Objectives of Obtaining Arterial Blood Gases stick

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  1. Describe the equipment is needed for a given procedure and how it is
     properly used.
        a. Arterial Puncture
        b. Indwelling Catheter
        c. Capillary Blood Sample

      Equipment for an ABG stick:
        Blood gas kit with 2x2 gauze, band-aid, alcohol wipe, antiseptic wipe, etc
        Gloves,towel to support wrist
      Equipment for an arterial line draw
        10cc syrine with blunt needle, another blunt needle to replace syringe kit
        needle, 2 alcohol wipes
      Equipment for a Capillary draw
        Lance, capillary tube, alcohol wipe, 2x2 gauze, warming cloth

  2. Name common arterial puncture sites.

     The radial is the preferred site. Alternates are brachial and femoral.

  3. Describe the standard isolation precautions with an ABG puncture.

     Univeral precautions, Wearing gloves (Gloves provide little protection from needle
     punctures but should be worn to prevent splashing of blood on sores or other skin breaks) ,
     wiping area of puncture, disposing of needles in sharps container, preventing
     inadvertent needle stick to therapists and other health care workers, one hand
     resheathing or rubber plug capping, transport without needle

  4. Describe the contra-indications for arterial puncture.

     Contraindications are absolute unless specified otherwise.
     1. Negative results of a modified Allen test (collateral circulation test) are
     indicative of inadequate blood supply to the hand' and suggest the need to select
     another extremity as the site for puncture.
     2. Arterial puncture should not be performed through a lesion or through or distal
     to a surgical shunt (eg, as in a dialysis patient). If there is evidence of infection or
     peripheral vascular disease involving the selected limb, an alternate site should
     be selected.
     3. Agreement is lacking regarding the puncture sites associated with a lesser
     likelihood of complications; however, because of the need for monitoring the
     femoral puncture site for an extended period, femoral punctures should not be
     performed outside the hospital (usually only by ER doctor).
     5.4 A coagulopathy or medium-to-high-dose anticoagulation therapy (eg, heparin
     or coumadin, streptokinase, and tissue plasminogen activator but not necessarily
     aspirin) may be a relative contraindication for arterial puncture.
5. List the precautions and/or possible complications.

   They are
   1. Hematoma
   2. Arteriospasm
   3. Air or clotted-blood emboli
   4. Anaphylaxis from local anesthestic
   5. Introduction of contagion at sampling site and consequent infection in patient;
   introduction of contagion to sampler by inadvertent needle 'stick.'
   6. Hemorrhage
   7. Trauma to the vessel
   8. Arterial occlusion – loss of blood flow and circulation
   9. Vasovagal response
   10. Pain

6. Be able to perform the Allens Test

   Have patient make a fist while you tightly squeeze both the radial and ulnar
   arteries; Let go of the ulnar and watch to see if hand is uniformly re-perfused
   (pinks up). If large areas remain pale - check the other hand.

7. How to obtain blood from an arterial line.

A. Gather material (10cc waste syringe, alcohol wipes, blunt tip needle), check
   order, confirm patient
B. Identify the arterial line with:
      a. Proximal port
      b. Distal port
      c. Opening stopcock
      d. Flush mechanism
C. Close the stopcock to allow the art line to occluded – Confirm with monitor check
D. With the 10cc syringe, draw from the distal port until blood appears at the port,
   (Hint - withdraw needle with negative pressure)
E. Using a blunt tip in the proximal port, insert and fill the ABG syringe, wipe
F. Open the stopcock and flush the line of blood

8. What are some common errors that contribute to analysis errors?

A. Venous puncture
      a. Occasionally blood is drawn from a vein. Take heart, it happens to
          everyone and it takes great skill to draw from a vein.
B. Delay in processing
          a. Place the sample on ice. The living tissue (blood) will continue to consume
             oxygen and nutrients and to produce carbon dioxide. PaCO2 will be
   C. Air bubbles in sample
          a. The room air oxygen can diffuse into the sample and cause an increase in
             PaO2. If the PaO2 is greater than 160 it will decrease the in the sample.
             The carbon dioxide will diffuse out and decreased the PaCO2.

   9. What are the normal values expected from an ABG?

       Arterial blood – pH 7.40, PaCO2 40, PaO2 80-100
       Venous blood - pH 7.45, PaCO2 45, PaO2 40
       Alveolar partial pressures
       Cellular partial pressures


Anti-coagulants (Rau Page 327-331)
   A drug that thins the blood and prevents quick clotting times. Typical in heart
   patients. Measured with PT and PTT. Once-a-day aspirin could be considered.
   Example Heparin, warfarin, and comindin

Arterial blood
   Blood in the arteries. It is brighter red color, has a higher oxygen level, a higher
   carbondioxide level, and a less acidotic pH

Collateral circulation
   A secondary (back road – ‘detour’ of backup circulation- like I-5 and Hwy 99).

   Within the body, as apposed to pulse oximetry values can be obtained non-invasively

   A drug that causes the clot to break up. A suspected heart attack patients in ER get
   these. It is called tPA protocol. Example: Streptokinase

   An abnormal condition where a thrombus (clot) develops in the blood stream and
   obstructs the flow, sometimes with dire consequences.

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