Hemodynamics in Critical Care
Arterial Line (Art. Line)
The arterial line with transducers is usually used to obtain accurate blood pressure readings every few seconds. This is especially important in monitoring the hemodynamic status of a critical patient. With an arterial line, the immediate effects of medication can be seen. Both systolic, diastolic and mean pressures can be monitored immediately. This is especially important when pressors such as Nipride, dopamine or Levophed are being used. Another advantage of using an arterial line is that frequent blood samples can be obtained.
1. Prepare a 500 ml bag of normal saline. Most institutions no longer use a heparinized bag. Spike the bag with the transducer administration set. Remove all air from the tubing and transducer set. Pay particular attention to the transducer part of the Tubing and the flush port. The smallest air bubble must be removed to insure transducer accuracy. The easiest way to do this is to pressurize the bag up to 300 mm Hg, then invert the bag, and fast flush it to remove all air from the bag.
2. Pressurize the pressure bag to 300 mm Hg. The purpose of this is to provide backpressure to prevent blood from contaminating the transducer.
3. With the transducer connected to the monitor, select arterial monitor, and perform a transducer check by fast flushing the line. As you do this, you should see a change in the waveform. This is called a square wave test.
4. Zero the transducer and monitor by placing the transducer at the phlebostatic axis of the patient. Close the line off to patient and open to air. Press zero on the monitor. To monitor pressure, close the port off to an air and open to patient.
5. At this point the patient catheter is ready to be connected. Connect the catheter and fast flush to clear the catheter of blood.
6. You should now see an arterial waveform on the monitor with arterial blood pressure and mean should be on the monitor screen. Check for good waveform.
Arterial Puncture Checklist
ARTERIAL PUNCTURE OF RADIAL ARTERY CHECKLIST
COMPETENCY STATEMENT: Provides nursing care for the patient requiring arterial blood sampling.
1. Identifies the indications for obtaining arterial blood samples.
2. Verifies order, gathers supplies, washes hands, positions patient.
3. Selects site- Performs Allen test according to procedure.
4. Interprets Allen test.
5. States method of heparinizing syringe if kit not available
6. Preps site and fingers of glove used to palpate site.
arterial blood sample from radial artery.
a. Performs puncture and allows syringe to fill.
b. Expels air from syringe, caps tightly and places on ice.
c. Applies pressure at least 5 minutes.
8. Notifies laboratory personnel of patient’s temperature to allow for temperature correction of the blood sample.
9. Wash hands, reassess patient, and document.
10. States the normal range for ABG results, and correlates the current result to previous or baseline ABG values.
11. States precautions and nursing measures aimed at reducing risk of complications.
Arterial Line Monitoring Checklist
COMPETENCY STATEMENT: Provides nursing care for the patient requiring arterial pressure monitoring.
1. Identifies the indications for arterial pressure monitoring.
2. Assembles necessary equipment for insertion of an arterial catheter.
3. Performs Allen test.
4. Assists the physician with the procedure by supporting the patient’s hand and dorsiflexing the wrist.
5. Places the air-fluid interfaces of the transducer system at the level of the phlebostatic axis.
6. Levels and zeros the transducer to atmospheric pressure at least every 4 hours or as needed by patient’s status.
7. Identifies the normal arterial waveform, various physiologic effects, and troubleshoots deviations as necessary.
8. Compares the direct arterial pressure measurements with the indirect sphygmomanometer or non-invasive measurement.
9. Assess pulse, color, sensation, and temperature distal to the insertion site every 2 to 4 hours.
10. Observes the skin at the site and distally for blanching during irrigation.
11. Changes the flush solution, tubing, and dressing in accordance with local infection control guidelines. Inspects for signs of infection.
12. Draws bloods samples from the arterial catheter using the blood sampling port and the needless system.
13. Discontinues the arterial catheter by removing the sutures and holding direct pressure over the site for 10 minutes.
14. Documents all pertinent information
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