In this video we are learning how to set up for an arterial line! Monitoring arterial blood pressure is an ICU nursing skill that I have set up for many times and I'm so happy to have the opportunity to show you how we do it at my facility here!
When caring for critical patients in the ICU setting, we give many drips in order to raise or lower the blood pressure. Many times, the patients are so critical, that we cannot rely on the regular non-invasive blood pressure monitoring, due to the frequency that we need to take the blood pressure and also the need for the most accurate blood pressure.
The advance provider is the person who will insert this line, however, at least at my facility, it is the nurse who is gathering the supplies and also setting up the materials to transduce the blood pressure so that we can see it on the monitor.
When giving vasoactive medications, we usually refer to the MAP or mean arterial pressure, the advance provider will order parameters for us to follow and we adjust the dose based on the patients MAP. For example, if I have a patient who has a levophed (norepinephrine) or epinephrine drip, the order may say to keep the map above 65. We are usually given a starting dose, for example, at my facility, the starting dose is 5mcg per minute. Then based on the patients map, we can go up or down on the drip.
The arterial line, will give you an updated blood pressure every few seconds, so sometimes I will wait in the room and document my assessments, while I look at the blood pressure to see if I need to continue to adjust the dose.
I have found that every patient is different and will react to different medications individually, so it takes some time to see what works for each patient.
Some patients are very sensitive to levophed, others epinephrine and still others vasopressin. In each situation, my monitoring of the effects will be individualized, with the main goal of getting your patient off pressors!
Keeping a close eye on your patients labs is also key... does your patient need blood? Or are there electrolytes off? Is your patient dehydrated. do they need fluid? Or are the intravascularly dry, but third spacing... these are all considerations that you want to think about.
You can bring your concerns to your intensivist or advance practice RN or PA - many times they are looking at multiple patients at the same time and are appreciative of your educated contributions!
The reasons for using an arterial line could be to monitor the most accurate blood pressure very closely. Perhaps the patient is on medications known as pressors, which can include these medications: Levophed or norepinephrine, Epinephrine drip, phenylephrine drip or vasopressin drip.
You can also see some patients with the opposite problem, high blood pressure. In this instance, they may be on critical drips to lower the blood pressure, such as nitroglycerin drip, or cardene/nicardipine drip.
Whether your goal is to lower the blood pressure or raise the blood pressure, the arterial line gives you up to the second accurate blood pressure. It is imperative to monitor these medications carefully, which is why your patient is in critical care… because depending on the sensitivity of the patient to the medications, the blood pressure may quickly rise or lower, causing hemodynamic instability in your patient.
From what I have seen, the most hemodynamicly unstable patients have been our open heart or CABG patients… you honestly have to stare at the blood pressure for the first 2 hours because rises or drops are quite dramatic and scary.
So thats it for now, I will have another ICU video coming your way very soon!
Please remember to like this video, subscribe to my channel for more ICU content!
See you soon!
31 янв 2023
