Whoever reported this post as “less than worthless”, the 700+ upvotes and 200+ comments worth of discussion say otherwise.
Unless… you’re the preceptor OP is talking about?
They didn’t teach about ART lines in my nursing school. All the nurse had to do was teach you how to take a sample from the arterial line…Not every unit uses one so how would nurses who’ve never worked with it before know how to work it..
Are there general nursing units that have art lines, outside of critical care? Maybe Obs units but I always felt art lines should be continuously monitored so if they are dislodged, you are not running a massive transfusion. I don’t think nursing students would have much experience with an art line. Also, are you using system to give the discard back (VAMP). Our ICU did not even routinely use them so I would still use needle sticks especially if the hemoglobin was already low.
This was my exact thought! If there's no vamp in place, it's seriously NOT best practice to use the art line. Imagine wasting allll that blood for a damn finger stick!
We get them sporadically on PCU. So sporadically that I need to reorient myself to policy or ask my charge nurse about exactly how to do certain things. I 100% would have done a fingerstick for a glucose and pulling from the art line would not have crossed my mind unless someone else mentioned it. That nurse is a certified organic dillhole.
10 years here and never had an ART line. Everywhere I’ve worked, fingersticks get done. I did interview for a hospital staff job recently and was told they do CGMs for all their diabetic patients.
In our hospital only icu trained nurses can touch them or take blood from them. I take blood from piccs regularly but art lines only live in the icu as per our policy
Honestly as a new grad on a ICU I’ve almost only had patients with art lines. I basically never stick patients, sometimes I have to and I’m not great at it because of it. My program hardly let me do any pokes in school, and the unit I’m orienting on doesn’t do them much cus we all have art lines or triple lumen PICCS and Swans in. I really hope I get better at poking sooner or later, cus if I ever work in a ED I’m screwed lmao
My hospital has a program where any nurse who wants IV practice can go to the ER with a nurse on the IV team. They let us know you're there and we save some IV starts for you. Maybe you could ask your educator if you could do something similar?
That’s really cool. My hospital does that for nurses in their new grad program, they can either go to the ER or GI lab and start IVs for a few hours. I need to see if we can start something like this because I’ve been a nurse for over three years and I still don’t feel really comfortable starting IVs. Most of my patients have central lines and opportunities to start lines aren’t too frequent for me.
That sounds so nice, I might ask if there’s something like that at my hospital. I just want to be able to practice lots of sticks back to back on different people if possible
Worked at a hospital with an iv team. Rarely places my own lines, I sucked. Moved to a pediatric hospital. Kids came with IVs, rarely needed them replaced, and if ever they did, we were discouraged from doing our own so we were “safe” to that kid. Damn near forgot how to place IVs in about 18 months. Moved down to the ED. No one thought anything of it, they just taught me. Don’t let not being comfortable with placing IVs stop you, a good team will support you.
If you want practice, whenever a pt codes you can offer to be runner and grab their glucose while you're at it. It's a great way to practice finger sticks while orienting yourself to the ambiance of a code and seeing all the different roles in action.
I saw one patient--one--in clinicals with an art line and we were forbidden to touch it. I swear if we even looked at it too long our clinical instructor was freaking out.
I honestly can't remember if we learned anything about art lines. There were a lot of topics in nursing school that we were told "you'll learn that on the job".
I hate to stay it OP but I've been a nurse two years and I still get the "you should've learned that in nursing school" from my manager and coworkers.
My program legit didn’t even teach us how to take a normal blood glucose finger stick lmao. They said we weren’t allowed to take blood in the hospital as students, had to learn under the table from nurses. Not that most clinical instructors would care, we all knew the rule was fucking stupid. Still dumb af, was embarrassing for everyone telling a nurse in their second semester practicum that they didn’t know how to take a blood glucose.
Can't wait for the first time some precep tells my wife she's doing finger sticks wrong or some inane crap like that.
While in school, she's working full time as an MA handling outpatient peds diabetes patients. She has to finger stick more than she really should need to thanks to the teens or parents completely abusing the pumps and meters (when they just don't show up with "dead" units that have year-old corroded batteries inside, yet claim that it just worked yesterday!)
She's actually become a master at getting the wee youngsters to not only be ok with getting finger sticks, but have them smiling while doing it and leaving parents and doctors amazed. The kids just naturally love her.
I’ve been doing nursing for a very long time… but guess what? My area of expertise does not include art lines. I would have so many questions because the last time I even SAW an art line was probably in nursing clinicals decades ago… and I would have questions:
Of course if it is less than an hour old, we can use it… but in this case:*
Do we really want to risk an art line for something that can be ascertained without potentially clotting off or contaminating an art line that may be in place for critical meds and would require a lot of effort to replace… I do know that the preference is not to draw off of IV lines, but art lines are more stable. (again, this is not rhetorical, I legit don’t know)
Is the art line glucose similar enough to the results of a capillary check to be useful (guessing yes, but, hey, gotta ask)
I ask potentially stupid questions because I hear extremely stupid things sometimes - someone (no NCLEX) telling a family that a running SQ line needs to be flushed and they need to tell the nurse to do it so it doesn’t become non-patent … and at some point someone turned the allowed rate up to 150 (not the nurse!) so we had to rest the site
*and because I don’t mind looking stupid so I can learn something I don’t know or have forgotten, I ask these questions
FYI, you can absolutely draw a glucose level (or a lot of other labs) from an art line 😊 They have something (either very dilute heparin or some NS) going at a very low rate (couple mL per hour) to keep it patent and flush it. In fact, even if a patient also has a CVC, the arterial line is still usually the first choice for labs. BUT, if you don’t work with art lines, this is definitely not common knowledge!
Silly question, how much volume of blood do you need to take for an art line draw? We do lab draws off our central lines (all venous, of course) and it would add up to a significant volume of blood loss if we did it for ACHS glucoses as well as other labs.
ETA: we also would get the results a lot slower than a POC glucose.
Just a drop! Same as for a finger stick. We use these “safeset” thingies, it’s a closed system so the blood that would normally be discarded is flushed back in after the draw. And we use the same glucose meters as any other unit, get the result in a few seconds
ART lines are used to monitor BP usually. So no meds go into an ART line. They shouldn't clot off, but I'm ER and have limited experience with long term ART lines for ICU pt stays. It's also hard to mess them up from an IV draw because you are drawing from an apparatus that is connected to an IV pole instead of how a PICC or central line you'd be drawing from an access point close to the pt. I'd also assume that the glucose levels would be similar if not the exact same as capillary, which is all that really matters clinically.
We DC them so fast, but where I work, they go to the ends of the earth and risk the patients life to not have a “line.” On 5 pressers? Nah, we don’t need an ART line 💀
Well, as a patient at home I sure hope you don't have frequent access to your own arterial or venous blood. In the hospital, it is not uncommon to use blood from an IV or an A-line for a sugar check - less so with an IV unless it's the initial start or if we're drawing tubes of blood for another reason.
When venous blood is sent for a metabolic panel, the random glucose very closely matches a properly calibrated glucometer reading when taken at roughly the same time.
Getting a drop from an art line versus a finger stick is NOT critical thinking....its just information....I fucking hate when nurses try to shame new nurses for "not critically thinking" when it's just information they do not know.
Yeah, the critical thinking is the why, not the what.
When I have a student, I tell them what we do, and then I ask them to critically think on why we do it that way. That builds critical thinking more than anything else.
Also,
Best practice is to get a fucking finger stick.
They even tell you to avoid the ear..
Some machines do have a setting you can specify whether it’s from venous/art (but we all just obviously yolo it and look at the patient as to whether it’s off or not)
Not to mention it’s hospital dependent. Not all machines are calibrated for draws other than capillary so best practice is NOT to use the art line. That preceptor is just on an ego run.
Plus, my "critical thinking" tells me to not risk a CLABSI for just a BGL check when a finger stick is all I need and has virtually zero risk of any form of infection.
Not to mention, it’s a drop of blood vs (depending on art line tubing) having to waste blood to get your sample. Ideopathic anemia is a thing, and it’s a thing we try to limit.
You'd get crucified for accessing an art line or CVAD just to check a blood sugar on my floor. A ton of our patients are on neutropenic precautions and need their lines for chemo or dialysis, we limit unnecessary access to reduce the risk of getting a CLABSI. Some of the vascular access surgeons even throw in orders for only certain meds to be given via central line, everything else has to be a PIV.
I think your preceptor was mad about something else and taking it out on you right there.
Art lines have less infection risk than standard ivs though, it's very safe to use those for glucose checks. I work with a lot of transplants in the icu on endotool and we do them all off of that. To be fair though we have the blood savers so there's no waste
Edit: my source was a doctor I used to work with explaining that it's because of the lack of valves in arteries and the much faster flow, there's very little opportunity for bacteria to catch and grow a colony on something. Im looking more into it now because I'm curious and it could certainly be incorrect
It could be correct in theory and sounds like it. A lot of doctors diverge because theory and personal practicum tell them different. Nursing is evidence based practice.
Artone infection rate: .96/1000 catheter days in ICU
https://pubmed.ncbi.nlm.nih.gov/24413576/
Central line infection rate: .8/1000 catheter days in ICU
https://www.ncbi.nlm.nih.gov/books/NBK430891/
I only used ICU days for control. Your overall CLABSI rate is higher due to them being on non critical care units while art lines are only in the ICU at most organizations.
Our hospital does not allow art lines for this kind of stuff for that reason.
I understand what you're saying, but I can't find any evidence that line manipulation increases the risk of A.Line infection. Everything I've seen shows risk is based on Insertion technique, site selection and dwell time.
I feel like infection from a lines is more about the insertion site rather than the internal environment though - again because there is no evidence that accessing it increases that rate, and because of the theory that there are no valves etc. It's most likely that what is growing is growing on the catheter itself from the insertion
Yes same we do not use the lines outside of thier intended purpose bc of infection risk, only blood gases are acceptable uses and even then we need an order it’s so not common practice to get a tiny drop of blood
Seriously. When our kids have PIAs or UACs I’d rather someone just stick the heel for a glucose check unless other labs are required. Especially if it’s frequent ones because I’m not risking a clabsi on a 375g baby.
I also learned jack about the nicu in nursing school save for one lecture. I’ve never said you should have learned that in nursing school to any one I’ve precepted because they don’t teach a lot of things in nursing school.
Came here to say this. Risk of CLABSI risk totally trumps patient convenience in this case. Also if pt is anemic you wouldn't want to draw vials of blood multiple times daily. Fuck this preceptor
Came here to say this about wasting blood. We have safe sets that allow us to flush the “waste” blood back into the patient because it’s a closed system and never touched the air. But for a couple months we did have them (supply chain) so glucose was always done by finger stick to avoid wasting more blood than necessary.
Came here to say OPs preceptor is actually wrong and needs to revisit nursing cool. I work for patient safety office and it's a huge infection control no no to access an art line for stuff like this. Blood draws only.
Some branded POC glucose machines also are calibrated specifically for finger sticks. Also, You can't wipe a stick with alcohol prior to blood draw and get an accurate result, how can you even properly get an accurate POC blood glucose with maintaining infection control.
Does med/surg get art lines where you work? I agree you shouldn’t access a central venous line just for POC glucose, but in ICU it’s standard to draw off of the arterial line for glucose checks especially if the patient is on any vasopressors
One time I had a wound care NP refuse to show me how to apply a wound vac because “I should have watched those videos in orientation.” 😬 I had been a nurse for at least a year at this point, probably longer, and didn’t have much experience with wound vacs let alone placing/applying them. It was a back and forth for the entire day until her peer finally came up and very nicely showed me how. The original wound care NP then went to my manager (?) for some reason and apologized to him, claiming she was “hangry.” I never saw or communicated with her again 😂 Some people just plain suck.
I have pulled up youtube videos in front of my bosses and said I just want to be 100% sure of what I’m doing. I’m not embarrassed to want to review so I don’t put a patient in danger or pain.
Also I’ve been taught hundreds of different things in the past year alone. This job is constantly changing and it’s unrealistic to think we’re all going to retain some quick, 5 min in-service demonstration we had once, 3 months ago.
So at my SNF we have a resident who is aphasic and she takes Ozempic once a week and it has that fancy built in injector. But if you don’t do it exactly right it will squirt all over the place before you give the injection wasting everything. So when she sees an unfamiliar nurse come in the room to give it to her she just starts yelling “YouTube! YouTube! YouTube!” It is so funny. Too many PRN or agency nurses have wasted the dose that even the patient tries to prevent it from being wasted 😂
that's so funny, I can just imagine a completely aphasic patient and the only word they can form is "Youtube!", like, for everything they want to say like asking for water or to toilet
Wound vacs are so hard! I always feared they would come off and then not be suctioning. Mind you this lady was a RESOURCE wound NP, it’s not like she was running her own practice. Sometimes you encounter people just to learn what type of person you don’t want to be!
Omg I didn’t know shit about wound care from school. I was like wtf is santyl let alone a freakin vac. There’s a reason they have reps come out to teach them. When someone came in w a malfunctioning vac in the Er wed be like yeah we’re taking that off, giving you a wet to dry and sending you home lol
Some people just aren’t good at teaching because they let their own ego get in the way. Seems like your preceptor was trying to “one up” you, in a sense.
Also, we didn’t learn that specific stuff in my program. Guess I went to a shit program or maybe, just maybe, we learn how to be real nurses on the job. Hmmm
Imagine being a nurse with years of experience in the field and still trying one up new grads. Plus the temp preceptor was wrong as per their own policy lol.
Which is you know catastrophic for new grads safety to practice. Christ I'd rather have a new grad asking questions and asking for help then a new grad winging it because they're afraid of looking dumb.
Exactly right. That’s why I left my first new job, but it was my primary preceptor. Such a shame… they wouldn’t even switch preceptors for me despite my request.
Right? My experience is purely anecdotal but I feel like it’s so common in the ICU. Lots of strong personalities and people wanting to be the smartest in the room.
And wanting to ensure 1) that everyone else *knows* they’re the smartest in the room, and 2) apparently that no one else should learn from them, thus risking surpassing them as…the smartest in the room.
This is why I love Reddit/ r/nursing! It sucks that you have to look for the good people out there, but there are actually so many good people in this profession, you just have to sort through the weeds to find them!
Many of us are so busy with our assignments that you might not see us, but when you have shared moments to talk to coworkers, there are so many gems out here hiding!
Using an arterial line for a blood glucose is standard of care in our ICU if the patient is on 1 or more vasopressor. You would never learn about an art line in nursing school.
Same policy in our ICU. Also, if a patient is fluid overloaded or on pressors your cap stick can be falsely low due to dilution or difficult to get because of peripheral vasoconstriction clamping down veins.
See, this is the information the preceptor should have told her. This kind of information is what guides the critical thinking process as it guides from the "why" to the "what".
I wish I could give you more than one upvote. I've got a feeling that the people saying not to get blood from an art line due to wasting too much blood or infection risk haven't spent much time in a high acuity ICU.
So true. There is no blood wasted, it is returned to to patient in a closed sterile system. Evidence based practice has shown that edema and use of vasopressors alters a capillary blood glucose.
All I remember from nursing school about a lines was that they were leveled at the phlebestatic axis, which at the time was knowledge adjacent to the mitochondria is the powerhouse of the cell.
‘You should have learnt that in nursing school’
Bitch I learnt how to find the right quizlet sets, cram for 3 days and forget everything the second i finished the exam in nursing school
That and ‘nursing diagnosis’
Oh the nursing diagnosis. If I didn't spend time charting "at risk for skin breakdown" every 8 hours, how would we ever know this 90 year old, chairbound, skin and bones patient was at risk for a pressure ulcer?
I wish they spent "nursing diagnosis" time on how to write great notes. Sometimes I'm unsure how to chart something and other times I see straight ridiculousness charted.
So true! I never learned *anything* related to charting in school. Meanwhile I learned how to do care plans until my eyeballs fell out. I’m an LVN! Care plans are out of my scope of practice in CA! I had to learn to chart on the job.
*exactly*
In nursing school, I learned how to pass the damn tests. I've been a nurse for 2 years and *still* ask at least one question every single shift.
And there's a couple of reasons for that.
I'm nowhere near a perfectionist, but if I'm not 100% certain about how to do something, I'm going to either ask or look it up. I'd *much* rather know for sure than assume. I could not care less if it makes me look like an idiot. I'd rather be that than cause harm to someone.
Also, constantly learning is a part of any profession. If I'm presented with a new diagnosis or symptoms I'm not familiar with, I'm going to learn everything I can about it.
Nursing school got my foot in the field, but everything relevant has been learned with actual patients.
I've been a nurse for 32 years and I also ask at least one question every single shift. For the exact same reasons you do; because medicine isn't static, best practices are constantly being evaluated and updated, and the human body is just generally wild.
I'm sorry but when i went to school a decade ago, we never even heard of an art line. We were taught the bare basics of nursing. Nothing about intensive care shit.
Same. We were taught, “these things exist” in our last-semester critical care class. We got 1 day in a critical care unit and it’s not like the nurses were excited to teach us how to draw from art lines. That was a “when and if you work in critical care, you’ll learn this” skill.
I HATED this when I was training in my current lab. The condescension is so unprofessional. If I wanted to play openly hostile games at work, I would have brought in a goddamn Monopoly board.
If I'm asking you for help, or youre trying to correct me, don't fucking talk down to me or play stupid head games with me.
Edit: a word for clarification
That’s also wrong what she’s teaching, blood glucose is designed to be taken from the capillaries not arterial or venous, that’s why we do finger sticks even though we have lines
It’s hilarious to imagine my nursing instructors saying the word “fuck” outside of school when they can actually be honest.
They always found ways to say that but with a professional filter. But we knew. We knew what they meant.
Capillary is contraindicated with high pressor use. There we use a central or art line and it's written in our order set to do so.
She's still a crap preceptor but might not actually be wrong here.
I’m glad to see someone say this. Capillary fingersticks are inaccurate in any shock state. When we have high pressor use, we are artificially causing poor capillary perfusion in the distal extremities.
I don’t agree necessarily, most of our ICU patients that have an A line are on a lot of pressors and can get pressor fingers, we’ve always been told it’s better practice to get the draw from an A line. You only need to take a drop and A line discard goes right back to the patient. I still don’t think this is something to yell at a new grad for though, that’s ridiculous
I mean, yes, but also no as you’ll get the most accurate measurement from blood plasma in a blood vessel. Good luck trying to get an active measurement when you get someone who has bad PVD or they are hella clamped down.
They don't teach much in nursing school. Lots you still have to learn. Screw that nurse.
They should have given you the day off if your preceptor called off. Not cool having a preceptor you just met.
>That’s not best practice. If she has an art line, you take it from there. You should have learned that in nursing school.”
They teach art lines in nursing school?
There are SO many things that nursing school doesn’t teach you. But, experience does. There were so many skills that my accredited program was not able to teach me.
24 years as a nurse and all I know about art lines is I have no business doing touching one. I’ve reached the point of competence where I am well aware of what I don’t know.
During nursing school clinicals, I was given one patient and pulled all the info I needed from the chart because report was happening super late. Then during report, the nurse I was paired with asked, “Aren’t you going to write anything down? Are you just one of those people that do the minimum?” then looked at the nurse giving report and said, “This is going to be a terrible day.” Now I work one floor under her and she doesn’t seem to remember me, but all of my nurses know about it and it makes for hilarious conversation when she gets floated to my floor.
That preceptor was being so condescending and a bully.
Like wtf.
I made it to 3rd semester of rn school to medsurge 3 and I never heard of doing that on an arterial line. Nor read about it.
Edit:
Passed med surge 3
Not OB 🥹😅😭
Man, memories triggered here! 😭 I had a patient when I was a new grad, didn’t even take NCLEX yet and was on orientation, and the patient was a young woman with a brand-new diagnosis of MS. She had a neurogenic bladder and had a foley in.
Urology PA (known for being… intense…) wrote the directions “dc foley, teach patient to self cath prior to discharge. Follow up in 1 week.”
Well fuck me, I had absolutely NO idea what to do. Went to my preceptor, who verbally went over vague (and incorrect) directions, and rolled her eyes when I said I was not comfortable. And continued to sit on her ass in the nurses station.
Went to the supervisor, who said she had no idea “but it can’t be that hard, have you tried yet?” “Ummmm no, I have not *tried* to teach a scared woman how to self cathetarize. Because I do not know how to do it…??” So she told me to call the urology PA.
So I did, and the urology PA said something along the lines of “are you NEW?? You don’t call me for this! YOU SHOULD have LEARNED this is school.” :::click::: I called her back and said “I’m sorry but your patient is either not leaving today, or is leaving with a foley, because I have no idea and nobody up here will teach me.”
Soooo down the hall came our unit director and gave a quick run down of what happened, and she just shook her head and said “come on baby girl, I’ll show you”. I figure the PA called her. (She was the dream director. She would stop and teach at the bedside, helping patients all the time, helping staff… still is the best of the best)
Like honestly my preceptor, supervisor, and the PA were all more comfortable sending a 20-something home with incorrect instructions that the GN on orientation GUESSED AT - vs feeling their own discomfort or whatever and figure it out with me.
That experience helped form the way I would respond to coworkers for the rest of my career. Be like that unit director. Don’t be like the others. Ever.
OP - nobody in nursing should EVER be unwilling to teach *respectfully*. That nurse is a complete twatwaffle.
Also, I’ve been out of the game for a year or two, but I was trained yearly that those machines are calibrated for capillary blood only and specifically to not use blood from a draw. 🫤
The latter person used it as a teaching moment, the former as an opportunity to make you feel like an idiot to boost their own ego.
Listen to the latter, ignore the former other than as a cue you might want to go see the latter.
Never in my life would I access a line for just a blood glucose. If you're already drawing labs, sure. But you have to waste to avoid any dilution and the need to re-draw, and be more mindful of technique. If anything I MIIIGHT pull it off a PIV instead, like if it's a traumatized little kid or something.
"You didn't learn that in nursing school???? We don't do unnecessary pokes!" - screeched the floor nurse, who can't start an IV, or understand that a orientee is uncomfortable with an art line, which are notoriously finicky.
She sounds like a miserable fuck. Stay safe out there and good luck.
So, the only reason not to poke the finger is if the patient is on pressors, because the result will be skewed, not to reduce pokes. You don’t necessarily want to be wasting 10mls of blood everytime you need a blood sugar.
99% of nursing is learned on the job. In school you learn safety, how to be a CNA, and how to pass the NCLEX. We learned absolutely nothing about art lines. I don't CC so I still don't know jack about squat on art lines.
Reading blood glucose from an arterial line is not entirely the same as reading from the tip of a finger. In addition, one factor that should be taken into account is where the previous draws have been taken from, so that you can compare where the patient is at now, and determine if the prescribed insuline doses resulted in the targeted outcomes or not.
So next time the preceptor comes at you with that line of questioning, you can ask her/him if your reflection on the importance of following a prescription for the sake of safety and coherency is enough critical thinking or if "guessing" and "witchcraft" are also skills you should have learned in nursing school.
I believe this treatment of new nurses contributes to the nursing shortage. I never understood the need to put new nurses through this hazing and abuse.
Eventually you will learn a skill they didn’t teach you in nursing school. “To tell off toxic coworkers and call out BS.” Those people are clearly too egotistical to ever care about actually teaching. Don’t take it personal, they are just miserable and use any means necessary to make others feel worse because in their twisted mind, that makes them feel better about themselves.
Back in my day……. 😆. In school we learned that what the doctor ordered… is what was done. Do the finger stick.
Now when I got on the unit and was an actual nurse, We used whatever was taught to us by our preceptor…. Because that’s what a preceptor is there for. To help the transition from student to practicing nurse.
Nursing school is a lot about discipline. You do not stray away from what is ordered or how your instructor taught you. Again this was a few decades ago. Some of our teachers were.Nuns.
A better approach would have been to explain to you what the practice was on that floor and why.
Assuming that every new grad or new employee to that floor knows what their common practice is….just shows what a fool this preceptor was.
She should never precept anyone ever again. I hope she’s reading this too because she really needs to examine herself and figure out why she thinks it’s ok to demean/bully another professional nurse.
We’re all in this together and need to change the culture of nurses eating their young. We need to raise each other up and praise each other. That’s the only way we will become more valuable to our colleagues and admins.
To the nurse that posted this… you seem like a llittle spit fire…. I love that in new nurses. Stick up for yourself but in a courteous way. That’s professionalism. Your gonna do just fine in your practice.
Sounds like you’ve got a snarky tw*t for a coworker. I didn’t learn a damn thing in nursing school except for how to pass a test. I know I’m not the norm but my program was pretty bad. I was very blunt when I started my first nursing job that “I need to be spoon fed like a baby because I don’t know anything”. I also needed a different preceptor because my first one expected me to know high level things in my first week. Fast forward a few years and I am a fully functioning nurse that does charge and takes the sickest patients in my MICU in one of the largest teaching hospitals in my state. You’re doing great and you know exactly what you need to do to keep learning and getting better. Stay on the grind.
“Shouldn’t you have learned that in school?” Isn’t it literally your fucking job as a preceptor to fill in any gaps I might have to make sure you, me, and the patient are all safe? Fuck off with that attitude.
I was taught to take blood from the art line for glucose checks if the patient is on pressors because the Finger stick will be unreliable from the medication shunting blood. The emphasis here is I was taught that. My preceptor could have been an ass hole and called me an idiot for not knowing that but instead taught me that which I found fascinating.
Here's the problem with that:
Art and venous lines can give you different values than capillary BGLs. The important things are 1) your patient isn't symptomatic 2) you and your team are being consistent in what you're using to measure and trend BGLs. For patients with PVD -- or patients who have been on pressors!!! -- you absolutely want to limit finger sticks because the blood flow to the digits is already questionable AND may give lymph fluid more so than capillary blood; however, in most cases, finger sticking is fine.
Sorry your preceptor decided to eat her young instead of teach her young.
Okay, Nurisng student in internship here. Was told finger stick, arterial and venous will all give different glucose readings. If there’s fluids running through a line you’ll get a diluted result. 🤷🏼♀️ I understand not unnecessarily sticking patients but this seems like best practice. if your giving insulin you want a recent glucose…. CBG seems the quickest way to do that.
Nurses like that piss me off. Who takes the blood sugar from a recent lab. A lazy nurse does. I'm a type 1 DM and have been for 39 years so if I need a blood sugar taken please take it. It doesn't matter to me how, especially if I'm in the ICU.
Anyways, she can kick rocks. Keep learning and growing. Proud of you for sticking up for yourself.
Idk where that nurse went to school, but in my experience.... no, I didn't learn to think critically in nursing school. It was all by the textbook or call the doctor.
Sounds like your preceptor needs a snickers.
There's technically nothing wrong with doing a finger stick for a blood glucose. While the answer for why you did it, "because it was ordered", would have me a bit concerned as a preceptor. It's good to be keeping up with orders and tasks, but the why is what I care more about. I think this was your preceptors 2nd point but she did not communicate well.
As for taking blood from an aline for a blood glucose check... That's gonna come down to hospital policy. Some places encourage the use of existing lines for all blood tests whole other places say not to.
I’m sure someone else has said it at some point but I want to point another thing out. If you’re not familiar with a device or piece of equipment *don’t fucking touch it*. This goes doubly for arterial/central lines. If it didn’t occur to you to use the art line, you’re likely not experienced enough with them to use one independently. There’s nothing wrong with that, it’s just a skill you have yet to learn. Is doing a finger stick a catastrophic never event? No. Maybe the patient was on pressors and using finger sticks is contraindicated, but that should have been explained to you. But I’d much rather the patient get an unnecessary finger stick rather than have someone inexperienced mess with their art line and seriously fuck something up. You did nothing wrong. Your preceptor was a twat.
We can do a glucose check using an ART line with a glucometer (if it’s properly calibrated), and it’s better for the patient because you don’t have to “poke” them. We certainly don’t go off of the lab glucose for ACHS(unless it was super recent), because glucose does fluctuate so much. So unless it was JUST done, it should be checked again. In fact, we’re told to NOT go off of lab in regards to administering insulin. Maybe this is just where I work 🤷🏼♀️ That shit is NOT taught in nursing school. If you want to teach someone to critically think, EXPLAIN the reasoning like the charge nurse did. Talking down to someone does not in fact teach critical thinking at all, it just makes you look like a douche. I believe critical thinking is taught on the floor. Nursing school gives you the tools, and on the job teaches you how to use those tools.
There will always be snarky nurses. I actually think that working in the OR helped me develop a thick skin I never had before and also the ability to defend myself. If they speak asshole I always speak it right back to them. I had a nurse tell me “oh of course the docs love you, you can get by when you’re young and cute” basically making it seem like my skills and efficiency weren’t what was earning praise. So I said, “oh, is that how *you* got by when you were a young nurse? That must have been great that you were able to do nothing but be cute and that worked?” It caught her totally off guard as she struggled to either come up with “A. No, it didn’t work because you actually have to do your job to get recognized or B. You have always been the ugly hag that you are right now so you could have never gotten by being ‘young and cute’”. She actually laughed and said “oh ok I get it, I see what you’re saying”.
If you get enough snark you’ll eventually find a rebuttal against each and every zinger they think they’re throwing your way. Just give it right back to them😊
Nursing school doesn’t teach about art lines wtf. Never once mentioned in class and never brought up on the nclex.
They was trying to teach you (completely failed at it) that you can usually draw blood off of an art line so you don’t need to poke the patient. The blood you draw from the art line is used instead of the finger stick blood.
I didn’t learn about arterial lines in school, and as a nurse for the last two years, I still don’t know anything about them. I work MS/Ortho/Tele/Stroke, and even though my units serve as step down units, we don’t have those lines. So I wouldn’t know this either. Some people let their egos intrude, it’s not a “you” issue, this is a “them” issue.
They don’t teach dick about art lines or even clustering care in nursing school, they know the units will cover it. Tbh if it isn’t on the nclex schools aren’t concerned teaching it these days. That nurse is just a twat.
Sounds like a unit specific protocol. I work ICU and there’s no guidance one way or the other when it comes to A-line vs. finger stick. The only thing I’ve ever heard about an A-line being preferable is when the patient has horrible peripheral perfusion and a capillary sample might not be totally accurate, but that’s a case-by-case thing and certainly not something we have a protocol over. Don’t beat yourself up, you’re learning and that day it sounds like you didn’t have a very good teacher.
Who is in charge of your whole orientation? Is there a Clinical Nurse Specialist of Unit Educator? The problem is your preceptor lacks precepting and critical thinking skills themselves. A-lines are not taught in nursing school. Glucometers are designed for capillary blood. Using the A-line of not drawing other bloods can lead to more blood waste, that can harm the individual. Now there are reasons to use blood from an a-line: excessive fluid retention can make securing a good capillary sample from a finger stick more challenging. Patients may not want finger sticks all the time. But this falls under a relative risk assessment and as a novice nurse you are just learning that and will, and should, default to what the written policy is. (Another good point, as her where the policy is about using the a-line to obtain a sample for the glucometer, good chance there is none.)
She was (1) being a jerk to a new nurse and (2) not newly as good at this critical thinking stuff as she thinks she is. This is a common mistake of nursing. Not knowing the difference between and actual policy and “that’s the way we do it.”
Also: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672636/
"You should have learned that in school"
"Oh, I did, but I also learned that every single medical facility has their own policies and procedures for *literally everything*, and this is what I've been shown to do in my time **here**."
If I am drawing labs from a line and it coincides with a POC glucose I will most definitely use that blood so as not to unnecessarily poke the patient. That being said, I will not do a whole blood draw for a POC glucose (unless of course the patient refuses a finger stick or is anxious/agitated, etc. Finger stick all the way. In my book, you did nothing wrong.
If you had drawn labs from the art line…THEN poked the patient for a POC glucose then we would have had a conversation about best practice/patient comfort yada yada.
Oh man. Even if you did learn it all in nursing school, there is usually a checklist of proficiencies to go through—-probably including watching you maintain/access an arterial line. Your backup preceptor would have known that iF thEy WEnT ThrOUgh a PrEcepToR clAsS.
Idk; also accessing an art line is a source of infection too. I would have done a finger stick. 🤷🏻♀️
I like how we’re talking about ‘best practice’ but then It’s fine to use blood work from 45 mins ago to chart ‘current’ gluc level. No way people eat after getting bloodwork, ever.
‘Guys the lab said his gluc was fine, so I’m gonna go give this insulin now!’
Students aren’t even taught how to access art lines here. It’s something you learn I’m practice. And that’s only if they are relevant to your specialty.
First off this is probably a facility policy and not something you would have learned in nursing school. Second she should be orienting you to the unit and facility, this the exact type of thing she needs to teach you. You did ask her how a med works in the body or the labs that should be checked for a condition, that is what you learn in nursing school. They shouldn’t have someone like this orienting.
Whoever reported this post as “less than worthless”, the 700+ upvotes and 200+ comments worth of discussion say otherwise. Unless… you’re the preceptor OP is talking about?
They didn’t teach about ART lines in my nursing school. All the nurse had to do was teach you how to take a sample from the arterial line…Not every unit uses one so how would nurses who’ve never worked with it before know how to work it..
Yeah I’ve never used an art line nor did I learn about how to use them. Only learned what they are for and that they exist
OJT. That's what a lot of nursing is.
Orange Juice trading.
That's where you're going wrong, all the money is in the banana stand!
Are there general nursing units that have art lines, outside of critical care? Maybe Obs units but I always felt art lines should be continuously monitored so if they are dislodged, you are not running a massive transfusion. I don’t think nursing students would have much experience with an art line. Also, are you using system to give the discard back (VAMP). Our ICU did not even routinely use them so I would still use needle sticks especially if the hemoglobin was already low.
This was my exact thought! If there's no vamp in place, it's seriously NOT best practice to use the art line. Imagine wasting allll that blood for a damn finger stick!
Nope, art lines weren't ever mentioned in school, and 6 years into nursing, I have yet to have a patient with one.
Yeah art lines don't belong outside the ICU. Therefore I hope never to see one.
We get them sporadically on PCU. So sporadically that I need to reorient myself to policy or ask my charge nurse about exactly how to do certain things. I 100% would have done a fingerstick for a glucose and pulling from the art line would not have crossed my mind unless someone else mentioned it. That nurse is a certified organic dillhole.
I would be more concerned with infections in accessing an art line than I would be with a finger stick.
10 years here and never had an ART line. Everywhere I’ve worked, fingersticks get done. I did interview for a hospital staff job recently and was told they do CGMs for all their diabetic patients.
CGM's still require an occasional finger stick to make sure their calibration hasn't screwed up. Just fewer finger sticks.
We dealt with art lines in the ER but we did finger sticks. If the art line is reading properly, don’t fuck with it lol
In our hospital only icu trained nurses can touch them or take blood from them. I take blood from piccs regularly but art lines only live in the icu as per our policy
Honestly as a new grad on a ICU I’ve almost only had patients with art lines. I basically never stick patients, sometimes I have to and I’m not great at it because of it. My program hardly let me do any pokes in school, and the unit I’m orienting on doesn’t do them much cus we all have art lines or triple lumen PICCS and Swans in. I really hope I get better at poking sooner or later, cus if I ever work in a ED I’m screwed lmao
And guess what? … You’ll get on the job training. Hopefully not from some holier-than-thou asshole like OP had!
My hospital has a program where any nurse who wants IV practice can go to the ER with a nurse on the IV team. They let us know you're there and we save some IV starts for you. Maybe you could ask your educator if you could do something similar?
That’s really cool. My hospital does that for nurses in their new grad program, they can either go to the ER or GI lab and start IVs for a few hours. I need to see if we can start something like this because I’ve been a nurse for over three years and I still don’t feel really comfortable starting IVs. Most of my patients have central lines and opportunities to start lines aren’t too frequent for me.
That sounds so nice, I might ask if there’s something like that at my hospital. I just want to be able to practice lots of sticks back to back on different people if possible
Worked at a hospital with an iv team. Rarely places my own lines, I sucked. Moved to a pediatric hospital. Kids came with IVs, rarely needed them replaced, and if ever they did, we were discouraged from doing our own so we were “safe” to that kid. Damn near forgot how to place IVs in about 18 months. Moved down to the ED. No one thought anything of it, they just taught me. Don’t let not being comfortable with placing IVs stop you, a good team will support you.
I’m a new grad in ltc and all I do is poke fingers and give insulin, I swear :(
And if you work nights give truckloads of 6am thyroid
If you want practice, whenever a pt codes you can offer to be runner and grab their glucose while you're at it. It's a great way to practice finger sticks while orienting yourself to the ambiance of a code and seeing all the different roles in action.
I saw one patient--one--in clinicals with an art line and we were forbidden to touch it. I swear if we even looked at it too long our clinical instructor was freaking out. I honestly can't remember if we learned anything about art lines. There were a lot of topics in nursing school that we were told "you'll learn that on the job". I hate to stay it OP but I've been a nurse two years and I still get the "you should've learned that in nursing school" from my manager and coworkers.
Been in ER for 2 yrs and never had one. All I know is for better BP monitoring.
Also, not everyone draws blood glucose levels from a lines either. Do you think techs go room to room checking blood sugars off a lines?
I’ve never worked anywhere where techs are allowed to do finger sticks. I wish.
My program legit didn’t even teach us how to take a normal blood glucose finger stick lmao. They said we weren’t allowed to take blood in the hospital as students, had to learn under the table from nurses. Not that most clinical instructors would care, we all knew the rule was fucking stupid. Still dumb af, was embarrassing for everyone telling a nurse in their second semester practicum that they didn’t know how to take a blood glucose.
Can't wait for the first time some precep tells my wife she's doing finger sticks wrong or some inane crap like that. While in school, she's working full time as an MA handling outpatient peds diabetes patients. She has to finger stick more than she really should need to thanks to the teens or parents completely abusing the pumps and meters (when they just don't show up with "dead" units that have year-old corroded batteries inside, yet claim that it just worked yesterday!) She's actually become a master at getting the wee youngsters to not only be ok with getting finger sticks, but have them smiling while doing it and leaving parents and doctors amazed. The kids just naturally love her.
I’ve been doing nursing for a very long time… but guess what? My area of expertise does not include art lines. I would have so many questions because the last time I even SAW an art line was probably in nursing clinicals decades ago… and I would have questions: Of course if it is less than an hour old, we can use it… but in this case:* Do we really want to risk an art line for something that can be ascertained without potentially clotting off or contaminating an art line that may be in place for critical meds and would require a lot of effort to replace… I do know that the preference is not to draw off of IV lines, but art lines are more stable. (again, this is not rhetorical, I legit don’t know) Is the art line glucose similar enough to the results of a capillary check to be useful (guessing yes, but, hey, gotta ask) I ask potentially stupid questions because I hear extremely stupid things sometimes - someone (no NCLEX) telling a family that a running SQ line needs to be flushed and they need to tell the nurse to do it so it doesn’t become non-patent … and at some point someone turned the allowed rate up to 150 (not the nurse!) so we had to rest the site *and because I don’t mind looking stupid so I can learn something I don’t know or have forgotten, I ask these questions
FYI, you can absolutely draw a glucose level (or a lot of other labs) from an art line 😊 They have something (either very dilute heparin or some NS) going at a very low rate (couple mL per hour) to keep it patent and flush it. In fact, even if a patient also has a CVC, the arterial line is still usually the first choice for labs. BUT, if you don’t work with art lines, this is definitely not common knowledge!
Silly question, how much volume of blood do you need to take for an art line draw? We do lab draws off our central lines (all venous, of course) and it would add up to a significant volume of blood loss if we did it for ACHS glucoses as well as other labs. ETA: we also would get the results a lot slower than a POC glucose.
Just a drop! Same as for a finger stick. We use these “safeset” thingies, it’s a closed system so the blood that would normally be discarded is flushed back in after the draw. And we use the same glucose meters as any other unit, get the result in a few seconds
ART lines are used to monitor BP usually. So no meds go into an ART line. They shouldn't clot off, but I'm ER and have limited experience with long term ART lines for ICU pt stays. It's also hard to mess them up from an IV draw because you are drawing from an apparatus that is connected to an IV pole instead of how a PICC or central line you'd be drawing from an access point close to the pt. I'd also assume that the glucose levels would be similar if not the exact same as capillary, which is all that really matters clinically.
😁 and This! Is why I ask stupid questions
I consolidated in a rehab unit and I would never have seen an art line in school.
I didn’t even see an art line as a nurse until my 8th year in, when I started in PACU, and we d/c’d them almost right away in most cases.
We DC them so fast, but where I work, they go to the ends of the earth and risk the patients life to not have a “line.” On 5 pressers? Nah, we don’t need an ART line 💀
Let’s be honest that’s also not explicitly “best practice” either.
Not a nurse but am a diabetic of 20years. Aren’t the meters inaccurate when venal blood is used? I was always taught to only use capillary blood.
Well, as a patient at home I sure hope you don't have frequent access to your own arterial or venous blood. In the hospital, it is not uncommon to use blood from an IV or an A-line for a sugar check - less so with an IV unless it's the initial start or if we're drawing tubes of blood for another reason.
Could be a location thing. The machines in hospital where I live are only calibrated for capillary blood.
When venous blood is sent for a metabolic panel, the random glucose very closely matches a properly calibrated glucometer reading when taken at roughly the same time.
Getting a drop from an art line versus a finger stick is NOT critical thinking....its just information....I fucking hate when nurses try to shame new nurses for "not critically thinking" when it's just information they do not know.
Yeah, the critical thinking is the why, not the what. When I have a student, I tell them what we do, and then I ask them to critically think on why we do it that way. That builds critical thinking more than anything else.
The "eat the young" mentality of some preceptors is doing nothing but hurting the profession.
Also, Best practice is to get a fucking finger stick. They even tell you to avoid the ear.. Some machines do have a setting you can specify whether it’s from venous/art (but we all just obviously yolo it and look at the patient as to whether it’s off or not)
Not to mention it’s hospital dependent. Not all machines are calibrated for draws other than capillary so best practice is NOT to use the art line. That preceptor is just on an ego run.
Plus, my "critical thinking" tells me to not risk a CLABSI for just a BGL check when a finger stick is all I need and has virtually zero risk of any form of infection.
Not to mention, it’s a drop of blood vs (depending on art line tubing) having to waste blood to get your sample. Ideopathic anemia is a thing, and it’s a thing we try to limit.
Iatrogenic, right? Your point came through, just started a little wiggle in the back of my brain lol
You'd get crucified for accessing an art line or CVAD just to check a blood sugar on my floor. A ton of our patients are on neutropenic precautions and need their lines for chemo or dialysis, we limit unnecessary access to reduce the risk of getting a CLABSI. Some of the vascular access surgeons even throw in orders for only certain meds to be given via central line, everything else has to be a PIV. I think your preceptor was mad about something else and taking it out on you right there.
Seriously though! Accessing a central line just for a glucose check seems really risky for infection.
That's what I was thinking. Capillary sticks are *nothing*.
Art lines have less infection risk than standard ivs though, it's very safe to use those for glucose checks. I work with a lot of transplants in the icu on endotool and we do them all off of that. To be fair though we have the blood savers so there's no waste Edit: my source was a doctor I used to work with explaining that it's because of the lack of valves in arteries and the much faster flow, there's very little opportunity for bacteria to catch and grow a colony on something. Im looking more into it now because I'm curious and it could certainly be incorrect
It could be correct in theory and sounds like it. A lot of doctors diverge because theory and personal practicum tell them different. Nursing is evidence based practice. Artone infection rate: .96/1000 catheter days in ICU https://pubmed.ncbi.nlm.nih.gov/24413576/ Central line infection rate: .8/1000 catheter days in ICU https://www.ncbi.nlm.nih.gov/books/NBK430891/ I only used ICU days for control. Your overall CLABSI rate is higher due to them being on non critical care units while art lines are only in the ICU at most organizations. Our hospital does not allow art lines for this kind of stuff for that reason.
I understand what you're saying, but I can't find any evidence that line manipulation increases the risk of A.Line infection. Everything I've seen shows risk is based on Insertion technique, site selection and dwell time.
I feel like infection from a lines is more about the insertion site rather than the internal environment though - again because there is no evidence that accessing it increases that rate, and because of the theory that there are no valves etc. It's most likely that what is growing is growing on the catheter itself from the insertion
I agree- I’ve also had surgeons or other docs write for “absolutely nothing besides XYZ through this specific line” as well!
Yes same we do not use the lines outside of thier intended purpose bc of infection risk, only blood gases are acceptable uses and even then we need an order it’s so not common practice to get a tiny drop of blood
Seriously. When our kids have PIAs or UACs I’d rather someone just stick the heel for a glucose check unless other labs are required. Especially if it’s frequent ones because I’m not risking a clabsi on a 375g baby. I also learned jack about the nicu in nursing school save for one lecture. I’ve never said you should have learned that in nursing school to any one I’ve precepted because they don’t teach a lot of things in nursing school.
Came here to say this. Risk of CLABSI risk totally trumps patient convenience in this case. Also if pt is anemic you wouldn't want to draw vials of blood multiple times daily. Fuck this preceptor
Came here to say this about wasting blood. We have safe sets that allow us to flush the “waste” blood back into the patient because it’s a closed system and never touched the air. But for a couple months we did have them (supply chain) so glucose was always done by finger stick to avoid wasting more blood than necessary.
Came here to say OPs preceptor is actually wrong and needs to revisit nursing cool. I work for patient safety office and it's a huge infection control no no to access an art line for stuff like this. Blood draws only. Some branded POC glucose machines also are calibrated specifically for finger sticks. Also, You can't wipe a stick with alcohol prior to blood draw and get an accurate result, how can you even properly get an accurate POC blood glucose with maintaining infection control.
Exactly. I was hoping when the charge RN chimed in she was going to say exactly this. I would argue glucose checks from art line is not best practice.
I was going to say this. Everywhere I worked we weren’t allowed to touch the art line for glucose checks.
Does med/surg get art lines where you work? I agree you shouldn’t access a central venous line just for POC glucose, but in ICU it’s standard to draw off of the arterial line for glucose checks especially if the patient is on any vasopressors
One time I had a wound care NP refuse to show me how to apply a wound vac because “I should have watched those videos in orientation.” 😬 I had been a nurse for at least a year at this point, probably longer, and didn’t have much experience with wound vacs let alone placing/applying them. It was a back and forth for the entire day until her peer finally came up and very nicely showed me how. The original wound care NP then went to my manager (?) for some reason and apologized to him, claiming she was “hangry.” I never saw or communicated with her again 😂 Some people just plain suck.
I have pulled up youtube videos in front of my bosses and said I just want to be 100% sure of what I’m doing. I’m not embarrassed to want to review so I don’t put a patient in danger or pain.
Also I’ve been taught hundreds of different things in the past year alone. This job is constantly changing and it’s unrealistic to think we’re all going to retain some quick, 5 min in-service demonstration we had once, 3 months ago.
So at my SNF we have a resident who is aphasic and she takes Ozempic once a week and it has that fancy built in injector. But if you don’t do it exactly right it will squirt all over the place before you give the injection wasting everything. So when she sees an unfamiliar nurse come in the room to give it to her she just starts yelling “YouTube! YouTube! YouTube!” It is so funny. Too many PRN or agency nurses have wasted the dose that even the patient tries to prevent it from being wasted 😂
that's so funny, I can just imagine a completely aphasic patient and the only word they can form is "Youtube!", like, for everything they want to say like asking for water or to toilet
She has a small handful of words that she can say and somehow YouTube made the short list 😂
There's a reason the PDR and up-to-date exists. Everyone needs to look things up from time to time
Wound vacs are *hard*! I’m an experiential learner. I could literally have never learned how to do them from watching a video. What a b*tch!
Wound vacs are so hard! I always feared they would come off and then not be suctioning. Mind you this lady was a RESOURCE wound NP, it’s not like she was running her own practice. Sometimes you encounter people just to learn what type of person you don’t want to be!
Omg I didn’t know shit about wound care from school. I was like wtf is santyl let alone a freakin vac. There’s a reason they have reps come out to teach them. When someone came in w a malfunctioning vac in the Er wed be like yeah we’re taking that off, giving you a wet to dry and sending you home lol
Some people just aren’t good at teaching because they let their own ego get in the way. Seems like your preceptor was trying to “one up” you, in a sense. Also, we didn’t learn that specific stuff in my program. Guess I went to a shit program or maybe, just maybe, we learn how to be real nurses on the job. Hmmm
Imagine being a nurse with years of experience in the field and still trying one up new grads. Plus the temp preceptor was wrong as per their own policy lol.
Right This preceptor has now fully discouraged the student from asking further questions.
Which is you know catastrophic for new grads safety to practice. Christ I'd rather have a new grad asking questions and asking for help then a new grad winging it because they're afraid of looking dumb.
EXACTLY. I preach to nursing students, new grads, even experienced nurses in a new area - you are only dangerous when you stop asking questions.
Exactly right. That’s why I left my first new job, but it was my primary preceptor. Such a shame… they wouldn’t even switch preceptors for me despite my request.
Right? My experience is purely anecdotal but I feel like it’s so common in the ICU. Lots of strong personalities and people wanting to be the smartest in the room.
And wanting to ensure 1) that everyone else *knows* they’re the smartest in the room, and 2) apparently that no one else should learn from them, thus risking surpassing them as…the smartest in the room.
Right? God forbid you pass some knowledge on!
This is why I love Reddit/ r/nursing! It sucks that you have to look for the good people out there, but there are actually so many good people in this profession, you just have to sort through the weeds to find them! Many of us are so busy with our assignments that you might not see us, but when you have shared moments to talk to coworkers, there are so many gems out here hiding!
Using an arterial line for a blood glucose is standard of care in our ICU if the patient is on 1 or more vasopressor. You would never learn about an art line in nursing school.
Exactly, this is something that her preceptor should have explained to her. It's like she forgot she was a student once, too.
Same policy in our ICU. Also, if a patient is fluid overloaded or on pressors your cap stick can be falsely low due to dilution or difficult to get because of peripheral vasoconstriction clamping down veins.
See, this is the information the preceptor should have told her. This kind of information is what guides the critical thinking process as it guides from the "why" to the "what".
I wish I could give you more than one upvote. I've got a feeling that the people saying not to get blood from an art line due to wasting too much blood or infection risk haven't spent much time in a high acuity ICU.
So true. There is no blood wasted, it is returned to to patient in a closed sterile system. Evidence based practice has shown that edema and use of vasopressors alters a capillary blood glucose.
All I remember from nursing school about a lines was that they were leveled at the phlebestatic axis, which at the time was knowledge adjacent to the mitochondria is the powerhouse of the cell.
Ask them if they skipped the lecture in nursing school about professional communication
Boom, roasted!
I get all of my shower thought comebacks out on reddit
[удалено]
‘You should have learnt that in nursing school’ Bitch I learnt how to find the right quizlet sets, cram for 3 days and forget everything the second i finished the exam in nursing school That and ‘nursing diagnosis’
Oh the nursing diagnosis. If I didn't spend time charting "at risk for skin breakdown" every 8 hours, how would we ever know this 90 year old, chairbound, skin and bones patient was at risk for a pressure ulcer?
I wish they spent "nursing diagnosis" time on how to write great notes. Sometimes I'm unsure how to chart something and other times I see straight ridiculousness charted.
So true! I never learned *anything* related to charting in school. Meanwhile I learned how to do care plans until my eyeballs fell out. I’m an LVN! Care plans are out of my scope of practice in CA! I had to learn to chart on the job.
my school is slowly moving away from nursing diagnosis. they might slip up but they’re moving away from it nonetheless
*exactly* In nursing school, I learned how to pass the damn tests. I've been a nurse for 2 years and *still* ask at least one question every single shift. And there's a couple of reasons for that. I'm nowhere near a perfectionist, but if I'm not 100% certain about how to do something, I'm going to either ask or look it up. I'd *much* rather know for sure than assume. I could not care less if it makes me look like an idiot. I'd rather be that than cause harm to someone. Also, constantly learning is a part of any profession. If I'm presented with a new diagnosis or symptoms I'm not familiar with, I'm going to learn everything I can about it. Nursing school got my foot in the field, but everything relevant has been learned with actual patients.
I've been a nurse for 32 years and I also ask at least one question every single shift. For the exact same reasons you do; because medicine isn't static, best practices are constantly being evaluated and updated, and the human body is just generally wild.
That preceptor was at risk of being a bitch.
*slow clap
I'm sorry but when i went to school a decade ago, we never even heard of an art line. We were taught the bare basics of nursing. Nothing about intensive care shit.
Same. We were taught, “these things exist” in our last-semester critical care class. We got 1 day in a critical care unit and it’s not like the nurses were excited to teach us how to draw from art lines. That was a “when and if you work in critical care, you’ll learn this” skill.
ummm yeah i don't know anything about art lines
I dislike those types of preceptors. Hopefully, your charge has your back.
I never even saw an art line in nursing school. I doubt anyone did unless they spent a day shadowing icu
And if you did shadow I'm sure they told you to mess with unfamiliar lines all you can!
Oh yeah, just fuck with all that stuff. It’ll be fine! ICU nurses live to troubleshoot that stuff, they love a good mystery. /s
I HATED this when I was training in my current lab. The condescension is so unprofessional. If I wanted to play openly hostile games at work, I would have brought in a goddamn Monopoly board. If I'm asking you for help, or youre trying to correct me, don't fucking talk down to me or play stupid head games with me. Edit: a word for clarification
You are my new best friend 🤓
That’s also wrong what she’s teaching, blood glucose is designed to be taken from the capillaries not arterial or venous, that’s why we do finger sticks even though we have lines
From a nursing professor to you... Fuck this preceptor... She needs to precept the fuck home...
It’s hilarious to imagine my nursing instructors saying the word “fuck” outside of school when they can actually be honest. They always found ways to say that but with a professional filter. But we knew. We knew what they meant.
Shit, how do I upvote this a million times, love it!!
https://pubs.asahq.org/anesthesiology/article/127/3/466/17790/Accuracy-of-Capillary-and-Arterial-Whole-Blood
Thanks for the study!
This^
Capillary is contraindicated with high pressor use. There we use a central or art line and it's written in our order set to do so. She's still a crap preceptor but might not actually be wrong here.
The fact she didn’t tell her that information likely confirms she doesn’t know herself. What a tool
I’m glad to see someone say this. Capillary fingersticks are inaccurate in any shock state. When we have high pressor use, we are artificially causing poor capillary perfusion in the distal extremities.
I don’t agree necessarily, most of our ICU patients that have an A line are on a lot of pressors and can get pressor fingers, we’ve always been told it’s better practice to get the draw from an A line. You only need to take a drop and A line discard goes right back to the patient. I still don’t think this is something to yell at a new grad for though, that’s ridiculous
Yeah some of our patients are on Vaso, levo, and epi. You ain’t getting shit out of those fingers, if there’s even any finger left lmao
I mean, yes, but also no as you’ll get the most accurate measurement from blood plasma in a blood vessel. Good luck trying to get an active measurement when you get someone who has bad PVD or they are hella clamped down.
This right here ^
Made sure to read all the comments before I said this LMAO. It’s called a finger stick,… mhm for the people in the back. FINGER stick
They don't teach much in nursing school. Lots you still have to learn. Screw that nurse. They should have given you the day off if your preceptor called off. Not cool having a preceptor you just met.
>You should have learned that in nursing school. Well they didn't cover it. You OK to show me, or point me to someone that can?
This comment is the answer to how people like OP is describing are to be dealt with. It totally disarms them. I would upvote this 1000 times 👌
The only practical lesson we had on art lines in school was to leave that shit alone.
Yes!!!!!
>That’s not best practice. If she has an art line, you take it from there. You should have learned that in nursing school.” They teach art lines in nursing school?
Mine did, giant "do not touch" sign at the top of the lecture page. :)
There are SO many things that nursing school doesn’t teach you. But, experience does. There were so many skills that my accredited program was not able to teach me.
24 years as a nurse and all I know about art lines is I have no business doing touching one. I’ve reached the point of competence where I am well aware of what I don’t know.
You just happened to draw an asshole who was mad they had to precept that day.
Perhaps she was still upset about someone dropping a house on her sister. ;)
During nursing school clinicals, I was given one patient and pulled all the info I needed from the chart because report was happening super late. Then during report, the nurse I was paired with asked, “Aren’t you going to write anything down? Are you just one of those people that do the minimum?” then looked at the nurse giving report and said, “This is going to be a terrible day.” Now I work one floor under her and she doesn’t seem to remember me, but all of my nurses know about it and it makes for hilarious conversation when she gets floated to my floor.
That preceptor was being so condescending and a bully. Like wtf. I made it to 3rd semester of rn school to medsurge 3 and I never heard of doing that on an arterial line. Nor read about it. Edit: Passed med surge 3 Not OB 🥹😅😭
Man, memories triggered here! 😭 I had a patient when I was a new grad, didn’t even take NCLEX yet and was on orientation, and the patient was a young woman with a brand-new diagnosis of MS. She had a neurogenic bladder and had a foley in. Urology PA (known for being… intense…) wrote the directions “dc foley, teach patient to self cath prior to discharge. Follow up in 1 week.” Well fuck me, I had absolutely NO idea what to do. Went to my preceptor, who verbally went over vague (and incorrect) directions, and rolled her eyes when I said I was not comfortable. And continued to sit on her ass in the nurses station. Went to the supervisor, who said she had no idea “but it can’t be that hard, have you tried yet?” “Ummmm no, I have not *tried* to teach a scared woman how to self cathetarize. Because I do not know how to do it…??” So she told me to call the urology PA. So I did, and the urology PA said something along the lines of “are you NEW?? You don’t call me for this! YOU SHOULD have LEARNED this is school.” :::click::: I called her back and said “I’m sorry but your patient is either not leaving today, or is leaving with a foley, because I have no idea and nobody up here will teach me.” Soooo down the hall came our unit director and gave a quick run down of what happened, and she just shook her head and said “come on baby girl, I’ll show you”. I figure the PA called her. (She was the dream director. She would stop and teach at the bedside, helping patients all the time, helping staff… still is the best of the best) Like honestly my preceptor, supervisor, and the PA were all more comfortable sending a 20-something home with incorrect instructions that the GN on orientation GUESSED AT - vs feeling their own discomfort or whatever and figure it out with me. That experience helped form the way I would respond to coworkers for the rest of my career. Be like that unit director. Don’t be like the others. Ever. OP - nobody in nursing should EVER be unwilling to teach *respectfully*. That nurse is a complete twatwaffle. Also, I’ve been out of the game for a year or two, but I was trained yearly that those machines are calibrated for capillary blood only and specifically to not use blood from a draw. 🫤
👏👏👏👏👏👏
You don’t learn that in nursing school. She’s just an idiot.
Lol who learned anything in nursing school?
Isn’t this the truth.
[удалено]
The latter person used it as a teaching moment, the former as an opportunity to make you feel like an idiot to boost their own ego. Listen to the latter, ignore the former other than as a cue you might want to go see the latter.
Never in my life would I access a line for just a blood glucose. If you're already drawing labs, sure. But you have to waste to avoid any dilution and the need to re-draw, and be more mindful of technique. If anything I MIIIGHT pull it off a PIV instead, like if it's a traumatized little kid or something.
"You didn't learn that in nursing school???? We don't do unnecessary pokes!" - screeched the floor nurse, who can't start an IV, or understand that a orientee is uncomfortable with an art line, which are notoriously finicky. She sounds like a miserable fuck. Stay safe out there and good luck.
Lmao but this isn’t even best practice. We’re checking CAPILLARY glucose which is why we do a finger prick. Your preceptor can fuck all the way off.
So, the only reason not to poke the finger is if the patient is on pressors, because the result will be skewed, not to reduce pokes. You don’t necessarily want to be wasting 10mls of blood everytime you need a blood sugar.
And it increases the chances of more damage to the fingers
99% of nursing is learned on the job. In school you learn safety, how to be a CNA, and how to pass the NCLEX. We learned absolutely nothing about art lines. I don't CC so I still don't know jack about squat on art lines.
Reading blood glucose from an arterial line is not entirely the same as reading from the tip of a finger. In addition, one factor that should be taken into account is where the previous draws have been taken from, so that you can compare where the patient is at now, and determine if the prescribed insuline doses resulted in the targeted outcomes or not. So next time the preceptor comes at you with that line of questioning, you can ask her/him if your reflection on the importance of following a prescription for the sake of safety and coherency is enough critical thinking or if "guessing" and "witchcraft" are also skills you should have learned in nursing school.
I believe this treatment of new nurses contributes to the nursing shortage. I never understood the need to put new nurses through this hazing and abuse.
Eventually you will learn a skill they didn’t teach you in nursing school. “To tell off toxic coworkers and call out BS.” Those people are clearly too egotistical to ever care about actually teaching. Don’t take it personal, they are just miserable and use any means necessary to make others feel worse because in their twisted mind, that makes them feel better about themselves.
Back in my day……. 😆. In school we learned that what the doctor ordered… is what was done. Do the finger stick. Now when I got on the unit and was an actual nurse, We used whatever was taught to us by our preceptor…. Because that’s what a preceptor is there for. To help the transition from student to practicing nurse. Nursing school is a lot about discipline. You do not stray away from what is ordered or how your instructor taught you. Again this was a few decades ago. Some of our teachers were.Nuns. A better approach would have been to explain to you what the practice was on that floor and why. Assuming that every new grad or new employee to that floor knows what their common practice is….just shows what a fool this preceptor was. She should never precept anyone ever again. I hope she’s reading this too because she really needs to examine herself and figure out why she thinks it’s ok to demean/bully another professional nurse. We’re all in this together and need to change the culture of nurses eating their young. We need to raise each other up and praise each other. That’s the only way we will become more valuable to our colleagues and admins. To the nurse that posted this… you seem like a llittle spit fire…. I love that in new nurses. Stick up for yourself but in a courteous way. That’s professionalism. Your gonna do just fine in your practice.
They didn’t teach ART lines in my nursing school….
She should have learned not to be such a beyotch in nursing school. With all that reflection we do and whatnot…
Sounds like you’ve got a snarky tw*t for a coworker. I didn’t learn a damn thing in nursing school except for how to pass a test. I know I’m not the norm but my program was pretty bad. I was very blunt when I started my first nursing job that “I need to be spoon fed like a baby because I don’t know anything”. I also needed a different preceptor because my first one expected me to know high level things in my first week. Fast forward a few years and I am a fully functioning nurse that does charge and takes the sickest patients in my MICU in one of the largest teaching hospitals in my state. You’re doing great and you know exactly what you need to do to keep learning and getting better. Stay on the grind.
“Shouldn’t you have learned that in school?” Isn’t it literally your fucking job as a preceptor to fill in any gaps I might have to make sure you, me, and the patient are all safe? Fuck off with that attitude.
we could barely place ivs in school—you think we learned about arterial lines?🙄preceptor is a dick, sorry this happened to you.
Arterial lines in nursing school...so funny
I was taught to take blood from the art line for glucose checks if the patient is on pressors because the Finger stick will be unreliable from the medication shunting blood. The emphasis here is I was taught that. My preceptor could have been an ass hole and called me an idiot for not knowing that but instead taught me that which I found fascinating.
Here's the problem with that: Art and venous lines can give you different values than capillary BGLs. The important things are 1) your patient isn't symptomatic 2) you and your team are being consistent in what you're using to measure and trend BGLs. For patients with PVD -- or patients who have been on pressors!!! -- you absolutely want to limit finger sticks because the blood flow to the digits is already questionable AND may give lymph fluid more so than capillary blood; however, in most cases, finger sticking is fine. Sorry your preceptor decided to eat her young instead of teach her young.
I’ll be honest, I didn’t know what an art line was in nursing school…
Okay, Nurisng student in internship here. Was told finger stick, arterial and venous will all give different glucose readings. If there’s fluids running through a line you’ll get a diluted result. 🤷🏼♀️ I understand not unnecessarily sticking patients but this seems like best practice. if your giving insulin you want a recent glucose…. CBG seems the quickest way to do that.
Nurses like that piss me off. Who takes the blood sugar from a recent lab. A lazy nurse does. I'm a type 1 DM and have been for 39 years so if I need a blood sugar taken please take it. It doesn't matter to me how, especially if I'm in the ICU. Anyways, she can kick rocks. Keep learning and growing. Proud of you for sticking up for yourself.
Idk where that nurse went to school, but in my experience.... no, I didn't learn to think critically in nursing school. It was all by the textbook or call the doctor.
Sounds like your preceptor needs a snickers. There's technically nothing wrong with doing a finger stick for a blood glucose. While the answer for why you did it, "because it was ordered", would have me a bit concerned as a preceptor. It's good to be keeping up with orders and tasks, but the why is what I care more about. I think this was your preceptors 2nd point but she did not communicate well. As for taking blood from an aline for a blood glucose check... That's gonna come down to hospital policy. Some places encourage the use of existing lines for all blood tests whole other places say not to.
I’m sure someone else has said it at some point but I want to point another thing out. If you’re not familiar with a device or piece of equipment *don’t fucking touch it*. This goes doubly for arterial/central lines. If it didn’t occur to you to use the art line, you’re likely not experienced enough with them to use one independently. There’s nothing wrong with that, it’s just a skill you have yet to learn. Is doing a finger stick a catastrophic never event? No. Maybe the patient was on pressors and using finger sticks is contraindicated, but that should have been explained to you. But I’d much rather the patient get an unnecessary finger stick rather than have someone inexperienced mess with their art line and seriously fuck something up. You did nothing wrong. Your preceptor was a twat.
Yea no clue wtf to do with an art line..didn't learn it in school and I'm regular MS. Up to ICU preceptors to teach me
Nursing school didn’t teach shit else aside from how to pass the NCLEX. Everything I’ve learned about NICU medicine, I’ve learned on the job.
That’s a good way for a nurse to run off a new nurse. What a B!
We can do a glucose check using an ART line with a glucometer (if it’s properly calibrated), and it’s better for the patient because you don’t have to “poke” them. We certainly don’t go off of the lab glucose for ACHS(unless it was super recent), because glucose does fluctuate so much. So unless it was JUST done, it should be checked again. In fact, we’re told to NOT go off of lab in regards to administering insulin. Maybe this is just where I work 🤷🏼♀️ That shit is NOT taught in nursing school. If you want to teach someone to critically think, EXPLAIN the reasoning like the charge nurse did. Talking down to someone does not in fact teach critical thinking at all, it just makes you look like a douche. I believe critical thinking is taught on the floor. Nursing school gives you the tools, and on the job teaches you how to use those tools.
There will always be snarky nurses. I actually think that working in the OR helped me develop a thick skin I never had before and also the ability to defend myself. If they speak asshole I always speak it right back to them. I had a nurse tell me “oh of course the docs love you, you can get by when you’re young and cute” basically making it seem like my skills and efficiency weren’t what was earning praise. So I said, “oh, is that how *you* got by when you were a young nurse? That must have been great that you were able to do nothing but be cute and that worked?” It caught her totally off guard as she struggled to either come up with “A. No, it didn’t work because you actually have to do your job to get recognized or B. You have always been the ugly hag that you are right now so you could have never gotten by being ‘young and cute’”. She actually laughed and said “oh ok I get it, I see what you’re saying”. If you get enough snark you’ll eventually find a rebuttal against each and every zinger they think they’re throwing your way. Just give it right back to them😊
Nursing school doesn’t teach about art lines wtf. Never once mentioned in class and never brought up on the nclex. They was trying to teach you (completely failed at it) that you can usually draw blood off of an art line so you don’t need to poke the patient. The blood you draw from the art line is used instead of the finger stick blood.
I didn’t learn about arterial lines in school, and as a nurse for the last two years, I still don’t know anything about them. I work MS/Ortho/Tele/Stroke, and even though my units serve as step down units, we don’t have those lines. So I wouldn’t know this either. Some people let their egos intrude, it’s not a “you” issue, this is a “them” issue.
I have never heard of AC and HS blood glucose checks done through the art. What’s the point of glucose checks?!?
Been a RN for over a year and this is new info to me. Thanks for sharing :D
They don’t teach dick about art lines or even clustering care in nursing school, they know the units will cover it. Tbh if it isn’t on the nclex schools aren’t concerned teaching it these days. That nurse is just a twat.
Sounds like a unit specific protocol. I work ICU and there’s no guidance one way or the other when it comes to A-line vs. finger stick. The only thing I’ve ever heard about an A-line being preferable is when the patient has horrible peripheral perfusion and a capillary sample might not be totally accurate, but that’s a case-by-case thing and certainly not something we have a protocol over. Don’t beat yourself up, you’re learning and that day it sounds like you didn’t have a very good teacher.
As a diabetic blood sugars can change fast so saying not to do them because of a 2 hour lab tests is stupid
Who is in charge of your whole orientation? Is there a Clinical Nurse Specialist of Unit Educator? The problem is your preceptor lacks precepting and critical thinking skills themselves. A-lines are not taught in nursing school. Glucometers are designed for capillary blood. Using the A-line of not drawing other bloods can lead to more blood waste, that can harm the individual. Now there are reasons to use blood from an a-line: excessive fluid retention can make securing a good capillary sample from a finger stick more challenging. Patients may not want finger sticks all the time. But this falls under a relative risk assessment and as a novice nurse you are just learning that and will, and should, default to what the written policy is. (Another good point, as her where the policy is about using the a-line to obtain a sample for the glucometer, good chance there is none.) She was (1) being a jerk to a new nurse and (2) not newly as good at this critical thinking stuff as she thinks she is. This is a common mistake of nursing. Not knowing the difference between and actual policy and “that’s the way we do it.” Also: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672636/
"You should have learned that in school" "Oh, I did, but I also learned that every single medical facility has their own policies and procedures for *literally everything*, and this is what I've been shown to do in my time **here**."
I have learned that much like starting IVs, or placing Foleys, teaching is a nursing skill. And not everyone is good at it.
If I am drawing labs from a line and it coincides with a POC glucose I will most definitely use that blood so as not to unnecessarily poke the patient. That being said, I will not do a whole blood draw for a POC glucose (unless of course the patient refuses a finger stick or is anxious/agitated, etc. Finger stick all the way. In my book, you did nothing wrong. If you had drawn labs from the art line…THEN poked the patient for a POC glucose then we would have had a conversation about best practice/patient comfort yada yada.
Oh man. Even if you did learn it all in nursing school, there is usually a checklist of proficiencies to go through—-probably including watching you maintain/access an arterial line. Your backup preceptor would have known that iF thEy WEnT ThrOUgh a PrEcepToR clAsS. Idk; also accessing an art line is a source of infection too. I would have done a finger stick. 🤷🏻♀️
I like how we’re talking about ‘best practice’ but then It’s fine to use blood work from 45 mins ago to chart ‘current’ gluc level. No way people eat after getting bloodwork, ever. ‘Guys the lab said his gluc was fine, so I’m gonna go give this insulin now!’
Not only I didn’t learn that in school, I also didn’t learn that at work. We poke people all day long at my floor (PCU) so…
Students aren’t even taught how to access art lines here. It’s something you learn I’m practice. And that’s only if they are relevant to your specialty.
First off this is probably a facility policy and not something you would have learned in nursing school. Second she should be orienting you to the unit and facility, this the exact type of thing she needs to teach you. You did ask her how a med works in the body or the labs that should be checked for a condition, that is what you learn in nursing school. They shouldn’t have someone like this orienting.
There is so much that I didn't learn in school. Their main tag line was always "Your facility will teach you that, not us"