Tips on Drawing from Arterial Line

umcRN, BSN, RN · Mar 31, 2013

I guess I don't understand why you can't use the same system for both your UAC's & peripherals?

LadyFree28, BSN, LPN, RN · Mar 31, 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.[/quote']
^This. I say, pull off the 3ccs...and make sure that the a-line is closed off from the fluids.

NicuGal, MSN, RN · Mar 31, 2013

Truly, the goal is to keep everything closed and not have anything open. When you leave the line open to bleed or let drip you are breaking the closed system which can increase your chances of contaminating the line and increasing the chances of sepsis.

acenab4jc · Apr 6, 2013

We had the closed system briefly, not sure why we don't anymore. We use a stopcock close to the insertion site (between the t-connector and art line set) for drawing off of. close stopcock off to fluids, draw waste with 3 ml syringe until > 1 ml frank blood, half cock to prevent bleeding out (always do when changing syringes unless drawing through smart site), change syringe to ABG or 3ml for gas/labs turn off to fluid again, draw needed amount (half cock between if need multiple syringes), then we return waste and flush line (either leaving flush or a smart site on port) and return stopcock to neutral (off to smart site port part). hope that wasn't too confusing.

Bortaz, MSN, RN · Apr 9, 2013

I've only seen anyone use the "three drop system" a couple of times in nearly 4 years in the NICU. My charge nurse has shown me how to do it a couple times, but I've never actually done it myself. I think it's a very old school technique that isn't standard of practice anymore.

Jory, MSN, APRN, CNM · Apr 9, 2013

I know what system you are referring to and to those that are confused, it's typically in a radial line.

I have never allowed more than three drops of blood to fall and never had any issues, but I can tell you that you need to make sure the arm is in the down position...if you are holding it up you are restricting flow and that is why you are having issues.

After your three drops, you need to have the syringe ready to connect to allow the desired amount to flow into it. If you are letting too much of it hit air, that is also, why you are having issues.

mslema · Apr 10, 2013

Yes, I've tried wasting more than 3 drops with no change.

Jory- yes, we use this system with our radial art lines and I do keep the arm down to increase flow. I think I have my syringe ready fairly quickly, but maybe the air is affecting results.

NicuGal, MSN, RN · Apr 11, 2013

I still don't understand why places aren't using the closed system on radial lines? Our ID department would have a stroke if we opened a line lol

Jory, MSN, APRN, CNM · Apr 12, 2013

I still don't understand why places aren't using the closed system on radial lines? Our ID department would have a stroke if we opened a line lol

It's still a closed system and is very common in NICU's. It's a port and you use a needleless cannula to access. We have a slightly different system for UA's.

mslema...what size syringe are you using for draws? That makes a huge difference. I used to take the 1 ml syringe pulled out of blood gas kit, but if I used anything larger, it wouldn't flow. I got the two collection tubes that we used the most one day and measured how much each one held with water...I discovered that for a green top (NP) I would need a 0.6 ml and for purple (CBC) I would need 0.4 ml. I would calculate how much blood I needed to draw and then lay out more than one 1 ml syringe if I needed it.

Then I would have a needle (yes, the real thing) ready and when I was finished with my draw, I would put the needle on my 1 ml and then inject it into the tube SLOWLY, when I was nearing the line I would PULL BACK just a hair (because if you just stop injecting and pull it out, it will squirt).

The other key is you have to be ready...have everything layed out and tops off your tubes so you can collect quickly.

ALWAYS flush when you are done before you do anything else...be sure to PULSE the flush and NEVER draw back on a radial ART line...it should flow easily if the line is still good.

umcRN, BSN, RN · Apr 12, 2013

ALWAYS flush when you are done before you do anything else...be sure to PULSE the flush and NEVER draw back on a radial ART line...it should flow easily if the line is still good.

The closed system we use we still always pull back on the radial art line, we have to to get the 3cc waste.

I guess I just don't understand this system! I'd have to see it

NicuGal, MSN, RN · Apr 12, 2013

I guess I'd have to see it too. But we always draw back on our lines without a problem. Our system is Biosensor and is a two syringe system so we aren't taking off and replacing syringes for waste, sample and flush.

Jory, MSN, APRN, CNM · Apr 13, 2013

The closed system, you can pull back...because the system is designed that way. You have to pulse the draw and pulse the flush. It's not really a waste, because you are putting it back.

The radial line she is describing, your access is directly into the port...if you pull back on this system, it will risk collapsing the line, thus, your baby losing it's fingers.