The question of whether a nurse can place an arterial line, often called an A-line, is not answered with a simple yes or no. An arterial line is a thin catheter inserted into an artery, most commonly the radial artery in the wrist, to gain direct access to the body’s arterial system. This invasive procedure is generally reserved for patients requiring intensive monitoring. For the vast majority of bedside Registered Nurses (RNs), it is a task performed by other specialized providers. The ability of a nurse to perform this procedure depends on state-level regulations, advanced training, and specific institutional credentialing.
The Purpose and Function of Arterial Lines
Arterial lines serve two primary functions in the care of critically ill or perioperative patients, offering a level of data collection that non-invasive methods cannot match. The most significant function is providing continuous, real-time blood pressure monitoring directly from the artery. This level of precision is necessary for patients receiving powerful vasoactive medications, such as vasopressors or inotropes, where slight changes in blood pressure require immediate and frequent adjustments to drug dosages.
The second major function is facilitating easy and frequent sampling of arterial blood for laboratory analysis, especially for Arterial Blood Gas (ABG) testing. ABG results provide data on oxygenation, carbon dioxide levels, and blood pH, which is essential for managing patients on mechanical ventilation or those experiencing respiratory failure. The indwelling catheter eliminates the need for repeated needle sticks to draw blood.
Determining Scope of Practice: State Regulations and Hospital Credentialing
The authority for a nurse to perform any procedure, including the placement of an arterial line, begins with the state’s Nurse Practice Act (NPA) and the State Board of Nursing. The NPA defines the legal boundaries of practice for all nurses within that state. Some states explicitly allow a Registered Nurse to insert arterial lines, provided they have additional training and their competency is formally assessed and verified.
Even when state law permits the procedure, it is the individual hospital or healthcare facility that sets the final, more restrictive policy. A facility must provide specific training, establish detailed protocols, and formally credential the nurse to perform the task, often requiring the use of ultrasound guidance to minimize risk. For a general staff RN, arterial line placement is typically considered outside the standard scope of practice, making the procedure an exception rather than the rule.
Specialized and Advanced Practice Roles in Placement
The most common nursing professionals who routinely place arterial lines are those in advanced practice or highly specialized roles. Certified Registered Nurse Anesthetists (CRNAs) regularly perform arterial cannulation as a standard part of their practice in the operating room and other settings where continuous hemodynamic monitoring is required. Their extensive training in anesthesia and patient monitoring includes the technical skills and anatomical knowledge necessary for this invasive procedure.
Beyond CRNAs, some highly specialized Registered Nurses in critical care or emergency departments may also be trained and credentialed to place arterial lines. This is most often seen in high-acuity environments like Level I trauma centers or large academic medical centers. These nurses must undergo intensive training and demonstrate proven competency, often following protocols established by organizations like the Infusion Nurses Society (INS) or the Association for Vascular Access (AVA).
The Primary Nursing Role in Arterial Line Management
While few nurses place the arterial line, all nurses caring for a patient with one are responsible for its management and maintenance. This begins with consistent monitoring of the arterial waveform on the bedside monitor, which provides visual confirmation of the line’s function and the patient’s heart activity. Nurses must regularly “zero” and “level” the transducer system, typically every four hours or when the patient is repositioned, to ensure the blood pressure readings are accurate relative to the patient’s right atrium.
Troubleshooting involves assessing for issues like “damping,” which is a distortion of the waveform that can lead to inaccurate pressure readings, and performing a dynamic response (square wave) test to check the system’s responsiveness. Site care and infection prevention are essential, requiring regular assessment of the dressing and the insertion site for signs of bleeding, infection, or neurovascular compromise. Finally, when the line is no longer needed, a trained nurse can safely remove it, which requires applying direct, sustained pressure to the artery to ensure hemostasis and prevent hematoma formation.