Introduction
The therapeutic modality chosen for this research is invasive blood pressure monitoring via the cannulation of a peripheral artery. The expediency of this choice is presupposed by the modality’s meeting the particular criteria. First of all, it requires specific training above and beyond general entry-level nursing education. In addition, it is applied to extremely ill patients in special circumstances, such as in the case of Mr. Johnson. Mr. Johnson is a 50-year-old African American who has recently undergone a stomach operation. However, this intervention was complicated by substantial body loss. In addition, the patient has an increased risk of cardiovascular issues. In this case, he requires constant blood pressure monitoring, which is impossible with interval non-invasive procedures. In this paper, arterial cannulation, its benefits and complications, and related nurses’ responsibilities will be reviewed.
Explanation and Background
Transducing arterial blood pressure is the continuous invasive monitoring of systemic and pulmonary blood pressure performed via a peripheral artery’s cannulation. The cannula is an arterial catheter in the form of a thin and hollow tube; in the intensive care unit (ICU), it is frequently called an ART line (“Arterial catheterization,” 2018). Via non-compliant fluid-filled tubing, an ART line is connected with the transducer. Every cardiac contraction produces pressure, resulting in the fluid’s mechanical motion being transmitted to the transducer (Nguyen, 2022). In turn, the transducer converts this motion into electrical signals performed in the monitor in the format of numerical pressures and beat-to-beat arterial waves (Nguyen, 2022). Continuous blood pressure monitoring is traditionally applied in ICU, which practice presupposes related expenditures.
While transducing arterial blood pressure cannot be regarded as a safer intervention in comparison with a non-invasive one, it is essential for critically ill hospitalized and surgical patients who require constant blood pressure monitoring. In addition, this technology is also applied to patients treated with vasoactive medications and patients who need frequent lab draws (Nguyen, 2022). In these cases, invasive monitoring reduces the risk of infection and enhances the accuracy of treatment.
Risks and Benefits
As previously mentioned, invasive blood pressure measurement is highly important for ICU patients who are particularly vulnerable to morbidity and mortality due to complicated treatment or pre-existing comorbidities. For them, interval blood pressure monitoring may be unsafe as it does not allow to detect of vital changes. In turn, transducing ensures timely attention and accurate assistance if necessary. In addition, positive outcomes are promoted for a patient by having an ART line that allows them to repeat invasive arterial procedures without a substantial risk of infection and manage the correct dosage of medicines.
However, arterial cannulation cannot be regarded as routine patient care. Thus, it is not prescribed for every surgical patient, and contraindications include “infection at the site of insertion, an anatomic variant in which collateral circulation is absent or compromised, the presence of peripheral arterial vascular insufficiency, and peripheral arterial vascular diseases such as small to medium vessel arteritis” (Nguyen, 2022, para. 7). They may lead to serious complications, such as infection, an arteriovenous fistula, a hematoma, the stenosis of vessel, and blood loss. In order to prevent them, healthcare providers should pay particular attention to patients’ health conditions or physical peculiarities to define whether arterial cannulation is allowed or not.
Interdisciplinary Team’s Roles and Responsibilities
Invasive blood pressure monitoring may be performed by one medical specialist or a group. In other words, the insertion of ART lines may be made by critical care, thoracic, or cardiac surgeons, emergency medicine and critical care doctors, respiratory therapist, Certified Registered Nurse Anesthetists, and advanced practice registered nurses who have “substantial specialized knowledge in intravenous therapy and vascular access practice” (Kentucky Board of Nursing, 2020, p. 3). In turn, monitoring may be performed by ICU doctors and nurses with related competence.
Nursing Scope of Practice
As previously mentioned, a nurse cannot measure arterial blood pressure by applying arterial cannulation without specialized training that provides essential knowledge and skills. They are related to this procedure, including the insertion and removal of an ART line, safety standards, possible complications and their prevention, and monitoring of waveforms (Pierre et al., 2022). At the same time, a qualified Registered Nurse may perform this procedure or assist another specialist. In addition, a nurse is able to assess the arterial waveform and address potential inaccuracies being responsible for the a-line’s zeroing after blood draws, when the shift is changing, every four hours, and any time when accuracy is required (Saugel et al., 2020). Moreover, a nurse should constantly monitor the patient’s well-being and the site of insertion in order to detect any sign of hematoma formation, bleeding, or infection.
Patient Education
As arterial cannulation is not routine patient care, only qualified healthcare providers should be responsible for its performance. In this case, a nurse should educate patients and their family members prior to the procedure. First of all, he or she should explain the purpose of this intervention and its step to avoid major concerns and misunderstandings. In addition, a nurse may provide a handout with the general rules and the rules of hygiene for patients with an ART line. Moreover, a nurse should underline that all manipulations should be performed by health care providers, however, patients should be informed about potential complications and their signs to be able to report them to clinicians as soon as possible.
Conclusion
Transducing arterial blood pressure is the procedure of a peripheral artery’s cannulation for continuous monitoring of systemic and pulmonary blood pressure. It presupposes the insertion of an ART line that transmits mechanical motion produced by cardiac contraction to the transducer via fluid-filled tubing. The transducer converts them into electrical signals that may be seen in the monitor for the continuous control of blood pressure. This procedure is essential for critically ill ICU patients who have an increased risk of mortality and morbidity due to pre-existing health complications or surgery and other complex interventions. It allows healthcare providers to monitor their blood pressure in a time-sensitive manner to avoid medical errors and devastating consequences.
In turn, not every ICU patient requires arterial cannulation, which may lead to particular complications, such as blood loss, bleeding, and hematoma. For their prevention, an interdisciplinary team should have particular knowledge and skills essential for this procedure. However, a Registered Nurse should undergo training to be able to perform invasive blood pressure monitoring. In addition, patients should be informed about the purpose of the procedure, its steps, and their actions in the case of complications as well. At the same time, considering the case of Mr. Johnson, it is possible to continue the current research and address the impact of race or age on the aspects of arterial cannulation with the use of theme-related scholarly resources.
References
Arterial catheterization. (2018). American Thoracic Society. Web.
Kentucky Board of Nursing. (2020). Placement of central and arterial lines and arterial blood sampling by nurses. Kentucky Board of Nursing. Web.
Nguyen, Y. (2022). Arterial pressure monitoring. StatPearls. Web.
Pierre, L., Pasrija, D., & Keenaghan, M. (2022). Arterial lines. National Library of Medicine. Web.
Saugel, B., Kouz, K., Meidert, A. S., Schulte-Uentrop, L., & Romagnoli, S. (2020). How to measure blood pressure using an arterial catheter: A systematic 5-step approach. Critical Care, 24(1), 1-10.