Arterial Line Sources of Error

arterial line arterial line complications arterial line errors invasive blood pressure monitoring invasive device patient safety May 09, 2024
Invasive blood pressure monitoring provides you with 5 key pieces of information:
 
1️⃣ Mean arterial pressure (accurate if zeroed)
2️⃣ Systolic pressure (accurate if zeroed & normal trace)
3️⃣ Diastolic (accurate if zeroed & normal trace)
4️⃣ A waveform (provides important information about accuracy of reading)
5️⃣ The heart rate
 
It is a complex system, so it helps to group the sources of error like this:
 
👉🏻 Patient errors
🔺 Vessel spasm or occlusion
🔺 Patient movement/flexion at wrist
🔺 Unilateral arterial conditions (stenosis, coarctation, dissection)
🔺 NIBP inflating on same side OR proximal compression of artery
 
👉🏻 Transducer errors
🔺 Failure to zero
🔺 Incorrect transducer height
🔺 Loose connections
🔺 Pressure bag <300mmHg
🔺 Tubing system too stiff (underdamping)
🔺 Air bubble in system (overdamping)
🔺 Other causes of overdamping
 
👉🏻 Cannula errors
🔺 Kinking
🔺 Dislodged
🔺 Clotted cannula
 
We rely on an accurate invasive blood pressure to ensure our patient is safe, so if you see a problem with your arterial line trace:
🔺 Trace quality (steep rise, curved peak, dicrotic notch)
🔺 Numbers don’t look right
 
Then use our “TRUE BP” framework to troubleshoot the problem:
 
👉🏻 Tighten connections
👉🏻 Repeat zero (and confirm transducer height)
👉🏻 Use non-invasive (to compare & ensure patient is safe)
👉🏻 Extend the wrist (if radial)
👉🏻 Bubble check (purge if required)
👉🏻 Pressure (bag should be 300mmHg)
 
Remember, measurement errors can distract you from a real patient issue, so call for help early if you can’t get an accurate reading!
 
Build knowledge ✅
Improve safety ✅
 
Ref: https://resources.wfsahq.org/wp-content/uploads/uia28-Invasive-blood-pressure-monitoring.pdf
 

 

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