What are the steps to set up an arterial line system?

Arterial Line System Setup

The proper setup of an arterial line system requires using only sodium chloride 0.9% (with or without heparin) as flush solution, clearly identifying arterial lines, proper storage of fluids, documentation of flush solution, independent double-checking, and using appropriate sampling techniques to prevent contamination. 1

Preparation and Materials

• Use only sodium chloride 0.9% (with or without heparin) as the arterial line flush solution to prevent dangerous sampling errors 1
• Store bags of sodium chloride 0.9% for arterial line flush away from other intravenous fluids to prevent mix-ups 1
• Store flush solution bags in a suitable receptacle, not scattered across shelves 1
• Only store fluid solutions in regular use in the clinical area to prevent errors 1

Documentation and Verification

• Document the arterial line flush solution by prescription, record of administration, or standard operating procedure as defined in the hospital's policy 1
• Independently double-check the flush solution with a second practitioner before setting up and attaching to an arterial line 1
• Ensure all staff involved in arterial line management are appropriately trained and competent 1

Setting Up the System

1. Select appropriate site for arterial line placement (note that femoral lines have lower failure rates than radial lines) 2
2. Gather all necessary equipment for the procedure 3
3. Ensure arterial infusion lines are clearly identifiable with labels and color differentiation 1
4. Use pressurizing devices designed to permit unimpaired inspection of the contained flush infusion bag 1
5. Use a fully transparent front panel on pressurizing devices 1
6. Set up the system to minimize dead space volume between sampling port and arterial lumen 1

Blood Sampling Technique

• Use 'closed' arterial line sampling systems when possible to avoid sample contamination with flush infusions 1
• When using an 'open' system, minimize contamination by making the dead space volume between sampling port and arterial lumen as small as practicable 1
• Ensure the syringe used for removal of dead space volume is readily distinguishable from the sampling syringe 1
• Throughout sampling, prevent flush solution from entering the dead space, sample, or any three-way tap at the sampling site 1

Ongoing Monitoring and Maintenance

• Independently double-check the flush infusion bag at least once during each nursing shift 1
• Double-check the flush bag whenever nursing care of the patient is handed over 1
• Include removal of the flush bag from its pressurizing device during checks 1

Safety Considerations

• Be aware that arterial line sample contamination errors can result in serious patient harm, particularly hypoglycemic brain injury 1
• When using glucose measurements from arterial lines, unexpectedly high values should trigger a medical review and check for sample contamination 1
• For diabetic patients or when increasing insulin infusion rates above policy-defined thresholds based on samples from flushed lines, conduct a medical review 1
• Check the source of blood samples to ensure no possibility of contamination 1
• If contamination cannot be ruled out, draw a confirmatory sample from an alternative site 1

Common Pitfalls and Prevention

• Avoid using glucose-containing solutions as arterial line flush, as even minimal contamination can lead to dangerous sampling errors 1
• Be cautious with sodium chloride 0.9% with glucose 5%, which can be easily confused with plain sodium chloride 0.9% 1
• Watch for erratic or highly varying sequential test results, which should heighten suspicion of blood sample contamination 1
• Remember that even with proper technique using 5× dead space removal, significant glucose contamination can occur with glucose-containing flush solutions 1