Who You’ll Hear
Kati Kleber, MSN RN CCRN-K – Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, speaker
Sean Dent, MSN ACNP-BC, critical care nurse practitioner
What You’ll Learn:
- Art Lines
- Efficacy of blood pressure cuffs
- A-Line tips
- Fluid monitoring devices
- Cooling Devices
Intensive Care Devices: Part 1
Arterial lines, ventilators, central lines galore! Together with Acute Care Nurse Practitioner Sean Dent, Melissa and Kati discuss some tips and tricks for dealing with typical Intensive Care devices.
Introduction to Nurse Practitioner Sean Dent
- An older “seasoned” nurse of 13+ years
- Practiced in the ICU for his entire career except for about 3-6 months where he tried working in orthopedics
- 7 years ago he went back to school and got his bachelor’s and master’s
- He is now on his 5th year as an acute care nurse practitioner
- He provides services to all of the ICUs inside the hospital
Let’s Talk Art Lines
As a brand new nurse, never dealt with art lines before, what are some big “never do,” and “always do” tips?
- Understand why the patient is needing it – This is important because it’s not a permanent device, it’s a temporary device.
- The sooner you can get it out the better.
- It’s usually because their hemodynamics are compromised in some way that they need invasive monitoring.
- An art line gives you continuous monitoring of their arterial pressure vs a cuff pressure which is intermittent and not as accurate
Efficacy of Blood Pressure Cuffs with Art Lines
You see a number on the screen. Should you be checking that with a regular blood pressure cuff? If so, where and how often?
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- It is very patient-specific
- Some patients that will always return inaccurate blood pressure cuff results are:
- Patients that are third-spacing
- Patients that are severely obese
- Someone who is very cachectic
- Blood pressure cuffs can be inaccurate
- They can be used to compare
- If you are interested in getting rid of the A-Line, you definitely need to start checking cuff pressures because you need to have some sort of correlation.
- A-line should correlate with the cuff pressure. They usually don’t, but there should be some variance.
- Is your A-line higher or lower than your cuff pressure?
- You need to have this in the back of your mind so that when you get rid of the A-line you know ahead of time that the cuffer is going to be falsely elevated or going to be falsely lower.
- When to discontinue the A-line is completely up to you and your team.
- It should come out as soon as possible.
- The sooner it comes out the better because it is an opportunity for infection and injury.
Follow these tips to provide excellent care for patients with A-lines
- Make sure all the connections are tight
- You don’t want your patient to lose blood due to loose connections
- The A-line has to be leveled appropriately to get an accurate blood pressure
- If the transducers are too high you aren’t going to get a good pressure
- If you have a patient on drips and are you titrating drips off that art line, it is imperative that you make sure it is accurate
- A quick tip: A lot of families and patients know not to bother nurses when they are giving meds, but they don’t always connect that when you are working with equipment. They don’t realize that me messing with this arterial line impacts how I give this medication and how much of it.
How to Use Different Kinds of Fluid Monitoring Devices
Tips for how to use common monitoring devices such as CVP and NICOM.
- Know the Why – why you are doing it and how it’s working
- You need to have a good solid foundation of anatomy and physiology and where the catheter is and what it is measuring.
- CVP is part of a central line that is measuring fluid volume status and it is measuring central venous pressure.
- Traditionally it sits somewhere in the SVC – just above your right atrium.
- CVP is up from interpretation.
- There is no normal.
- There are trends
- You are looking for a response to therapy.
- Understand why you are using a CVP.
- It is just another tool in the toolbox.
- When you are measuring fluid volume status with various tools, it gets complicated. This is advanced stuff, you won’t have to know it on the first day.
- CVPs can be just through a central line – they call them central venous catheters CVCs.
- You can also measure CVPs through a Swan Ganz Catheter, or a PA Catheter
- A PA Catheter sits in your Pulmonary Artery
- A CVP is just a piece of a monitoring tool
How to use cooling devices correctly as you monitor patients.
- Know how the equipment works
- Know how to troubleshoot when alarms go off – a lot of times it has to do with connections and pressure and it depends on where the catheter is on the body.
- Cooling devices are very specialized unless you are working in a unit where you are using it often like in a code-cool situation
- TTP – Targeted temperature management
- Hypothermia Protocol
- There are different brands and types of devices
- You can cool someone with an external device and an external device