Heparin?). Pulling an arterial line is similar to removing a peripheral IV but pressure needs to be maintained due to the high pressure in the arterial system. Hope this helps!

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Specializes in Cath Lab/ ICU.

Pulling an arterial sheath is *nothing* like pulling a peripheral IV. And pressure is held longer than 5-10 mins. We hold a good 20 and then lighten up for the next 10.

Since the OP specifically mentioned that their CCL/CCL Recovery staff do most of their pulls, I inferred that this topic was in reference to sheaths, and not your typical ICU Aline.

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Since the OP specifically mentioned that their CCL/CCL Recovery staff do most of their pulls, I inferred that this topic was in reference to sheaths, and not your typical ICU Aline.

yeah thats what I mistakenly thought at first

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Specializes in Neurosciences, cardiac, critical care.

Oh phew the 10 minutes thing was scaring me. We usually hold 30 mins for a femoral stick, more if it's antegrade or the pt is obese. One MD orders manual pressure for 45 minutes.... I just hope those come at the end of the day- you try typing notes after holding pressure in someone's groin for 45 minutes!!!! :eek:

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Specializes in Cath Lab/ ICU.
Fem-stop anyone?

No thanks....nothing works better than my hands...

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Specializes in ER, progressive care.

For femoral sheaths, we are required to see one, do one and teach one, then we are considered certified. We make sure their labs are okay and vitals are okay, premedicate them with some morphine or something and then hold pressure for at least 20 minutes. We always use a Syvek dressing, too, except for one cardiologist, who prefers a butterfly dressing...but he always does things differently :)

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