Tips on Drawing from Arterial Line

umcRN, BSN, RN · Mar 21, 2013

What is your a-line set up like? Is it a closed system? Wasting a "few drops" isn't going to be enough. We use a closed system that pulls off 3cc's of waste, then we take our sample and are able to return the 3cc's.

mslema · Mar 21, 2013

I forgot to mention that I'm talking about a peripheral art line where it has a port very close to the insertion site. You clamp the line, put a cannula through the port, waste 3 or so drops, and collect specimen. Other nurses do it without a problem. I notice it happens when the blood drops too slowly, perhaps, not clearing the art line fluid adequately? For UACs, I would of course draw up about 2ml or so of waste and return it after I collect my specimen.

aerorunner80, ADN, BSN, MSN, APRN · Mar 21, 2013

umcRN, do you like your closed system on your art lines? I'm assuming you are talking abou UAC's. I have experience with closed systems in adults and really liked them a lot. We have a really high rate of CLABSI's in our unit and am wondering if closed system arterial lines would help and have mentioned it several times but it has fallen on deaf ears.

umcRN, BSN, RN · Mar 21, 2013

We use the same closed system for both UAC's & periperals. I worked two years in NICU and now two years in peds CICU (still mostly infants, even the

I'm a little confused about mslema's system. You let the blood flow back then get your sample? That seems both dangerous and an infection risk to me.

This is the system we use in the CICU & PICU. It's a little different than the NICU one but same concept.

VAMP Jr. System

NicuGal, MSN, RN · Mar 22, 2013

We use a closed system on UAC's and PAL's. you should draw back 2-3 mls, draw your sample, return waste. Are you shutting the line off to your fluids? We use Biosensor.

Is your port open? It should have a syringe on anything that is open...

lemur87 · Mar 23, 2013

We use the same closed system for both UAC's & periperals. I worked two years in NICU and now two years in peds CICU (still mostly infants, even the
I'm a little confused about mslema's system. You let the blood flow back then get your sample? That seems both dangerous and an infection risk to me.
This is the system we use in the CICU & PICU. It's a little different than the NICU one but same concept.
VAMP Jr. System

I was unaware that this was an option....we use the closed system where you draw back 3cc's, draw blood sample, then return your waste via flush for UAC's, but the same system that the OP explained by letting drops fall as "waste" before collecting a specimen on our PAL's. Essentially the system consists of turning off the fluid flow to the patient, letting it bleed back, piercing the port with a needle and letting 3 drops fall, then connecting a syringe to the needle and drawing the lab sample. We have seen a ridiculous increase in CLABSI's in the past several months (due to other changes management has made recently) but I can see how having a closed system for the PAL as well would make a world of difference...just haven't seen it done and not sure how it works.

NicuGal, MSN, RN · Mar 23, 2013

There is your answer...the line is open! There really isn't any reason for this, so suggest the closed system!

umcRN, BSN, RN · Mar 24, 2013

Yes! Show them the info from the company! The system is so easy to use! I love it more than what we used in the NICU...I wish I remembered the brand of that but it was also pretty easy. Definitely look into it!

texas2007, BSN, RN · Mar 25, 2013

We use the same type of "open" system OP describes. Have you tried letting it drip a little more before you take the sample? I was always taught at least 5 drops but I usually count to 7 just to make sure all the art line fluid is gone.

imaginations · Mar 28, 2013

We run our art lines on Alaris GH syringe drivers. We take a discard from the transducer port. We bleed the line back to the transducer until we get 1-2mls frank blood in the syringe (2-3ml of hep saline should bleed back before you get frank blood) and then a sample from the port closest to the patient. We flush back down the line with the pump's purge function.

I've only ever seen art lines run on the syringe drivers or on pressure bags (usually post ops or in the adult world.)

ld42190RN · Mar 30, 2013

We use the closed system for UAC's and the same system you describe for peripherals. We clamp the line, let it bleed back, insert the needle into the port, let first the art line fluid drip out which is then followed by blood, waste 3-5 drops, then attach syringe to needle and pull off specimen, then we removed needle/syringe and unclamp the line which then allows the art line fluid to run again acting as its own flush. It sounds like you are doing it correctly- maybe try wasting a few more drops? I've never had any issues with any of my samples being diluted by following the same procedure but maybe there's just not enough being wasted before you collect?