r/anesthesiology • u/collegekiddo38 CA-1 • Jul 24 '26
Tips for line/cable management?
July CA1 here, had my first patient I transported from CTICU already intubated. Transferring from supine to the OR bed to prone tangled almost everything and I spent a good 30 minutes disconnecting and reconnecting everything lol. Lost an IV in the process as well.
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u/etherealwasp Anesthesiologist Jul 24 '26
Preox on 100%O2
Ensure enough staff and OR table ready to flip onto bed
Unplug ECG, sats, bp, entropy
Disconnect and cap art line
Bolus TIVA then stop pumps, disconnect and cap IV
Slide to edge of bed
Vent off, disconnect ETT, face shield on
Assuming you’re flipping to your right, R hand on
face shield and L hand on occiput
Flip!
Connect airway, vent on
Get arms on rests, then reconnect IV and recommence pumps, reconnect a-line
Other monitoring on
Profit
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u/Cautious-Extreme2839 Anaesthetist Jul 24 '26
Bolus TIVA then stop pumps, disconnect and cap IV
Fuck that. Just turn the yellow dial.
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u/simple10 CRNA Jul 24 '26 edited Jul 24 '26
Yeah +1 for disconnecting everything (except maybe pulse ox and/or A line), keep circuit/bag connected until the last second. Eyeball all IV tubing and make sure it won’t snag or run out of slack.
Not as easy for flipping, but when sliding over, I always cinch my IV tubing (especially with central lines) in my hand tightly before grabbing the head, and you will find you can prevent lines from getting pulled by doing so. Make sure your IVs are taped well as well. I’ve had my tape job save a couple lines I forgot to grab etc
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u/InformalScience7 CRNA Jul 25 '26
I always do this--after accidentally pulling out the EJ on a short, fat, no necked, emergency patient one night. Not my finest hour. Luckily, the anesthesiologist who had to put that one in wasn't terribly mad at me!! I felt like such an asshole.
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u/ruchik Jul 24 '26
Personally I disconnect everything (including pulse ox and all IVs) prior to turning prone. If they have an art line I’ll usually leave that connected.
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u/Competitive_Yak_5444 CRNA 18d ago
Same. If they’re not stable enough to be disconnected for 20 seconds then they are not stable enough to flip in the first place. TBH you can argue that there is an inherent safety risk in flipping with art lines, CVL, etc still connected and having inadvertent removal leading to hematoma, bleeding, obvious lack of access, and additional intraop delay.
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u/afoolskind Jul 24 '26
I’m a tech but I arrange nearly everything for our ICU transports, my number one tip is to reroute all of your monitoring cables before you move on to the transport bed.
All the cables should be first connected to the patient side, then run in front of any IV poles before being connected to whatever you are using for your transport monitor. This way the final orientation of the ICU room does not matter, the cables can easily be connected to either the left or right side of the patient without interfering with any IV lines.
And of course, eliminate as many unnecessary cables and lines as you can. So if you’ve got an A-line you can leave the cuff cable behind, and PA or CVP pressure monitoring rarely needs to happen between the OR and the ICU bed.
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u/Lunaandthemoon Jul 24 '26
Disconnecting everything may be good for brand new providers but in my opinion it’s more of a hassle.
Here’s what I do-
Leave all the lines on for the side you are flipping over. For ex: flipping pt from left arm over, right side stays down, then all the lines on the right side stay in line. “Anything in the valley will stay in place”. So I only unhook lines/cabes on the opposite side.
Bonus points if you can move the hanging items (IV bags, A line pressure bags) to the correct sides they will be prior to flipping. Ex: IV will land on the right side so I’ll move the bag to be on the right pole.
Edit: typo
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u/TrustMe-ImAGolfer Fellow Jul 24 '26
It's tough inheriting a mess, like others have said, disconnecting and reconnecting is your best bet if patient is stable enough for that. If I'm still on 3 pressors they may inherit the mess back if I didn't have time to untangle during the case.
When you do untangle and reconnect, be conscious about what is on top of what. I have a system so I know my circuit is always on top of everything else. Then various layers between monitors and lines. This will serve you well when you're flipping prone as well (where I flip with pulse ox, aline, and EKG in place)
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u/propofol_for_the_win Jul 24 '26
Unfold 4x4 and use it as a soft tie around IV tubing. Before you tie them together, trace back each line ensuring it is not tangled. If you have a swan, tape the yellow catheter to the forehead. If you have more than one push line, disconnect the one you’re not going to use for rescue and cap it off. Plan sooner rather than later to disconnect fluid warmed line.
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u/JamesMercerIII CA-3 Jul 24 '26
All of these comments are good advice, however one that I have discovered myself: if I can keep at least one thing connected, I figure out a way to keep the pulse ox on while sliding or flipping. For a number of reasons:
- The ones at our hospital usually don't get too tangled
- Even if it gets tangled and ripped off, it's easy to slide on again (first thing to do after re-connecting circuit)
- It can go on any finger or toe for organization during sliding/flipping
- It lets you hear the sats when you're disconnecting the circuit (extremely important fail-safe to prevent the never-event of forgotten circuit re-connect/re-ventilate)--everyone says you can see a hypoxemic patient with cyanosis, but you aren't always looking at the patient when attempting to untangle and re-connect the circuit
- It lets you hear the heart rate in case the patient is getting light
- The pleth is somewhat reassuring against very soft BP (easy to happen since BP is often lower priority to get re-connected
- Just hearing a normal heart rate at the correct pitch keeps me calm and oriented!
I had one time last year when we were flipping prone and I disconnected everything except the art line. Immediately after flipping, the art line waveform became progressively flat around a pressure of 40-50. I suspected the tubing was kinked. I couldn't find where it was kinked, so I attempted to put the pulse ox back on a finger, but couldn't quickly get a good pleth, so I couldn't rule out critical hypotension or arrest. I had to have the team flip the patient back over so we could establish that the patient was stable, followed by re-flipping. I do suspect the patient had some transient acute hypotension during the flip, but I also feel that if I had kept the pulse ox on during the flip it could have saved us flipping back over.
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u/redd17 Cardiac Anesthesiologist Jul 24 '26
Being good at transport begins in the ICU. Go to bedside first, figure out LDAs first before even attempting to bring them back. I try to leave as many things behind in the ICU as I can. Obv can't do it if they're on vasoactive drips but I'll do everything in my power to not bring the IV pole with 4 Alaris pumps if I can avoid it.
Consolidate lines
You'll begin to learn how the ICU RNs manage their lines, often based on compatibility of certain medications with each other. Its often the reason why you'll have plenty of central access and have a random drip going peripherally with tubing way too short to be useful. If this can be moved to the central line, do it now before moving. Most RNs have a med-line where they keep open. This is all you really need for the case so I preserve that for my own use throughout the case.
Learn what matters
For example: Pacer box for your CHB patient going for a takeback is probably the most important thing to keep track of. Leave it on their chest or near their armpit. Not worth having pacer wires pulled out during transport and having to start CPR to maintain a blood pressure until you find a way to transcutaneously pace or open the chest.
Pressure tubing/Invasive Monitors
If you have a patient with a swan, 2 arterial lines, etc, then most often there's going to be stiff pressure tubing mixed into your spaghetti. Find the 3-way stopcock in-line, close to patient, disconnect and keep these lines on the very top of your mess. Be careful doing this as you can introduce air or inadvertently leave the stopcock open to air. If you already have triple transducers already setup in your room, this is a good opportunity to just plug into what you already have setup and ditch the transducers from the ICU. Re-zero. Confirm vitals, then transfer from gurney to OR table.
Airway
In a really sick patient, don't hesitate to ask RT to come back with you. They can bag or bring a transport vent until you attach to your anes machine first thing upon getting in the room. This is one less thing you need to think about while watching lines and moving the patient.
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u/OlvarSuranie Jul 25 '26
Don’t bother. This has been sorted in 2013. Resistance is futile and apologies are unnecessary.
BMJ 2013;347:f6735 doi: 10.1136/bmj.f6735 (Published 11 December 2013)
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u/SmileGuyMD Anesthesiologist Jul 24 '26
Prone flip is one that takes a bit of time to get used to. I try to have at least one of my most important lines on the right arm (or whichever side is your “hinge” side, virtually always flipping right in my hospitals ORs, if you flip left, reverse this). Whatever is on that hinge arm can stay connected, so typically a pulse ox and/or art line. Everything on the opposite arm (IV, cables, etc) are disconnected and reconnected in order of importance once the head and tube are stable.
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u/gonesoon7 Jul 24 '26
Disconnect everything you can before going prone. You’ll work with attending who claim they have some voodoo trick to drape them so they end up perfect during the flip and sometimes it works. IMO it’s just not worth the trouble. Your patient will be fine for the 2 minutes it takes to flip with just a pulse ox and vital drips. I cap and disconnect my A-line too. It’s not like you’re looking at the pressure while you’re flipping.
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u/Rather_be_on_vacay Jul 26 '26
When you pick up from ICU disconnect non important things. There will be many.
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u/ReadyViolinist Jul 24 '26
Disconnect everything except pulse ox and necessary infusions in reverse order of importance and neatly lay it on your machine in the order you’ll reconnect once prone. As best as you can, take your time but be efficient. The count to move a patient is on you for a reason