Arterial Line System Setup and Management

Preparation and Materials

The American Society of Anesthesiologists recommends using only sodium chloride 0.9% (with or without heparin) as the arterial line flush solution to prevent dangerous sampling errors 1, 2
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 2

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

Ensure arterial infusion lines are clearly identifiable with labels and color differentiation 1
Use pressurizing devices designed to permit unimpaired inspection of the contained flush infusion bag 1
Use a fully transparent front panel on pressurizing devices 1
Set up the system to minimize dead space volume between sampling port and arterial lumen 1

Use 'closed' arterial line sampling systems when possible to avoid sample contamination with flush infusions 1, 3
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

Independently double-check the flush infusion bag at least once during each nursing shift 4
Double-check the flush bag whenever nursing care of the patient is handed over 4
Include removal of the flush bag from its pressurizing device during checks 4

Be aware that arterial line sample contamination errors can result in serious patient harm, particularly hypoglycemic brain injury 5
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 4
Check the source of blood samples to ensure no possibility of contamination 4
If contamination cannot be ruled out, draw a confirmatory sample from an alternative site 4

Avoid using glucose-containing solutions as arterial line flush, as even minimal contamination can lead to dangerous sampling errors 5
Be cautious with sodium chloride 0.9% with glucose 5%, which can be easily confused with plain sodium chloride 0.9% 3
Watch for erratic or highly varying sequential test results, which should heighten suspicion of blood sample contamination 5
Remember that even with proper technique using 5× dead space removal, significant glucose contamination can occur with glucose-containing flush solutions 5