The National Patient Safety Agency (NPSA) has issued a Rapid Response Report to healthcare professionals in the UK to offer guidance for arterial line use following reports of problems with infusions and sampling.
Arterial lines are routinely used in critical care areas to obtain samples of arterial blood, to test for blood gases, glucose and electrolytes. Slow infusions of sodium chloride or heparinised saline are currently used to keep the arterial line open. Patients may be harmed if the wrong infusion is given to keep the line open or when poor sampling leads to delayed or inappropriate treatment.
Contributing factors include similar labelling and packaging of intravenous infusion bags and inadequate checking before attachment. A particular risk is the need to cover the infusion with a pressure bag which obscures the label during use.
Risks of confusion are increased when patients are transferred from other areas. Sampling errors include problems when taking and managing the samples, contamination by inadequate flushing and confusing arterial with venous lines.
The report calls for immediate action to ensure sampling from arterial lines is performed by competent, trained staff. Arterial infusion lines must be clearly identified. Any infusion (or additive) attached to an arterial line must be prescribed and checked before administration. Staff should use only sodium chloride 0.9% to keep lines open.
To minimise risks, clinical teams should ask:
• Have I recorded the clinical reason for inserting this line? Is it clearly marked as an arterial line?
• Do I need to take this sample?
• Do I know how to do this safely?
• Have I picked the right infusion fluid bag?
• Did someone else check this?
• Can the label be seen, even if pressure bags are used?
• Is the reading from the sample within the expected range? Could it have been contaminated?
