We are beginning to use Arterial line pressure monitoring at our unit. I have been given the task of collecting information to educate and motivate our lvn's and techs to value this as a tool that is truly beneficial to dialysis patients. So far they see it as just another step that is a pain (seems to be setting off more alarms.) What kind of info can you give me, resources, etc that I can use to motivate us as to fluid dynamics travelling through the tubing, and how art line monitoring is really good sense.

thank you,
robert baxter rn

Robert,
You don't say whether you are using "pre pump" or "post pump" blood tubing, so I will try to describe the action of both. Pre pump monitoring measures the resultant pressure between the access and the blood pump.This segment of the tubing is normally under negative pressure during the dialysis procedure, and is the really the only source of "passive" air entry into the extracorporeal circuit. During the treatment, the negative pressure limit should be set at no more then -100 mm of Hg on the low end and at about zero on the high end. The greater the negative pressure, the more at risk you are for air entering the closed system. If the patient's access cannot support the prescribed blood flow, you will notice fluctuations in the negative pressure and couls potentially see "foaming" in the arterial line. If this occurs, the Qb should be reduced until the negative pressure remains constant.
Post pump monitoring, is in my opinion less useful the pre pump monitoring. It cannot tell you much about the ability of the access to support a prescribed blood flow. In this situation, we are monitoring a resultant positive pressure between the blood pump and the dialyzer. Post pump monitoring will detect resistance to blood flow in the dialyzer usually as a result of clotting or a "kink" in the blood line. Using blood lines with pre pump chambers is an excellent idea as you will be able to ascertain whether or not your patients are dialyzing at the prescribed Qb. This should also enhance any vascular access management program that you currently use in your unit.