30 years and this was the first time it happened, what about you?

[DutchgirlRN, ASN, RN]

The other day I started an IV in the AC of a woman who had absolutely nothing to stick. I went at the usual angle, nothing deep, when I went to hook the J loop on blood started pumping out. I though, hum artery? I hooked up the IV to see what would happen (did not turn on the pump) and yep there was the blood pulsating up the tubing. I pulled the IV. Several others tried to get an IV on her and she ended up with a PICC. This was the first time I've ever hit an artery! It was clear to me that it was an artery but the nurse who had the patient didn't want me to pull it and that is why I continued to hook it up to the IV tubing to show her it wouldn't run.Just curious does this happen often in the AC? What happens if the nurse doesn't realize and does run an IV through an artery? I do know that once we had a patient from the LTC facility across the street come in for an amputation of her right arm because her PICC line was in an artery. YIKES.

[dianah, ASN]

I've done it once. I do prefer ANY other veins rather than the AC, for many reasons: patient comfort, the AC is the one I tend to miss more than the others (really!) -- IF I'm going to miss, that is -- the flow is unreliable if the pt bends the arm (and who DOESN'T bend the AC???) . . .

That said, I do realize the OP said the pt had NO other veins. I have started many IVs in thumb (there is usually one or two juicy ones there ) -- WITH local anesthesia only, that is -- or on a knuckle, or on the underside of the wrist, for lack of other places. Not my first choices, I must say. Just had to start one, and did it there. Sometimes there is a BIG, ROLLING one on the underside of the forearm (not on the inside, AC area).

Glad the woman got the PICC line in her (I love PICC lines for the pts!!), and kudos to you for recognizing you were in the artery. I don't think it would have hurt the pt necessarily to run fluids thru it (the artery) -- we run them in sometimes in the cath lab, when we need a large bolus of fluid fast, and are running it in every other line as well. The A-lines do have a heparinized flush dripping in them at all times, as well.

The woman who had to have the amputation d/t the presence of the PICC probably had a clot form around the PICC, which clotted the artery the PICC was in, which probably irreversibly damaged the circulation to the arm. Just guessing here . . . It may have become infected . . . maybe was too far gone for tPA or urokinase etc. Very sad.

[DutchgirlRN, ASN, RN]

I've done it once. I do prefer ANY other veins rather than the AC, for many reasons: patient comfort, the AC is the one I tend to miss more than the others (really!) -- IF I'm going to miss, that is -- the flow is unreliable if the pt bends the arm (and who DOESN'T bend the AC???) . . That said, I do realize the OP said the pt had NO other veins.

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Yes, I agree. This patient was a new admit for severe nausea and vomitting and the doctor was wanting the phenergan in like yesterday. I ended up giving it IM. Same end effect just took a little longer. Besides I've read that Phenergan IV is really not desirable. Especially in a dose over 12.5 mg.

The woman who had to have the amputation d/t the presence of the PICC probably had a clot form around the PICC, which clotted the artery the PICC was in, which probably irreversibly damaged the circulation to the arm. Just guessing here . . . It may have become infected . . . maybe was too far gone for tPA or urokinase etc. Very sad.

Yes the circulation was irreversibly damaged, and yes very sad. Would placement in the artery not have shown on the x-ray taken for placement post PICC insertion? I think whoever read that x-ray would have been at fault?

[dianah, ASN]

Not necessarily, the PICC would have followed the same path whether it was arterial or venous; the f/u x-ray is usually mainly to confirm the tip's position, not the whole tube's pathway.

I don't place PICCs myself, so can't say how one can prevent placing one in an artery. . . if ultrasound was used, I would think that would help prevent arterial placement (the arteries and the veins behave/show up differently w/US). The VERY small needles used to access the vein (I'm used to the IR using a Micropuncture set, which uses a 21g long needle for initial access) may not have shown a distinctly "arterial" flow or color if the pt had a low BP and possibly was anemic???? Just pulling things off the top of my head. I would think, though, that the pulsating flow and bright red color would tip one off. But, again, I must say the disclaimer, that I don't place PICCs myself so really can't make a judgment call.

Ah yes, and dear Phenergan IV, do NOT want to give that in a small thumb vein, no in-deedy!! Tough situation. :)

[TiffyRN, BSN, PhD]

I've done it twice, the first time I knew immediately. I was trying to hit a large juicy vein that was right over the radial artery, I knew the artery was under there but there was a large juicy vein (all this lady had) running over the top of it. I obviously went too deep; the gushing of bright red blood when I removed the stylet was the dead give away. I took it out immediately, held pressure and started hunting another vein.

The second time was another poor veinless individual that was another nurse's patient. I started the "IV" on the top of his hand, if you can imagine right in that triangle between the thumb and forefinger about halfway up to the wrist. Not a real likely area for an artery. He was a very compromised older gentleman and this was only like a 22 gauge catheter. We needed the site for an AM antibiotic (some penicillin or cephalosporin as I recall) that we were then going to hang by gravity with roller clamp to run over about 20-30 minutes. I felt some obligation to this "IV" so I checked back on it to make sure the antibiotic had run in and flush it so it wouldn't clot off. Oh, and nothing funny when I was starting it, no gushing of bright red blood, no difficulty flushing, patient didn't complain of anything but he was pretty out of it. So when I checked it I noticed it was dripping pretty slowing so in checking the roller clamp I noticed it was almost all the way open. Also I noticed a really odd thing, the drip chamber was kind of bouncing. This led me to further assess the site and soon I realized one thing that might lead a line to bounce like that and not infuse very quickly is if there was back pressure, like if it was in an artery. I did a quick pulse check at the IV site and low and behold. Yea, that catheter came out really quickly (antibiotic was pretty well done anyway at that point), it did bleed nicely at that time, so held pressure. I told the patient's nurse what I had discovered and charted. Probably should have made out some kind of incident report but I didn't, patient suffered no ill effects.

Now I work with neonates it is not uncommon to be able to cannulate a tiny artery when starting a scalp IV so we carefully check refill and for a pulse before starting a scalp IV.

[Spidey's mom, ADN, BSN, RN]

I haven't done it but noticed recently on a woman who was a very bad IV candidate and had already lost two IV sites, a couple of places that she had obvious pulsating blood vessels in her AC. She was also dehydrated.

I ended up starting an IV in her lower leg - her foot was a great site too. The lab couldn't get blood so I did a blood draw from her foot.

Sometimes ya gotta look elsewhere -

steph

[Aneroo, LPN]

I have done it once. Actually got a debate started about it on here too. :imbar

I chalk mine up to inexperience and feeling rushed. I didn't look as carefully as I should have. The one I struck felt like a vein though- I just didn't inspect it close enough.

Now I'm paranoid about doing it again. This happened while in nursing school, doing an outside rotation in the dept I currently work in. Co-workers actually remember me from that moment (what a thing to be remembered for). I remember the first time I did and IV after that moment, I was still having problems with the whole hand coordination stuff, and didn't hold as much pressure as I should have when I removed the cath, and made a bloody mess, thinking "OMG, I've done it again".

However, my ABG skills are rockin'!

[SmilingBluEyes]

VERY unfortunately, a few years back, I did this to an OB patient. It was in her wrist (she has like NO veins anywhere else)---- and yep, hit an artery. It was immediately obvious when despite, running fluids, the blood was rushing UP the tubing. UGH. Fortunately, she was not harmed, and all was ok after holding direct pressure on the site for 15 min or so. BUT yep, I had to write myself up for that one.

[humglum, BSN, RN]

Wow. I've never done that and it sounds skeery.

[LoriAlabamaRN]

I had a stomach flu once and went to the ER of the hospital I work at for fluids, a friend of mine who is a CRNA tried to start a line on me. I have HORRIBLE veins. She finally got one in my AC, and it was an artery. She pulled it out but dropped the sterile pad and for a terrifying few seconds blood was pulsing from my arm and hitting the curtain in front of me. It scared me to death. Now I warn anyone who is trying to stick my right AC, the artery is very shallow!

Lori

[meownsmile, BSN, RN]

I avoid AC starts and thats why. It doesnt run well with bending, the pump beeping will make ya crazy, to close to arteries, and just a all around PIA. The one on the underside of the forearm,, our anesthetist calls "anesthesiologists delight" because thats where they go if there arent any available.

There is also sometimes a nice one in the upper arm along the bicep in pinch, i like that one when we have someone that is confused and is pulling out iv's. Out of sight out of mind.

[RazorbackRN, BSN, RN]

Just curious, how can you tell whether or not it is an artery as opposed to a vein before sticking?