Arterial Line Management & Nursing Care | NCLEX Review 2019

Arterial Line Management & Nursing Care | NCLEX Review 2019

Welcome to this video tutorial on the nursing
care of arterial lines. What is an arterial line Also known as an
art-line or a-line, an arterial line is a thin catheter that is inserted into an artery. It is most commonly used to monitor blood
pressure directly and accurately, as with close and accurate titration of blood pressure
medications. It is also used to obtain samples for arterial
blood gas analysis (ABG’s), and is convenient when frequent blood samples are needed, so
the patient does not have to be stuck multiple times. Common insertion sites include radial, brachial,
and femoral arteries. The radial artery is the most common site
and its advantages include easy access, accurate readings, easy bleeding control, collateral
circulation, and fairly easy mobility for the patient. The disadvantages of the radial artery are
the small diameter, making it difficult to insert, and possible nerve damage or thrombosis. The advantages of the brachial artery are
the large diameter, making it easier to insert, and fairly easy bleeding control. The disadvantages include immobilization of
the limb, thrombosis, and limited collateral circulation. The advantages of the femoral artery include
large diameter, making it easy to insert, even when the patient has low volumes. The disadvantages include difficulty visualizing,
hard to control bleeding, immobilization of the limb, and prone to infection, due to the
location. The dorsalis pedis is a riskier site that
is not used very often. Before inserting an arterial line in the radial
artery, the modified Allen’s test is done to determine collateral circulation of the
radial and ulnar artery. Have the patient elevate their hand and clench
their fist for about 30 seconds. Apply pressure to the radial and ulnar arteries
in the wrist to stop the blood flow to the hand. Still elevated, the hand is opened and should
appear blanched. Release ulnar pressure while maintaining radial
pressure to check if there is adequate blood flow back to the hand. If the hand quickly becomes warm and returns
to its normal color, this is a positive Allen’s test, meaning that one artery alone will be
enough to supply blood to the hand and fingers, therefore the radial artery can be used for
the arterial line. If the hand remains pale and cold, it is a
negative test, and an arterial line should not be placed in this location. When monitoring a patient with an arterial
line, the monitor will show waveforms in red. The systolic phase is when the heart contracts,
the dicrotic notch reflects the closure of the aortic valve, and the diastolic phase
is the pressure going down in diastole. Waveforms can be overdamped or underdamped. The overdamped waveform may be caused by compliant
tubing, loose connections, a blood clot at the cannula tip, or a cannula that is kinked
or up against an arterial wall. The underdamped waveform can be caused by
long stiff tubing, too many stopcocks, or a defective transducer. Along with understanding waveforms on the
monitor, the nurse is responsible for zeroing (calibrating) the arterial line. Zeroing the system tells the transducer to
“ignore” the pressure from the atmosphere. First, ensure the transducer pressure tubing
and flush solution are assembled correctly and free of air bubbles. Place the transducer at the level of the right
atrium (called the phlebostatic axis). Turn the stopcock off to the patient, remove
the cap this opens to air (atmosphere). Press ‘zero’ to set the atmospheric pressure
to a zero reference point. Replace the cap and turn the stopcock back
to neutral (off to the atmosphere). Remember, whenever the patient position is
altered, the transducer height should be altered to keep it at the level of the right atrium. Zeroing the line should be done at each shift
change, every 4 hours, after each time blood is taken from the ART-line system, and as
needed. To continue your assessment, check for blood
pressure accuracy. Do this by comparing the arterial line pressure
reading with the NIBP reading to be sure they fall under similar parameters. Discrepancies of 20 mmHg or more are considered
to be inaccurate. If the ART-line system was to fail, the non-invasive
reading can be used as a backup. Another portion of caring for an arterial
line is the neurovascular assessment that includes the 5 P’s… Pain check for pain in the extremity of the
arterial line Pulses check for collateral pulses and cap
refill Pallor check the hand for a nice pink color,
don’t want to see paleness or cyanosis Paresthesia sensation (no numbness or tingling) Paralysis movement of the extremity Check your hospital policy regarding who can
insert ART-lines. In most cases, the RN will be assisting the
doctor or respiratory therapist with the insertion of an arterial line, and the following equipment
is needed… Sterile gloves
ART-line kit Pressure tubing
500cc normal saline bag (with air removed) Pressure bag
IV pole Chloraprep
A-line needle Transparent dressing & tape
Cable to connect transducer to monitor Monitor The saline bag should be changed daily and
the tubing system every 72 hours or according to your hospital guidelines. When drawing blood from an arterial line,
always waste the first 10 mL this blood is hemodiluted and will not give accurate results. Use a shielded blunt cannula, turn the stopcock
off to the saline bag, so it is open between the patient and the port you’re drawing from. Draw blood tubes without additives first,
then tubes with additives, anticoagulation profiles, and ABG’s. ** Remember to zero the system after use and
flush with saline to clear the tubing of blood. Indications for removal of arterial line… Arterial pressure monitoring no longer needed
Frequent blood sampling no longer necessary Neurovascular compromise
Bleeding at the site Infection and sepsis
Arterial line system failure (such as a kinked catheter or thrombus at the tip) When removing the arterial line – Verify your MD order to remove the ART-line
Check the coagulation studies (PT & PTT) prior to removing the ART-line
Keep the tip sterile, in case a culture is needed
Apply direct pressure to the site for at least 15 minutes, then apply a pressure dressing
to the site checking for bleeding, hematoma, or bruising
Continue to assess the 5 P’s pain, pulses, pallor, paresthesia (sensation), paralysis

9 Replies to “Arterial Line Management & Nursing Care | NCLEX Review 2019”

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