So, I started my first IA line today.......

[BLSBoy]

completely inadvertantly. 90 y/o black female, 50kg. Hypertensive at 228/100something. NSR at 80. CC was nosebleed, BLS was tapped. They found her hypertensive as all get out, with SOB and diminished lung sounds. I start her on an albuterol updraft, go to start a line in R AC, since her hands and forearm veins are tiny and crappy. I palpate a good one, hit it with a 20, get a flash, advance a little more, cathether slides in, no problem. I look away, while tamponading, and the EMT goes, uhhhh, its squirting. I go, yea sure, and tamponade harder. I never saw it squirt, I just saw blood.
When I attached the loop and 10cc flush, I immediatly got a back flow of 2cc blood into the flush. I pushed the flush through, got orders for Solu-Medrol and Atrovent.
The Solu-Medrol went in nice and easy, as well as the second flush. The EMT was adamant about seeing bright red spurting blood, so I told the RN after we turned care over. She said she felt the loop pulsating, and pulled it.


Thoughts?
Done it yourself?

 

[Ridryder911]

Only accidentally punctured an artery once when attempting to establish an IV and definitely never pushed medications through it. It is usually difficult to perform arterial sticks unless it is purposeful.

I can almost guarantee, you did not puncture the artery as well. Did blood go back into the tubing no matter what?.. If not, again I doubt it was arterial. Was it bright red blood? With a blood pressure that high, I have seen many that assume it was arterial when in fact it was not. I have even seen the venous pressure so high, that it blew the cap of the back of the IV catheter off. As well, when someones pressure is that high, it is easier to palpate a pulsation.

How easy was it to occlude or seal off? Again, it usually takes at the least 5 minutes for a arterial stick to seal itself off.

If you presume that you did perform an arterial stick, NEVER administer any fluids & especially medications through the line.

R/r 911

 

[boingo]

Agree with Rid, very doubtful this was an arterial stick.

 

[triemal04]

Seen it done but haven't been able to manage yet myself...maybe one day... Like the above, I doubt that this was an arterial stick though; with a pressure that high I'd be more surprised if blood didn't push back into the lock and if it was easy to occlude. From when I've seen it happen, you'll know pretty quick with a pretty high degree of certainty that it's in an artery. And as has been said before, if there's any doubt, don't use that line!

 

[maxwell]

I was doing an EJ once, the dude started seizing (of course into the needle)...got the carotid. FML. +10 for me. h34r: Not to worry.

 

[rhan101277]

We hauled a guy has bp 220/110 the blood came back up the tube, first time I saw that.

 

[VGFDEMT34]

Interesting, you guys can do a-lines?

 

[Vizior]

Interesting, you guys can do a-lines?

LOL, I'm pretty sure that was the point of the post. They're not supposed to, but he's considering the idea that he may of put an IV cath into an artery.

As far as I know, a-lines are not really used outside of the ICU very much? I've seen them used for monitoring blood pressure, but I never got a chance to see much more.

My other question would be, would there be a benefit of being able to draw an ABG on scene for the hospital, especially in areas that have upwards of 30 minute transport times.

 

[AJ Hidell]

My other question would be, would there be a benefit of being able to draw an ABG on scene for the hospital, especially in areas that have upwards of 30 minute transport times.

No. There would be no benefit, and numerous risks.