Starting an art line while a patient is still awake...

[princessinpink]

I'm new to the OR and recently observed an AVR. I wasn't sure if the patient had severe aortic insufficiency or severe aortic stenosis, but the anesthesiologist wanted the art line to be started while the patient is still awake. From other CV surgeries that I've seen, they usually wait til the patient is asleep before starting the art line. What is the reasoning behind starting the art line while the patient (with AI or AS) is still awake?

Thanks!!

[Esme12, ASN, BSN, RN]

so they can monitor the B/P. When I worked in the OR I started a-lines on patients all the time in the holding room with their other large bore IV's...it's not a big deal.

[Sun0408, ASN, RN]

I agree, we with RRT start A-lines all the time on the ICU on awake pts. Same with PICC's, TLC's and other's. No need for them to be asleep.

[Rose_Queen, BSN, MSN, RN]

We only have one anesthesiologist who will induce without an arterial line. We also have one who will insert ALL lines while the patient is awake. The rest will do the a-line while awake, induce, then swan & central line. Lets the MDA watch the pressure closely- propofol and other anesthesia drugs can wreak havoc on a pressure, and a cuff only goes up so often. Also an MDA preference issue.

[princessinpink]

Thanks for the responses! I thought the anesthesiologist wanting the art line started while the patient is awake has something to do with the patient having AI or AS. I've worked withe the same anesthesiologist before (on a CABG) and he waited until the patient was induced before starting the art line.

[heartlover]

It does have to do with AS or AI. Especially AS when it is severe. AS makes it harder for the blood to leave the heart to the body. So the body usually increases BP to help get past that aortic stenosis. During induction the medications given (especially propofol) can drop the BP significantly and therefore drop preload and cardiac output making the heart basically collapse on itself from lack of blood and blood pressure. So the a-line is placed ahead of time to more closely monitor BP prior to and during induction. And like sweet wild rose said, sometimes the central line and swan will even be placed awake to make anesthesia feel more comfortable in having that access in critical aortic pts.

[princessinpink]

Thanks for explaining that to me! It makes perfect sense!