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07.02 Pressure Line Management

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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

Reference Links

Video Transcript

In this video we’re going to look at how to assess, level, and zero a pressure line. In this case, we’ll look at an arterial line, but they’re all very similar.

First, I always start at the fluid bag when I’m assessing and work my way down towards the patient.
The pressure bag should be inflated to 300 mmHg – there’s usually a green indicator line, so just add more pressure if you need to.

The IV fluid bag and tubing shouldn’t be expired and the drip chamber should be about ½ full.

There should be no air in the tubing all the way down to patient and all stopcocks should be open to allow monitoring. The only exception here is if you’re draining fluid from an External Ventricular Drain.

The tubing should be attached securely to the invasive line, wherever it is, and the dressing should not be expired.
Now that you know everything is as it should be, you can level the transducer. In the case of an arterial line, we’re going to use the patient’s phlebostatic axis, which is the 4th intercostal space, midaxillary line.

Line up the transducer stopcock with the phlebostatic axis using a carpenter’s level or laser level. The bed should be in the lowest, locked position, so you may have to move the transducer itself up or down a little.

Once you’re level, you can zero the transducer system. Start by turning the stopcock OFF to the patient.
Then you’ll remove the cap, keeping it sterile, to open the system to air. So off to the patient, open to air.

Sometimes I’ll flush a little bit of fluid through this to make sure there are no air bubbles.
Now, on the monitor, select the pressure waveform, then select Zero. This may look different depending on the type of monitor.

When the screen reads -0-, replace the cap on the transducer stopcock and turn the stopcock back to the OPEN position.
Flush the line with the fast flush feature to ensure there are no air bubbles.
Once it’s levelled AND zeroed – you can read your pressure reading and document it.

Now, in your outline, we’ve listed the different places you’ll level to depending on the type of line it is, so make sure you review that.
Freeze video – gray out

Now, go out and be your best selves today. And, as always, happy nursing!

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