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Arterial Puncture Procedures

Chapter 12. Arterial Puncture Procedures. Objectives. State the primary reason for performing arterial punctures and identify the personnel who may be required to perform them

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Arterial Puncture Procedures

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  1. Chapter 12 Arterial Puncture Procedures

  2. Objectives • State the primary reason for performing arterial punctures and identify the personnel who may be required to perform them • Explain the purpose of collecting arterial blood gas specimens and identify and describe commonly measured ABG parameters • Identify the sites that can be used for arterial puncture, the criteria used for selection of the site, and the advantages and disadvantages of each site • List equipment and supplies needed for arterial puncture

  3. Objectives • Identify typical required and supplemental requisition information, and describe patient assessment and preparation procedures, including the administering of local anesthetic prior to collecting arterial blood gases specimens • Explain the purpose of the modified Allen test, describe how it is performed, define what constitutes a positive or negative result, and give the procedure to follow for either result • Describe the procedure for collecting radial arterial blood gases specimens, and the role of the phlebotomist in other site collections. • List hazards and complications of arterial puncture, identify sampling errors that may affect the integrity of an arterial sample, and describe the criteria for specimen rejection

  4. Arterial Blood Gases (ABG) • Collected by directly puncturing an artery • Arterial specimens are ideal for most testing because arterial blood is relatively consistent throughout the body • Not routinely used because collection is technically more difficult and more painful and hazardous for the patient

  5. Arterial Blood Gases (ABG) • Primary reason is evaluation of arterial blood gases • ABG evaluation is used in: • Diagnosis and management of respiratory disease • Provides valuable information about a patient's oxygenation, ventilation, and acid‑base balance • Management of electrolyte and acid-base balance in patients with other disorders such as diabetes

  6. ABG • Components • pH • Partial pressure of carbon dioxide (PCO2) • Oxygen pressure (PO2) • Bicarbonate (HCO3) • Oxygen saturation • Base excess

  7. ABG

  8. Personnel who Perform ABG • Nurses • Medical technologists • Medical lab technicians • Respiratory therapists • Emergency medical technicians • Level II phlebotomists

  9. Arterial Puncture Sites • Criteria • Presence of collateral circulation • How large and accessible the artery is • Type of tissue surrounding the site • Sites • Radial artery • Brachial artery • Femoral artery

  10. Arteries

  11. Radial Artery • Advantages • Good collateral flow • Less chance of hematoma formation • Disadvantages • Small size • Difficult to locate

  12. Brachial Artery • Advantages • Easy to find because it is large • Easy to palpate • Adequate collateral circulation • Disadvantages • Deeper than radial • Close to basilic and median nerve • Increased risk of hematoma formation

  13. Femoral Artery • Advantages • Large • Easily palpated and punctures • May be only site for patient with low cardiac output • Disadvantages • Poor collateral flow • Increased risk of infection • Very close to femoral vein

  14. Other Sites • For infants • Scalp arteries • Umbilical arteries

  15. ABG Specimen Requisition • Patient’s full name • Medical record or identification number • Age or date of birth • Room number or other patient location • Date and time of test collection • Fraction of inspired oxygen (FiO2) or flow rate in liters per minute (L/M) • Body temperature • Respiration rate • Clinical indication for specimen collection

  16. ABG Specimen Requisition • Blood drawer’s initials • Requesting physician’s name • Supplemental information as required by institutional policy or regulatory agencies: • Ventilation status • Method of ventilation • Sampling site and type of procedure • Patient activity and position • Working diagnosis or ICD code

  17. Equipment and Supplies • Personal protective equipment (PPE) • Antiseptic, gauze, and bandage • Ice (if indicated) • Sterile prepackaged kits • Heparinized syringe • Special capping device • Safety needle or needle removal device • Needle usually 22 g or smaller • Labels, sharps container, etc.

  18. ABG Equipment

  19. Patient Assessment and Preparation Procedures • Identification and assessment • ID patient, explain procedure, obtain consent, reassure • Verify and document collection conditions • Check for anticoagulant therapy • Steady state • At least 20-30 minutes before obtaining sample • Do not perform until steady state has been achieved • Exception: emergency situations

  20. Patient Preparation • Modified Allen test • Assesses collateral circulation • No special equipment necessary • Steps: • Have the patient make a tight fist • Apply pressure to the patient's wrist, compressing both the radial and ulnar arteries at the same time • While maintaining pressure, have the patient open the hand slowly • Release pressure on the ulnar artery only • Assess results • Record the results on the request slip

  21. Modified Allen Test

  22. Modified Allen Test • Positive Allen test result • Hand flushed pink or returns to normal color within 15 seconds. Arterial puncture can be performed on radial artery • Negative Allen test result • Hand does not flush or return to normal color within 15 seconds. Radial artery should not be used

  23. Patient Preparation • Administration of local anesthetic • Routine administration unnecessary because of thin-wall needles • Blood gas results affected by patient anxiety • Local anesthetic used is 1% lidocaine with epinephrine • May cause prolonged bleeding in patients on anticoagulant therapy

  24. Radial ABG Procedure • Position arm • Locate the artery • Clean the site • Prepare equipment • Insert the needle • Advance the needle into the artery • Withdraw the needle and apply pressure • Remove air, cap, and mix • Check the site • Transport and handle

  25. Radial ABG Procedure

  26. ABG Collection from Other Sites • Similar to radial punctures • Not usually performed by phlebotomists • Phlebotomists may be asked to provide equipment and assistance • Labeling specimens • Transporting specimens

  27. Hazards and Complications • Arteriospasm = reflex (involuntary) contraction of the artery • Discomfort • Infection • Hematoma • Numbness • Thrombus formation = injury to the inner wall of the artery can lead to clot formation • Vasovagal syncope = faintness or loss of consciousness

  28. Sampling Errors • Air bubbles • Delay in analysis • Improper mixing • Improper syringe • Obtaining a venous sample by mistake • Use of improper anticoagulants • Use of too much or too little heparin

  29. Criteria for Rejection • Air bubbles in specimen • Clotted specimen • Hemolysis • Improper or absent labeling • Improper transportation temperature • Inadequate volume of specimen for the test (QNS) • Prolonged delay in delivery to the lab • Use of wrong syringe

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