INVASIVE BP AND CARE OF ARTERIAL LINES

ITU UHND

ALISON FERRER & MICHELLE SIMMONSMULHOLLAND

MONITORING AND CARE OF AN ARTERIAL CANNULA

AIMS
TO PROVIDE ADEQUATE KNOWLEDGE TO ENABLE THE PRACTITIONER TO SAFELY CARE FOR A PATIENT WITH AN ARTERIAL CANNULA THE PRACTITIONER TO BE ABLE TO IDENTIFY THE INDICATIONS FOR AN ARTERIAL CANNULA THE PRACTITIONER TO BE ABLE TO RECOGNIZE AND COMPLICATIONS WHICH CAN OCCUR WHEN AN ARTERIAL CANNULA IS IN PLACE.

INTRODUCTION
An arterial line is a cannula which is inserted into a peripheral artery. Intra arterial blood pressure monitoring has been a theoretical concept since the eighteenth century, but has only come into common practice since 1960s. It is a valuable monitoring tool however has inherent risks and requires knowledge and skill to be able to safely care for the patient. The radial artery is the most preferred site as it is clearly visible, easily accessible and clean. Other sites are the dorsalis pedis artery the brachial artery and finally the femoral artery. The femoral artery is only to be used in extreme circumstances due to the risk of contamination.

Why?

An arterial line may be required in several circumstances but usually when there is a need for continuous assessment of BP and/or respiratory function, i.e. when using inatropic drugs or blood gas analysis. This could be because of sepsis, neurological injury (i.e. when strict control of CO2) is required or post op complications.

MAP
In any type of illness/injury it is vital that the vital organs are perfused. This is achieved by maintaining a good mean arterial pressure (MAP) Normal pressures need to be maintained above 60mmHg to perfuse vital organs
Normal Values: MAO: 70mmHg-100mmHg (Miller & Burnard, 1994)

Common problems
A normal waveform on the monitor will have a sharp upstroke, a diacrotic notch and a clear end diastole.

The waveform represents the pressure generated in the arteries following ventricular contraction. If a waveform is not sharp and becomes flattened it may be: Deflation of the pressure bag Misplacement of the cannula Clot in the cannula Transducer has become detached

Care of the cannula

As with any invasive line, strict asepsis must be adhered to at all times when changing dressings etc. ITU at UHND have specific packs designed for arterial line care and insertion. Use a clear dressing so that the line can be visible for assessment needs. Clean using chloraprep.

ABG
Arterial blood gases are usually taken for analysis of respiratory function and as a guide to electrolyte levels and provide an analysis of acid base balance.

Achieving accuracy
At the beginning of each shift the arterial line needs to be re-zeroed in order to calibrate the equipment with atmospheric pressure. Maintain the pressure with Normal Saline 0.9% in a pressure bag with 300mmHg facilitating a continuous flush of 3mls/hr to ensure constant patency of the line (Huddack 1998) Some units use heparinised saline; however studies have shown that this does not make a difference too line patency. (Gamby & Bennett 1995) Note all saline must be prescribed by the doctor on the drug kardex and the bag should be labelled. Labels are available from ITU at UHND. The full transducer set and the bag of saline should be changed every 72hrs in line with trust policy using an aseptic technique SO REMEMBER TO LABEL LINES. The transducer should be placed in alignment with the right atrium (mid axilla) known as the Phlebostatic axis. Arm mountable bands are available from ITU UHND. (Chulay & Holland, 1997)

Further complications
Infection - as with any invasive line strict asepsis should be maintained and this includes when taking either bloods or ABGs. Haemorrhage - be careful not to dislodge the line when moving the patient, try to make the line visible and use an appropriate dressing to ensure it is secure. DO NOT PUT DRUGS INTO THE LINE ensure the line is well labelled, where possible use the lines that have the red lines running through them as used in ITU at UHND. Concentration of a drug into the tissues served by the cannulated artery can result in cell death skin necrosis, severe gangrene, limb ischemia, amputation & permanent disabilities Ischemia, arterial damage, haematoma and necrosis can result from an arterial line so it is imperative that the nurse observes for discoloration, swelling or loss of a pulse to the limb and if the patient can give an indication of pain then this is another consideration. Abscesses can also form at the site, if the cannuala is dislodged and touches the artery wall. If the nurse suspects that the cannula is blocked by a clot, then flush carefully using heplock, if possible try to withdraw blood into the syringe first. Arterial spasm may result from forceful flushing and aspirating excessively. (Mcquillan et al 2002)