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STANDARDS:
* Registered Nurses accredited to work with pressure lines in an Intensive Care setting and Registered Nurses training to work in an Intensive Care setting under the supervision of an accredited Registered Nurse may care for radial/femoral arterial lines.
* Procedure must be carried out under strict asepsis.
* Strict attention should be given to position of stop cock at end of procedure to prevent accidental uncontrolled bleeding of patient from radial/femoral artery.
* Proper use of available equipment to prevent accidental injury to staff or patients.
OUTCOMES:
* The patient will experience no infection through contamination of the Arterial Line during his or her stay in LBH.
* Proper position of stop cock will be ensured to prevent any accidental blood loss leading to injury of the patient during hospital stay.
* Potential injury to the nurse will be minimised through proper use of equipment.
EQUIPMENT: Yellow vacutainer shield Vacutainer for collecting blood samples
3ml syringe (arterial) 5ml syringe (femoral)
Alcohol swabs Vacutainer luer adaptor for pressure lines
10cm x 10cm sterile gauze Arterial blood gas syringe (if appropriate)
Eye protection Blue protective sheet
Gloves
If drawing cultures from an Arterial Line the following equipment will also be needed:
Blood culture bottles x 2; red and green topped
Chlorhexidine
Large clear vacutainer shield to accommodate blood culture bottle R : 37.1
PROCEDURE:
Procedure "A", removal of blood from a radial/femoral arterial line for routine screening
* Explain the procedure to the patient prior to procedure.
* Aseptic preparation prior to commencing procedure.
* Lay out necessary equipment on over bed table next to patient bed and within easy reach.
* Lay blue protective sheeting under limb with arterial line to protect patient and bed clothing from accidental back flow of blood from pressure line.
* Open sterile gauze package on bedside table.
* Open 3ml or 5ml syringe as required.
* Attach luer adaptor to yellow shied by removing top protector from adaptor and screwing adaptor into shield. The yellow shield severs several purposes:
- it helps to guide the vacutainer for collecting blood over the needle end of the luer adaptor,
- it protects the user from coming into contact with the needle end of the adaptor and
- prevents the plastic protector over the needle end of the adaptor from being sheered exposing the needle and allowing flow back of arterial blood.
* Hit three minutes silence alarm on overhead monitor.
* Place on gloves and eye protection.
* Ensure three way stop cock is turned off to sample port.
* Remove cap from pressure line transducer and place on sterile gauze to protect from contamination.
* Wipe down sample port with alcohol swab before starting procedure.
* Place appropriate syringe securely onto sample port.
* Turn stop cock off to pressure bag and with draw blood into syringe from arterial line. Withdraw 3mls from radial line and 5mls from femoral line.
* Turn stop cock 45 degrees back towards sample port and remove blood filled syringe and discard appropriately.
* Remove protection cover from bottom part of luer adaptor, place adaptor into sample port securely.
* Turn stop cock off to pressure bag. Observe for inappropriate leakage of blood from around or up through adaptor, turn stop cock off to sampler if this develops.
* Place vacutainer into shield and press down firmly over needle. Blood should be drawn into vacutainer automatically, self filling will stop when vacutainer filled.
* Remove vacutainer from shield without dislodging adaptor and repeat process until all bloods have been taken. It is not necessary to move stop cock during this procedure. R : 37.2
* Turn stop cock off to patient when blood is drawn and remove adaptor. Flush pressure line with stop cock in this position to clear blood from sample port. During procedure hold sterile gauze over open port to control fluid loss. Next turn stop cock off to sample port and flush pressure line for two to three seconds to clear all blood in line. Replace cap back on sample port.
Procedure "B", removal of blood from a radial/femoral arterial line for Arterial Blood Gases:
* Arterial Blood Gases (ABG's) may be drawn from arterial line using an ABG syringe after routine bloods have been drawn. In this case turn the stop cock only 45 degrees back towards sample before removing adaptor.
* Replace adaptor with ABG syringe then turn stop cock off to pressure bag.
* Draw 1ml to 1.5mls into syringe (arterial pressure should fill syringe). When blood is drawn remove and flush line as above.
* ABG's may be drawn on own after removal of appropriate amount of blood from line using the above procedure for removing routine bloods.
Procedure "C", removal of blood from radial/femoral arterial line for culture samples:
* Cultures may be drawn from arterial lines where other veins are inaccessible.
* Follow procedure above for removal of routine bloods except for the following:
- the sample port is wiped down with Proviadine instead of alcohol and allowed to dry prior to attaching adaptor to sample port.
- instead of the yellow shield a large clear plastic shield (removal butterfly line fro shield when used with arterial line) apply to accommodate the culture bottle is used.
* Sterility is important when drawing blood culture, therefore the clear plastic caps are left in place on the culture bottles until they are ready to be placed in the adaptor from drawing bloods. Bottles fill on own to desired amount needed.
* After the bottles have been removed, the tops of each bottle is wiped immediately with Proviadine.
* Procedure is terminated; has explained for routine bloods
R : 37.3
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DRESSING CHANGES TO RADIAL/FEMORAL ARTERIAL LINES |
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