Notes for this lesson (as well as other perks) are available to CZcams and Patreon members. Show your support and get a leg up in learning! CZcams Membership: adv.icu/3C4fiuR Patreon Membership: adv.icu/3A3m8yO
Thats awesome man! Congrats on the new MICU position. Wish I had even more stuff for you for future reference, but it's getting there over time. Wishing you the best.
We're not going to talk about that HR of 33 with MAP 76 and a cuff pressure that doesn't correlate at all with the A line? 😂 Thanks for the video, always appreciate your content!
😂😂 I was wondering how long until someone said something!! It was the only graphic in that style that I could find. And that rate is definitely NOT 33 lol. As for the BP cuff, I figured it cycled a while ago 😉😂
I literally could not comprehend what they meant when they said "off to the ____" until 2 secs ago when I saw/heard this depiction and explanation. THANK YOU SO MUCH, it's so simple idk why no one could explain this to me in a way that clicked until know. THANK YOU SO MUCH!!
I can't tell you how helpful your videos have been man! Jumped from Peds acute care to Adult MICU/BMT. Having to learn two specialties at once, your videos have been so helpful in learning the ICU side. Appreciate the work you put into making these!
You are very welcome Elise! I've got a lot of great stuff on here that is especially geared towards people like you starting out. Glad you find them helpful!
nice explanation. I would have liked to have a recorded video of the actual procedure, it’s hard to visualize this process. I’m an ER nurse at a level 1 trauma center so we hold a lot of ICU’s in our ER. I do not get to experience A-lines that frequently and would like to change that.
Yeah as an individual doing this, I unfortunately don't have access to be able to use actual equipment so I try to do the best I can with explanations and concepts that hopefully can be applied to practical application with whatever equipment someone may use. Glad you liked the lesson and hope you have to opportunity to get more a-line experience under your belt.
For some reason for many of my patients whenever I compare the BP cuff and the Art Line pressures, the MAP is typically spot on within 1-2. However, SBP/DBP typically deviates by 10 something. Anyone else?
Hey ,you are just fabulous. I have a question Saline line from pressure bag should it go from below the tra nsducer or it would not matter even if it is attached above
Great video as always! I was wondering about the Syringe setup: Why turn the stopcock off to patient when flushing blood out the open port after withdrawing a sample? (Why don't we just flush IV fluid + blood mix into pt like in the Traditional Setup?)
You can flush it all back to the patient, but to keep the stop cock patent flush the blood out of the port with normal saline using the whip tail to prevent clot formation
Perhaps I didn't explain that part well. My apologies. When it comes to dealing with the stopcock used for access, regardless of if it is the syringe setup or the traditional, we would handle it the same. Really should just flush the entire line, then make sure and turn off to the patient, and do a small flush to clear the bit of blood left in the open port on the stop cock, before turning it back off to the open port.
Do you hook the set up to the patient before inflating the pressure bag? Are all the stopcocks supposed to be off to open port before inflating the pressure bag as well? Just seeking some clarification, I have experience with A-Lines but have never set one up from scratch before.
You should have the pressure bag inflated and stop cocks open after setting up the system. This is so as soon as the provider gets in the artery it can be attached and immediately see what kind of waveform you have. There will be no saline flowing from the system even with the pressure bag inflated and stop cocks open because in order to open the flow, you have to pull your little flush tail. If you think about drawing blood from an A-line, it doesn't automatically flush itself even when the stop cocks are in the "open" position until you pull the tab to flush it.
@@brittanybb01 I don't disagree with with pressurizing the fluid bag prior to connecting the pressure tubing to the arterial catheter, but I disagree with your statement about "There will be no saline flowing from the system even with the pressure bag inflated and stop cocks open." Pressurizing the system serves 2 main functions... 1. Allows you to use the flush device to flush the line. 2. Provides slow continuous flow of fluids through the line to maintain line patency. 3 mL/hr approximately when the pressure bag is inflated to 300 mm Hg. Eddy even mentions this in the video but states 3-5mL/hr. This is not too important to know in most cases but if you are using a traditional setup to collect blood this concept is extremely important because you can potentially dilute the blood you collect.
@@jordankim2133 Technically you are right. Practically, however, the 3ml/hr is insignificant as you usually set up your system right before the provider inserts the line and it shouldn't take them hours to insert it (fingers crossed anyway lol). Collecting blood is a different topic and I always clamp when collecting blood. I was just using that as an example to explain that the saline is not going to "pour" out when stop cocks are open.
Good questions. So it truly doesn't matter if the bag is inflated or not prior to attaching to the patient. That said, have it inflated and ready to go. You will not get an accurate reading on your pressure until the bag is inflated, so have it all ready to attach and get your pressure right away. And yes, stopcocks off to open ports and capped when not in use. Only open them during priming, or if you need access. Otherwise, keep them off. Hope that helps!
You can. For some things the lab values can be different. Obviously ABG vs VBG, but even the value of lactate can change. It can all be accounted for as long as the specimen is properly identified where it was drawn from. As for your question, you certainly could draw from either if you have both, but typically the a-line is going to be the easiest and is typically what we use when we have it.
So sorry this slipped past me. If you go to the main ICU Advantage CZcams page then look for the "Community" tab, you'll find the link to the notes with the months current password.
From a patient’s view, I wish it was explained better. When I had to have TPN nutrition, a pic line was finally put in. It felt so much better. Blood was never drawn from that line, nor would I let anyone from checking my blood pressure on that side. I am alive and grateful to the fabulous surgeon and Anesthesiologist I was only on the ventilator for one day, only spent 10 days in a rehabilitation hospital. I lost a lot of strength though, but I am recovering well. I will say there’s a lot of tension between the floor nurses and the intervention team. They bicker like children sometimes. I was really scared when they told me it had to go in, with minimal explanation from anyone. Thanks for listening.
Notes for this lesson (as well as other perks) are available to CZcams and Patreon members. Show your support and get a leg up in learning!
CZcams Membership: adv.icu/3C4fiuR
Patreon Membership: adv.icu/3A3m8yO
As a new grad in the ICU, your videos are extremely beneficial!!!
Glad to hear this Juan! That's truly my hope!
I'm in my third week now as a new grad working in a MICU, and your videos are pretty much my primary study tool when I'm at home. Thank you for this!
Thats awesome man! Congrats on the new MICU position. Wish I had even more stuff for you for future reference, but it's getting there over time. Wishing you the best.
Your videos taught me more than my entire 6 month Critical Care Course thank you !
As a july intern tasked with giving a talk on A-lines, this series is saving my life right now. Thank you!
We're not going to talk about that HR of 33 with MAP 76 and a cuff pressure that doesn't correlate at all with the A line? 😂 Thanks for the video, always appreciate your content!
😂😂 I was wondering how long until someone said something!! It was the only graphic in that style that I could find. And that rate is definitely NOT 33 lol. As for the BP cuff, I figured it cycled a while ago 😉😂
Yes!! I was looking at that too!
I literally could not comprehend what they meant when they said "off to the ____" until 2 secs ago when I saw/heard this depiction and explanation. THANK YOU SO MUCH, it's so simple idk why no one could explain this to me in a way that clicked until know. THANK YOU SO MUCH!!
Starting my preceptorship in the ICU! So glad I’ve been watching your videos the past 2 years to prepare 🥲
Congratulations! You'll have a blast! And wow, you've been around for a while! This channel was really barely starting back then 😊
I can't tell you how helpful your videos have been man! Jumped from Peds acute care to Adult MICU/BMT. Having to learn two specialties at once, your videos have been so helpful in learning the ICU side. Appreciate the work you put into making these!
THANK YOU so much for all these lessons. As a new ICU RN, this channel is gold for me.
You are very welcome Elise! I've got a lot of great stuff on here that is especially geared towards people like you starting out. Glad you find them helpful!
Excellent content. You truly simplify complex subjects!
Thank you for this video. It made the notes I read come alive and easier to understand
Awesome Veronica! Glad it was helpful!
thank you for the videos, they are super helpful
You're welcome! Glad you like them.
Another excellent video! I learned so much in all your videos!
This is an excellent videos to learn ART line & its recommended for everyone !
Thank you so much! Glad you enjoyed it
nice explanation. I would have liked to have a recorded video of the actual procedure, it’s hard to visualize this process. I’m an ER nurse at a level 1 trauma center so we hold a lot of ICU’s in our ER. I do not get to experience A-lines that frequently and would like to change that.
Yeah as an individual doing this, I unfortunately don't have access to be able to use actual equipment so I try to do the best I can with explanations and concepts that hopefully can be applied to practical application with whatever equipment someone may use. Glad you liked the lesson and hope you have to opportunity to get more a-line experience under your belt.
You're a rockstar, THANK YOU!
For some reason for many of my patients whenever I compare the BP cuff and the Art Line pressures, the MAP is typically spot on within 1-2.
However, SBP/DBP typically deviates by 10 something.
Anyone else?
Thank you for the video well done
Thank you 👍👍👍 from turkey
Very cool! Hello in Turkey!
These videos are dope. I thank you.
Hey ,you are just fabulous.
I have a question
Saline line from pressure bag should it go from below the tra nsducer or it would not matter even if it is attached above
Thank you for the great video 🥰😍
But of course my friend! Take care!
@@ICUAdvantage you too my Bestie!!!!! Take care.. love you Loads!
It would be helpful to actually see it being done its hard to imagine things for people who only been in the ICU 2-3times
Before accessing the line for a blood sample, should you scrub the hub like you do with a central or PIV?
Yup!
Great video as always!
I was wondering about the Syringe setup:
Why turn the stopcock off to patient when flushing blood out the open port after withdrawing a sample? (Why don't we just flush IV fluid + blood mix into pt like in the Traditional Setup?)
You can flush it all back to the patient, but to keep the stop cock patent flush the blood out of the port
with normal saline using the whip tail to prevent clot formation
Perhaps I didn't explain that part well. My apologies.
When it comes to dealing with the stopcock used for access, regardless of if it is the syringe setup or the traditional, we would handle it the same. Really should just flush the entire line, then make sure and turn off to the patient, and do a small flush to clear the bit of blood left in the open port on the stop cock, before turning it back off to the open port.
Do you hook the set up to the patient before inflating the pressure bag? Are all the stopcocks supposed to be off to open port before inflating the pressure bag as well? Just seeking some clarification, I have experience with A-Lines but have never set one up from scratch before.
You should have the pressure bag inflated and stop cocks open after setting up the system. This is so as soon as the provider gets in the artery it can be attached and immediately see what kind of waveform you have. There will be no saline flowing from the system even with the pressure bag inflated and stop cocks open because in order to open the flow, you have to pull your little flush tail. If you think about drawing blood from an A-line, it doesn't automatically flush itself even when the stop cocks are in the "open" position until you pull the tab to flush it.
@@brittanybb01 I don't disagree with with pressurizing the fluid bag prior to connecting the pressure tubing to the arterial catheter, but I disagree with your statement about "There will be no saline flowing from the system even with the pressure bag inflated and stop cocks open."
Pressurizing the system serves 2 main functions...
1. Allows you to use the flush device to flush the line.
2. Provides slow continuous flow of fluids through the line to maintain line patency. 3 mL/hr approximately when the pressure bag is inflated to 300 mm Hg. Eddy even mentions this in the video but states 3-5mL/hr.
This is not too important to know in most cases but if you are using a traditional setup to collect blood this concept is extremely important because you can potentially dilute the blood you collect.
@@jordankim2133 Technically you are right. Practically, however, the 3ml/hr is insignificant as you usually set up your system right before the provider inserts the line and it shouldn't take them hours to insert it (fingers crossed anyway lol). Collecting blood is a different topic and I always clamp when collecting blood. I was just using that as an example to explain that the saline is not going to "pour" out when stop cocks are open.
Good questions. So it truly doesn't matter if the bag is inflated or not prior to attaching to the patient. That said, have it inflated and ready to go. You will not get an accurate reading on your pressure until the bag is inflated, so have it all ready to attach and get your pressure right away.
And yes, stopcocks off to open ports and capped when not in use. Only open them during priming, or if you need access. Otherwise, keep them off.
Hope that helps!
Would you still take blood samples from a central line if they have an arterial line? Are the lab values different between them?
You can. For some things the lab values can be different. Obviously ABG vs VBG, but even the value of lactate can change. It can all be accounted for as long as the specimen is properly identified where it was drawn from.
As for your question, you certainly could draw from either if you have both, but typically the a-line is going to be the easiest and is typically what we use when we have it.
What height should bag be placed?
It truly doesn't matter. Its pressurized. Ideally above heart, but being pressurized it still works if below.
Hey I'm looking for the notes. Please assist me to locate them. Thank you!
So sorry this slipped past me. If you go to the main ICU Advantage CZcams page then look for the "Community" tab, you'll find the link to the notes with the months current password.
From a patient’s view, I wish it was explained better. When I had to have TPN nutrition, a pic line was finally put in. It felt so much better.
Blood was never drawn from that line, nor would I let anyone from checking my blood pressure on that side. I am alive and grateful to the fabulous surgeon and Anesthesiologist I was only on the ventilator for one day, only spent 10 days in a rehabilitation hospital. I lost a lot of strength though, but I am recovering well. I will say there’s a lot of tension between the floor nurses and the intervention team. They bicker like children sometimes. I was really scared when they told me it had to go in, with minimal explanation from anyone. Thanks for listening.
Glad to hear you did well, and sorry for your experience. Where are you from?
Well, it's actually supposed to be the doctors who explain why you need one in the first place.