07.02 Pressure Line Management

Overview

1. Purpose
   1. Transducer pressure monitoring systems are used to measure the pressure of fluid-filled spaces
      1. Arterial Blood Pressure (ABP)
      2. Central Venous Pressure (CVP)
      3. Intracranial Pressure (ICP)
   2. These systems must be managed appropriately to ensure accurate readings
      1. Every 4 hours – Level and Zero

Nursing Points

General

1. Supplies Needed
   1. The pressure monitoring system, already hooked up
      1. Pressure bag
      2. 1 L sterile fluids (usually NS)
      3. Transducer
      4. Pressure tubing
      5. Invasive line
      6. Monitor
   2. Carpenter’s Level or Laser Level

Nursing Concepts

1. Steps and Nursing Considerations
   1. Perform hand hygiene
   2. Don clean gloves
   3. Start at the fluid bag and work your way down the system
      1. IV fluid bag and tubing should not be expired
      2. Pressure bag should be inflated to 300 mmHg
      3. Drip chamber should be ½ full
      4. There should be no air in the tubing all the way down to patient
      5. All stopcocks should be open to allow monitoring
         1. UNLESS draining fluid from an External Ventricular Drain
      6. The tubing should be attached securely to the invasive line
      7. Dressing should not be expired
   4. Level the transducer stopcock to the appropriate level using the carpenter’s level or laser level:
      1. ABP – phlebostatic axis – any HOB position
         1. 4th ICS, Midaxillary line
      2. CVP – phlebostatic axis with patient flat
      3. ICP – tragus of the ear OR temple (facility policy)
   5. Zero the transducer system
      1. AFTER LEVELLING
      2. Turn the transducer stopcock to be OFF to the patient
      3. Remove the cap from the top of the transducer stopcock – maintain sterility
      4. Flush a small amount of fluid through the stopcock with the fast flush feature if needed
      5. On the monitor, select the pressure waveform, then select Zero
         1. According to manufacturer instructions
      6. When the screen reads -0-, replace the cap on the transducer stopcock
      7. Turn the stopcock back to the OPEN position
      8. Flush the line with the fast flush feature to ensure no air bubbles
   6. Once levelled AND zeroed – you can read your pressure reading and document it
   7. Remove gloves
   8. Perform hand hygiene
2. Repeat these checks every 4 hours OR with any indication of problems in the pressure line

Patient Education

1. Purpose for pressure transducing
2. Importance of not pulling on invasive pressure line
3. Notify nurse of any bleeding at site