Suturing arterial lines

[soccerplayer]

Hi everyone. A-lines are easy to pull out, and the suture groove of the white catheter seems not enough to hold the catheter in place.

Anyone have any A-line suturing tips?

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[chocomorsel]

Lots of tegaderm and tape.

 

[McPoyle]

I virtually never suture them. I like the stat lock, the key though is place it not on the catheter but on the tubing just before the connection to the catheter. Also, use the little skin prep that comes with it, this helps it stick better. We also use CHG impregnated tegaderms that secure them additionally.


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[AdmiralChz]

You shouldn't need to suture radial lines, if they are coming out then you are probably securing the tubing incorrectly. When you tape it down put a loop in the tubing distally so tension will be placed on that loop rather than the catheter insertion site. You can also use an armboard to help secure the tubing.

Suturing other a-lines (brachial, femoral) is more reasonable - use a catheter with wings if you have it. Even then you don't want tension on the actual catheter so you'll need to have a loop or something as well - those small silk sutures break pretty easily.

 

[engineeredout]

I suture a knot in the skin right next to the Aline, then I take the long end of the suture, loop it around the catheter several times (trying to keep it in that stupid groove), and then I tie it back down to the short end of the suture that is attached to the knot.

I have no idea if that makes any sense, it's hard to explain in words.

 

[Fox800]

The Arrow kits come with that little blue piece with wings that you can attach to add suture points, but it just pops off when you try to attach it to the catheter. Totally worthless.

 

[Nephro critical care]

I believe it’s good practice to suture A-lines on ICU patients. In the OR it’s ok to have that arrow catheter because you aren’t really moving the patient but in ICU where arterial line is in for a week there is every chance that it may get pulled out if patient is getting hoyer-lifted, proned or ambulated by PT/OT. I use the 20 gauge Argon catheter for all my a-lines, it has wings which make suturing easy as compared with the stupid groove in Arrow catheters in which the sutures are a pain to put in and come out very easily.

 

[kemper6036]

I definitely agree with suturing for ICU patients. multiple wraps are a good idea, and perfecting your slip knot so it will cinch around the catheter is key

 

[Nephro critical care]

Suturing those Arrows is such a PITA. The blue piece just pops off and when you try to put a knot and catch the thread in the grove it invariably slips off to the end of the catheter and is hard to get in the groove. Maybe it gets better the more you do it but honestly I need the wings with holes to have a secure catheter.

 

[psychbender]

It's been years since I've sutured an art line. Proper taping of the catheter and tubing is sufficient, in my experience, to keep it from getting pulled out. If your nurses are regularly pulling out your art lines, maybe they need some better education, not nylon.

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[drmwvr]

Never seen an a line pulled out that was sutured that wouldn't have been pulled out if taped. They bleed more too. Come to think of it, every neck line that I've ever replaced because of an inadvertent removal was sutured. Ventric drain, j-tube, t-tube, JP drain, chest tube, all sutured, all get accidentally pulled.....mf'ing foleys...another conversation all together...

 

[jdh71]

I suture every A-line, every time. Didn't realize this was "controversial".

To be clear: not making any kind of argument.

Suturing the line seems reasonable to me.

 

[Hernandez]

I suture a knot in the skin right next to the Aline, then I take the long end of the suture, loop it around the catheter several times (trying to keep it in that stupid groove), and then I tie it back down to the short end of the suture that is attached to the knot.

I have no idea if that makes any sense, it's hard to explain in words.

This sounds exactly like what I️ do and works well for me. I️ also tape the hell out of the tubing and do not loop around the thumb.

 

[Laryngophed]

It's been years since I've sutured an art line. Proper taping of the catheter and tubing is sufficient, in my experience, to keep it from getting pulled out. If your nurses are regularly pulling out your art lines, maybe they need some better education, not nylon.

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While true, I choose to fight battles I can win. And a 2-0 silk is a much easier fight. FWIW, I only suture them in with someone I expect will keep it for more than a day or two.

 

[BigRedBeta]

Pretty much a requirement in the kiddos. Would have been strung up by my thumbs if I had tried to get away without suturing one during my PICU fellowship.

 

[Doctor Bob]

I put all of my patient's with A-lines on nimbex drips.

Saves me the trouble of suturing.

 

[vector2]

If you dry the patients wrist thoroughly, use a sticky CHG tegaderm, and loop and secure with silk tape so the tension is not on the catheter insertion site then suturing is completely unnecessary.

 

[Fox800]

One of the tricks I learned was twisting the catheter hub into the line, instead of twisting the line onto the catheter hub. Keeps the tubing from trying to unwind and pulling the catheter out.

 

[Bostonredsox]

ive never sutured nor felt the need to suture an A line in the wrist. tegaderm/bio-occlusive dressings with tape. i also loop the tubing around the pts thumb and then put a circumferential piece of tape around the catheter and the tubing at the insertion site. if someone yanks it, theyll be pulling against the thenar imminence and its highly unlikely to pull out. femoral lines I suture

 

[UKEMdoc]

Cyranoacelate wound glue plus ninja taping skills.

 

[lymphocyte]

Cyranoacelate wound glue plus ninja taping skills.

I just did this on a crash femoral line. Worked really well. Thank you for the tip.

 

[anbuitachi]

i tape it so hard i think i can lift the patient up by the arterial line without it coming out

 

[Hamhock]

i tape it so hard i think i can lift the patient up by the arterial line without it coming out

Based on many posts in this thread (including novel, to me, tricks; thanks Fox800), I think I am going to change my practice.

I think if I was an anesthesiologist, I would have been a taper long ago; but even in the ICU, I think a trial of extra secure taping using suggestions in this thread is worth a go.

HH

 

[stillers]

I suture a knot in the skin right next to the Aline, then I take the long end of the suture, loop it around the catheter several times (trying to keep it in that stupid groove), and then I tie it back down to the short end of the suture that is attached to the knot.

I have no idea if that makes any sense, it's hard to explain in words.

Agree, do the same thing with the Arrows. Anchor suture on the side, then wrap around the catheter, and tie to anchor. Works much better than the blue holder or suturing the catheter directly to skin. Wish I had figured this out as an intern =) For the Cook kits, much easier as the side wings are on the catheter itself.

 

[engineeredout]

Agree, do the same thing with the Arrows. Anchor suture on the side, then wrap around the catheter, and tie to anchor. Works much better than the blue holder or suturing the catheter directly to skin. Wish I had figured this out as an intern =) For the Cook kits, much easier as the side wings are on the catheter itself.

Actually since I made that post, I started working at another institution that has these things:

Works pretty well for keeping your Alines in place without suturing, especially if you use some skin prep to make the skin extra sticky. The blue part snaps around the Aline catheter (not the iv tubing like this picture shows). Haven't really been suturing them down since.

They do make an equivalent one for TLCs but I think it's much less secure and really don't need the central lines falling out.

 

[Hamhock]

Actually since I made that post, I started working at another institution that has these things:

Works pretty well for keeping your Alines in place without suturing, especially if you use some skin prep to make the skin extra sticky. The blue part snaps around the Aline catheter (not the iv tubing like this picture shows). Haven't really been suturing them down since.

They do make an equivalent one for TLCs but I think it's much less secure and really don't need the central lines falling out.

StatLocks are great for PIV.

I thought they didn't fit the Arrow aline catheter hubs securely. Are you referring to the Arrow in your post above?

Also, are you able to get the StatLocks without the rest of the "PIV kit". That is, are they sold alone?

HH

 

[Siggy]

Actually since I made that post, I started working at another institution that has these things:

Works pretty well for keeping your Alines in place without suturing, especially if you use some skin prep to make the skin extra sticky. The blue part snaps around the Aline catheter (not the iv tubing like this picture shows). Haven't really been suturing them down since.

They do make an equivalent one for TLCs but I think it's much less secure and really don't need the central lines falling out.

My hospital only stocks the 20cm CVC kits. One of the tricks I like is for right IJs I'll suture the Second Site hub at the insertion site, but use a PICC line StatLock for the CVC hub. 2 less sticks for the patient.

 

[Crash44]

Kind of old but the only thread that I found with a similar topic…are any of your institutions making you Statlock (and not suture at all) your central lines for infection prevention?