1998 OPEN FORUM Abstracts
INITIAL EXPERIENCE WITH A RESPIRATORY-THERAPIST ARTERIAL LINE PLACEMENT SERVICE
Daniel D. Rowley, RRT, CPFT, David F. Mayo, RRT, Charles G. Durbin, Jr., MD Surgical Services, University of Virginia Health System, Charlottesville, VA
Introduction: Indwelling arterial lines are often placed in critically ill patients to facilitate frequent blood sampling and for continuous arterial pressure monitoring and manipulation. Surgical housestaff and medical students usually place these lines with a varying degree of efficiency and success.
Methods: In order to improve efficiency and quality of line placement, 11 respiratory care practitioners (RCPs) completed a competency program for arterial catheterization and stabilization. Success in the educational program consisted of demonstration of cognitive and psychomotor skills and included use of subcutaneous local anesthesia and securing the line with surgical sutures. Following completion of the program, timeliness and quality data was collected on all arterial lines placed by RCPs. Success rate and complications were determined for 71 arterial cannulations attempted by RCPs.
Arterial Site # Attempts # Successful
Radial 60 57
Dorsal Pedal 11 11
Successful on: # Lines Cumulative %
First Attempt 57 81
Second Attempt 6 89
Third Attempt 5 96
Never 3 (4%)
Arterial Site Comments
Dorsal Pedal 8 in Burned Patients
Successful on: Comments
Second Attempt 2 MDs, 4 RCPs
Third Attempt 2 MDs, 3 RCPs
Overall success rate for RCP placement was 90%. There were no significant hematomas, local infections, neurologic deficits, skin lesions, or distal emboli related to line placements. Several lines were inadvertently removed accidentally by agitated patients without complications. In addition to the primary line placements described above, several existing lines that became dysfunctional were successfully replaced by RCPs using the Seldinger (catheter-over-a-wire) technique. The average time required for line insertion was 15 minutes, 90% of catheters were placed in less than 30 minutes.
Conclusions: RCPs can easily learn to safely and effectively place and suture indwelling arterial lines in critically ill patients. RCPs may provide a cost effective alternative to physician placement.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.