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ARTERIAL LINES AN INTRODUCTION FOR STUDENTS AND NEW STARTERS IN THE NHDU

E.Doidge.june05. ARTERIAL LINES AN INTRODUCTION FOR STUDENTS AND NEW STARTERS IN THE NHDU. BY Emma Doidge (Staff Nurse BSc Hons). E.Doidge.june05. AIM OF PRESENTATION. To provide students and new starters to NHDU an insight into:What an arterial line is and anatomyWhy we use themManagement of an arterial lineRisks associated with them.

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ARTERIAL LINES AN INTRODUCTION FOR STUDENTS AND NEW STARTERS IN THE NHDU

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    1. E.Doidge.june05 ARTERIAL LINES AN INTRODUCTION FOR STUDENTS AND NEW STARTERS IN THE NHDU BY Emma Doidge (Staff Nurse BSc Hons)

    2. E.Doidge.june05 ARTERIAL LINES AN INTRODUCTION FOR STUDENTS AND NEW STARTERS IN THE NHDU BY Emma Doidge (Staff Nurse BSc Hons)

    3. E.Doidge.june05 AIM OF PRESENTATION To provide students and new starters to NHDU an insight into: What an arterial line is and anatomy Why we use them Management of an arterial line Risks associated with them

    4. E.Doidge.june05 WHAT IS AN ARTERIAL LINE? ? An arterial catheter over a needle which is inserted into an artery using a percutaneous method, usually the radial artery Radial artery is used as it is the most accessible The axillary, femoral, brachial and pedal arteries may also be used Once inserted the catheter is attached to a pressure transducer and attached to the monitor where a continuous waveform will be seen A continuous heparin infusion is used to maintain the patencey of the arterial cannula once insitu (Stillwell, 2002)

    5. E.Doidge.june05 WHY USE AN ARTERIAL LINE? Main indications for use include: Alteration in cardiac output Alteration in fluid volume Alteration in tissue perfusion Continuous assessment in blood pressure and respiratory function i.e. theatres, NICU and NHDU Respiratory function includes levels of O2, CO2 and acid base status of the patients blood These can be early indicators of patients having respiratory difficulty (Thelan, Urden, Lough And Stacy, 1998)

    6. E.Doidge.june05 WHAT CREATES BLOOD PRESSURE? ? With any type of injury it is essential that brain perfusion is maintained ? This is achieved by maintaining a good mean arterial pressure (MAP) ? Blood pressure is the volume of blood in the arteries (cardiac output (C.O) the amount of blood ejected by the ventricle) and the vessels imposing resistance which the heart has to pump against (systemic vascular resistance (SVR)) ? Normal pressures need to be maintained above a minimum of 60mmHg to perfuse vital organs ? Normal Values: MAP: 70 100mmHg, Systolic: 100 140 mmHg and Diastolic: 60 90mmHg (Miller and Burnard, 1994)

    7. E.Doidge.june05 WAVEFORMS PRODUCED BY ARTERIAL PRESSURES! A normal waveform on the monitor will have a sharp upstroke, a dicrotic notch and a clear end diastole Systolic Pressure Sharp Upstroke Dicrotic Notch End Diastole Diastolic Pressure

    8. E.Doidge.june05 If a waveform does not have these special features an abnormal waveform might be seen (loss of the dicrotic notch or a flattened upstroke This may be caused by a deflation in the pressure bag, misplacement of the cannula, a clot in the cannula or the transducer may have become detached

    9. E.Doidge.june05 INSERTION OF THE ARTERIAL LINE! Completion by a competent practitioner Ensure all equipment is available Arterial cannula set Suture Dressing Pack 1 2% Lignocaine Betadine Transducer set primed Tegaderm with Heparin Sodium (LTHT Guideline 01.10.04)

    10. E.Doidge.june05 Maintain a sterile field to decrease risk of infection Prepare transducer system priming and flushing all ports to prevent embolis Assist the medical practitioner by holding the patient, providing a good position for insertion (Allen Test) Maintain sterile precautions Assist in suturing of the line to hold it in a secure position Cover with a clear dressing, ensure site is visable

    11. E.Doidge.june05 CLEANING AND MAINTAINING AN ARTERIAL LINE! Maintain an aseptic technique If not sutured, you may need two nurses when cleaning to prevent it being dislodged Use a clear dressing, so arterial line is visable at all times When cleaning observe for any signs of infection The transducer set must be changed every three days. When changing ensure once again that the set is fully primed and that the new transducer is changed as the actual line not at the 3 way tap nearest to the patient

    12. E.Doidge.june05 TAKING AN ARTERIAL SAMPLE OF BLOOD (ABG)! Taken for analysis of respiratory function post op (alter O2 flow to pt) and a guideline of electrolyte levels Can aid in ascertaining acid levels and severity of conditions It is essential that the practitioner is competent in taking an ABG and is able to understand and act on appropriately Ensure once a sample has been taken that the line is flushed via the transducer system, observing for any changes at the site including reddening, swelling and leakage.

    13. E.Doidge.june05 NURSING INTERVENTIONS! At the beginning of each shift the arterial line needs to be re zeroed in order to calibrate the equipment with normal atmospheric pressure Maintain the pressure within the Heparin pressure bag at 300mmHg to ensure constant patencey of the line Position of the transducer boards is important and must be level to the mid heart line each time the patient is moved

    14. E.Doidge.june05 RISKS ASSOCIATED WITH ARTERIAL LINES! Infection: this can occur with any invasive line. A strict aseptic technique must be adhered to at all times, including during system set up and insertion. During blood sampling procedures a sterile approach must be used Haemorrhage: this can be caused by the arterial catheter becoming dislodged or a loose connection. This can be prevented by suturing the catheter insitu. Avoid unnecessary pulling on the lines Ischemia, arterial damage, necrosis, blanching, coldness and loss of pulse to the limb, can be as a result of thrombosis forming in the cannula and/or artery

    15. E.Doidge.june05 Abscess can occur at the arterial sites if the cannula is dislodged and touches the arterial wall Inflammation can be caused by phlebitis, chemical and mechanical trauma Arterial spasm can be caused by forceful flushing of the line and aspiratingsamples for blood too vigorously (Mc Quillan et al. 2002)

    16. E.Doidge.june05 REMOVAL OF AN ARTERIAL LINE! Use of an aseptic technique Once dressing is withdrawn, cut the suture if in place and withdraw slowly from the patient Apply direct pressure with sterile gauze for approx. five minutes Whilst doing this maintain the circulation of the distal extremity. It may be worthwhile raising the arm in the air to stop bleeding

    17. E.Doidge.june05 REFERENCES Leeds Teaching Hospitals NHS Trust, Nursing and Midwifery And Health Visiting Guidelines, Guidelines For Undertaking Percutaneous Arterial Cannulation, Guideline No. 01.10.04 McQuillan KA, Von Reuden KT, Hartsock RL, Flynn MB, Whalen E (2002) Trauma Nursing From Resuscitation Through To Rehabilitation Third Edition, WB Saunders, USA Millar B and Burnard P (1994) Critical Care Nursing Caring For The Critically Ill Patient, Bailliere Tindall London Stillwell SB (2002) Critical Care Nursing Reference, Third Edition, Mosby USA Thelan LA, Urden LD, Lough ME, Stacy KM (1998) Critical Care Nursing Diagnosis and Management, Third Edition Mosby London www.edu.rcsed.ac.uk/lectures/lt8.htm

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