Management of arterial lines and blood sampling in intensive care: a threat to patient safety

Abstract

Summary In 2008, the UK National Patient Safety Agency (NPSA) made recommendations for safe arterial line management. Following a patient safety incident in our intensive care unit (ICU), we surveyed current practice in arterial line management and determined whether these recommendations had been adopted. We contacted all 241 adult ICUs in the UK; 228 (94.6%) completed the survey. Some NPSA recommendations have been widely implemented – use of sodium chloride 0.9% as flush fluid, two‐person checking of fluids before use – and their practice was consistent. Others have been incompletely implemented and many areas of practice (prescription of fluids, two‐person checking at shift changes, use of opaque pressure bags, arterial sampling technique) were highly variable. More importantly, the use of the wrong fluid as an arterial flush was reported by 30% of respondents for ICU practice, and a further 30% for practice elsewhere in the hospital. Our survey provides evidence of continuing risk to patients.

An analysis of patient safety incidents associated with medications reported from critical care units in the North West of England between 2009 and 2012

“…There has been more limited improvement in medication safety; for example, guidance published in 2008 [31] to improve arterial line safety has clearly not yet translated into widespread change in clinical practice [33]. The reasons for these differences in improvement rates between medication and airway safety remain unclear, but may reflect differences in the level of attention the two types of problem have received from professional organisations.…”

Finding a solution: Heparinised saline versus normal saline in the maintenance of invasive arterial lines in intensive care

“…In 2008, the National Patient Safety Agency (NPSA) published a report recommending exclusive use of 0.9% normal saline (NS) as an arterial flush solution: subsequently use of HS in UK adult intensive care units has reduced to 4.6%. 3,4 Despite this, 1 Intensive Care Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK serious errors involving administration of incorrect arterial flush solutions continue to occur. 5 In a recent publication, catheters flushed with HS had an increased lifespan and a significantly reduced likelihood of blockage.…”

The effect of hyperglycaemia on haemostasis testing – a volunteer study

“…Among the various types of potential errors that may occur during blood collection from vascular devices, blood sample contamination with glucose solutions has been described as an important cause of spurious hyperglycaemia [2,3], which may occasionally lead to serious harm due to unwarranted prescription of insulin and consequent iatrogenic hypoglycaemia [4,5].…”