PREPARE,ASSIST AND MANAGEMENT OF INVASIVE ARTERIAL BLOOD PRESSURE.pptx

ARTERIAL LINE

1. PREPARE,ASSIST AND MANAGEMENT OF INVASIVE ARTERIAL BLOOD PRESSURE Presented by :MOHD ASRUL MOHAMAD ZAINUDDIN : SRN U29 :WAD CICU

2. 2 Outline: 1. Definition of Arterial Line. 2. Indication of Arterial L ine insertion. 3. Location of Arterial Line. 4. Causes of overdamping and underdamping of Arterial wave. 5. Complication of Arterial L ine insertion. 6. N ursing responsibilities of patient with Arterial line.

3. 3 Objectives : 1. Understand about the definition, indication, location of insertion, causes of overdamping and underdamping of arterial wave and complication of arterial line insertion. 2. Understand about the nursing responsibilities of patient with arterial line.

4. What is an Arterial line 4 An arterial blood monitoring system consisting of a catheter inserted into an artery and connected to pressure tubing, a transducer, and a monitor. (Mosby’s Dictionary 9 th Edition)

5. Indication 1. Continuous arterial pressure monitoring: • Haemodynamically unstable patients • Patients supported on an intra-aortic balloon pump (IABP) • Patients receiving intracranial pressure monitoring 5

6. Indication…continue 2. Serial blood gas measurements: • Patients in respiratory failure • Patients being maintained on or being weaned from mechanical ventilator support • Patients with severe acid/base abnormalities 3. Frequent blood sample. 6

7. Location of insertion 7 Radial Femoral

8. 8 Location of insertion…continue Dorsalis Pedis

9. Arterial L ine Placement 9

10. PREPARATIONS

11. Arterial Line Transducer Set-Up Five Things You Need: 1. 500ml NS 2. Pressure Bag 3. Transducer Set (new sets will have syringe) 4. Transducer Holder (attaches to IV pole) 5. Transducer Pressure Cable Part I: Preparation and Pressure Bag Set-up 1. Open the transducer set 2. Tighten all the connections on the set 3. Close the syringe (if present). You should feel a click 4. Spike NS bag 5. Place NS in pressure bag and pump to 300mg Hg and turn stopcock to upwards position (to keep pressure bag inflated) 6. Hang pressure bag with NS on IV pole and clamp IV tubing 7. Clip transducer holder on IV pole so you can read words on it 8. Place syringe in in transducer holder pointing upwards (so you can read label on syringe) 9. Place transducer in transducer holder (so electric cable connector is downwards)

12. Part 2: Removing all air bubbles from IV tubing 1. Unclamp all the IV tubing 2. Point stopcock at the transducer UPWARDS (off towards the patient) 3. Pull on blue tab and allow fluid to flow from NS bag and out of port with WHITE cap on it at transducer to clear all air bubbles in first half of IV tubing 4. Now point stopcock at the transducer HORIZONTAL (off towards port with WHITE cap on it) 5. Pull on blue tab and allow fluid to flow from NS bag and out through all the IV tubing Part 3: Zero the arterial transducer 1. Hook up the Transducer Pressure Cable to the red port on the side of the monitor (use left red port at NYU on monitor) and then to transducer, a flat pressure wave should appear, you should see artifact when you move the end of your tubing 2. Level stop-cock on the transducer to the phlebostatic axis of the patient (intersection of 4th intercostal space and midaxillary line). You are leveling to the heart. 3. Turn the stopcock at the transducer UPWARDS (off to the patient) 4. Take the WHITE cap at the transducer off, now tubing is open to air 5. Hit “Zero” on monitor, then hit “Zero ABP” 6. Replace WHITE cap with BLUE cap (provided in transducer set) 7. Turn stopcock at transducer HORIZONTAL (off to atmospheric air) 8. Attach set-up to patient (you should see a waveform on the monitor)

13. TROUBLESHOOTING

14. • Characteristic – overestimates systolic and underestimates diastolic blood pressure – mean arterial pressure unchanged. • Causes – long stiff tubing, increased vascular resistance. 14

15. 15 Characteristic - W idened and slurred waveform. - Underestimates systolic and overestimates diastolic blood pressure. • Causes – Air bubbles, catheter kinks, blood clots, no fluid or low flush bag pressure.

16. 1- Hemorrhage 16 2- Infection Complications 3- Air Embolism 4- Thromboembolism 5 - Radial or Femoral nerve injury.

17. 17 Complication…continue 6 - Haematoma 7- Pseudoaneurysm.

18. 18 Nursing Responsibilities Prepare necessary equipment.

19. 19 Nursing Responsibilities…continue

20. 20 Nursing Responsibilities Hand washing or hand rub before and after procedure. Setting up the equipment for arterial line insertion. Dressing set and sterile gloves Steriprep Short tubing Arterial line 3way tap (red) Gauge Syringe 5cc with saline for flushing. Opsite / tape Torniquet.

21. 21 Nursing Responsibilities…continue 3. Wearing appropriate personal protective equipment (PPE). 4. Assisting doctor insertion of the arterial line. 5. Label the system when set up with date and time. 6. Ensure the line is secured

22. 22 Nursing Responsibilities…continue 7 . The drip chamber should be squeezed gently to fill only the bottom of the chamber . 8 . Ensure the pressure bag is maintained at 300mmhg. 9 . Examined for air bubbles. 10. Ensuring that the arterial line is appropriately labelled. 11. M aintaining the transducer at the phlebostatic axis.

23. 23 12. Re-level the transducer each time the patient changes position or the bed is raised or lowered. 13. Assess limb colour & temperature. 14. Monitoring and displaying the arterial waveform at all times. 15. Always zeroing the transducer. 16. Setting appropriate alarm limits. Nursing Responsibilities…continue

24. 24 Nursing Responsibilities…continue 17. Maintaining aseptic technique for blood sampling. 18. Documenting in the patient’s record each shift.

25. 25

26. 26 Reference Mosby’s Dictionary 9 th Edition Text Book Of Medical-surgical Nursing Twelfth Edition Oxford Handbook Of Cardiology Second Edition RN Expert Guide Of Cardiovascular Care