Arterial line question

[waterbottle10]

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Anyone know why we use normal saline for arterial lines and not plasmalyte? We use plasmalyte for 99% of pts for fluid but use only NS for a line. Why is this? Couldn't find a good reason on Google

 

[deleted87051]

Anyone know why we use normal saline for arterial lines and not plasmalyte? We use plasmalyte for 99% of pts for fluid but use only NS for a line. Why is this? Couldn't find a good reason on Google

Habit? Plasmalyte would be fine.

 

[McPoyle]

Wait, you use plasmalyte as your standard fluid? I mean I know the theoretical benefits and I use it for cases where I expect large volumes and metabolic derrangements (liver tx, thoracos, etc), but never heard of anyone using it routinely?


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[partydoc]

We use it routinely. Don't even have LR available in the OR

 

[fakin' the funk]

Anyone know why we use normal saline for arterial lines and not plasmalyte? We use plasmalyte for 99% of pts for fluid but use only NS for a line. Why is this? Couldn't find a good reason on Google

It is easy to find in 500ml bags?

 

[waterbottle10]

Wait, you use plasmalyte as your standard fluid? I mean I know the theoretical benefits and I use it for cases where I expect large volumes and metabolic derrangements (liver tx, thoracos, etc), but never heard of anyone using it routinely?



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Yea it's our routine go to fluid we use in OR and pacu. Even small cases like cataracts

It is easy to find in 500ml bags?

We use 1L NS for our arterial lines

 

[Druggernaut]

Habit? Plasmalyte would be fine.

Plasmalyte is also more expensive, even if it's not by much.

 

[anbuitachi]

All our attendings use NS here at our institution. I'm not sure why. One of them i believe mentioned it was due to plasmalyte having potassium in it, but not sure what that would cause

 

[WholeLottaGame7]

All our attendings use NS here at our institution. I'm not sure why. One of them i believe mentioned it was due to plasmalyte having potassium in it, but not sure what that would cause

Are you talking for arterial line setups or for intra-op fluids?

 

[anbuitachi]

Are you talking for arterial line setups or for intra-op fluids?

Arterial line

 

[WholeLottaGame7]

Arterial line

Gotcha. The way you worded it was just strange. Choice of fluid for arterial line setups is not something you typically choose on a case-by-case basis. The institution usually has a policy or preference and the anesthesia techs set it up a certain way.

 

[GABAergic]

All our attendings use NS here at our institution. I'm not sure why. One of them i believe mentioned it was due to plasmalyte having potassium in it, but not sure what that would cause

Are these the same attendings that demand only NS IVF for patients with renal insufficiency or ESRD? All these balanced solutions have electrolytes in essentially physiologic concentrations. Shouldn't make a bit of difference whether that solution enters through an artery or a vein.

On the other hand, I have heard of an accidental use of dextrose-containing fluid being used for an a-line. Eventually discovered as the patient required more and more insulin.


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[deleted87051]

All our attendings use NS here at our institution. I'm not sure why. One of them i believe mentioned it was due to plasmalyte having potassium in it, but not sure what that would cause

The plasma pulsing through the artery has potassium in it too.

 

[anbuitachi]

The plasma pulsing through the artery has potassium in it too.

Ya I know, that's why I dont really get it.

Are these the same attendings that demand only NS IVF for patients with renal insufficiency or ESRD? All these balanced solutions have electrolytes in essentially physiologic concentrations. Shouldn't make a bit of difference whether that solution enters through an artery or a vein.

On the other hand, I have heard of an accidental use of dextrose-containing fluid being used for an a-line. Eventually discovered as the patient required more and more insulin.


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Some of them use NS IVF for ESRD.
I do what i'm told since im not an attending yet.

However I have had an attending who showed me a paper saying that NS increases plasma K more than plasmalyte due to it's acidity.

 

[twoliter]

I'm kinda surprised this thread has gotten this long. Nearly everything we do is based on a risk:benefit:cost analysis, right? If awake fiberoptic intubation is the often the safest technique for a difficult airway, why not AFOI everyone? Because there's not much to gain on an easy airway, but it's distressing to the patient and adds costs and time unnecessarily.
I see this as the same thing. What benefit would you get from using Plasmalyte for the arterial line transducer fluid? Not much because you're only using a couple mL/hr. Plasmatlyte/LR vs NS for maintenance/bolus IVF in the OR is different. In that case you're potentially using 2-5+ liters of fluid. That can make a difference. NS is a little cheaper so why not use it for arterial lines.

 

[Laryngophed]

... the anesthesia techs set it up a certain way.

Ha! HA! HAHAHAHAHAHAHAHAHAHAHAHA!

Tell me where I can find these mythical anesthesia techs that set up lines. They are like unicorns, the yeti, and specialists at the VA after 1600. Often spoken of, rarely seen.

 

[anbuitachi]

Ha! HA! HAHAHAHAHAHAHAHAHAHAHAHA!

Tell me where I can find these mythical anesthesia techs that set up lines. They are like unicorns, the yeti, and specialists at the VA after 1600. Often spoken of, rarely seen.

The techs are great here. They usually put couple bags of NS on our carts so we can use it for A lines so I dont have to hunt down NS myself

 

[WholeLottaGame7]

Ha! HA! HAHAHAHAHAHAHAHAHAHAHAHA!

Tell me where I can find these mythical anesthesia techs that set up lines. They are like unicorns, the yeti, and specialists at the VA after 1600. Often spoken of, rarely seen.

You picked the residency program, not me. Hell, even at the VA the techs would set them up a good 80-ish% of the time.

 

[deleted87051]

Ha! HA! HAHAHAHAHAHAHAHAHAHAHAHA!

Tell me where I can find these mythical anesthesia techs that set up lines. They are like unicorns, the yeti, and specialists at the VA after 1600. Often spoken of, rarely seen.

That's too bad. I'm in MD only PP. I come in at 5:55 to get a heart back to the room at 6:15. Everything is set up for me by our techs. I'm spoiled🙂

 

[anbuitachi]

That's too bad. I'm in MD only PP. I come in at 5:55 to get a heart back to the room at 6:15. Everything is set up for me by our techs. I'm spoiled🙂

Thats messed up

 

[OB1🤙]

That's too bad. I'm in MD only PP. I come in at 5:55 to get a heart back to the room at 6:15. Everything is set up for me by our techs. I'm spoiled🙂

Wow that's early.

I show up at 645 to get my heart in the room at 7.

 

[deleted87051]

Wow that's early.

I show up at 645 to get my heart in the room at 7.

I need to empty my bladder and fill it with coffee.