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108 Unit 1
ABGs
| Term | Definition |
|---|---|
| Methods | -Percutaneous Stick -Arterial Line -Umbilical catheter -Capillary |
| Indications | -Evaluate the Adequacy of Acid-base (pH, PaCO2, and HCO3), Ventilation (paCO2), and oxygenation (PaO2, and O2Hb) -Determine the response to therapeutic intervention -Monitor Severity and Progression of a disease process |
| Therapeutic Interventions | -Supplemental Oxygen -Mechanical Ventilation -Diagnostic Evaluation (exercise desaturation) |
| Contraindications for ABG | -Negative modified Allen Test -Arteriovenous shunt (dialysis patient) -Improperly functional gas analyzer -Specimen not properly anticoagulated -Visible air bubbles -Incomplete requisition (interpretation and documentation) -unlabeled specimen |
| Hazards of ABG Puncture | -Infection of technician (needlestick) -Inappropriate medical treatment -Vessel spasm -Hematoma -Laceration of the artery -Hemorrhage -Vasovagal reaction -Loss of Limb |
| Equipment and Supplies | -ABG syring (3-5 cc pre-heparinized) -Needle (1-1.5 inch, 22 gauge) -Needle protection device -alcohol -gauze -band-aid -gloves -rubber stopper -biohazard bag -ice container |
| Glass Syringe | -Not gas permeable -results remain stable -if analysis cannot be performed in 30 minutes -place in ice/water slush to prevent metabolism changes -can remain stable iced for up to 2 hours |
| Plastic Syringe | -gas permeable -most common -don't ice -results main stable for 30 minutes |
| Heparin | prevents blood sample from clotting |
| Lithium Heparin | -lypholized (dry) -used if running electrolyte panels -premeasured amounts for preventing dilution of samples -white dot |
| Sodium Heparin | -usually in solution -can affect pH result -affects the electrolyte panels -used primarily with arterial lines |
| Adult Site Selection Sites | -Radial (site of choice) -Brachial -Femoral -Popliteal -Dorsalis Pedis |
| Pediatric Site Selection | -Radial -Brachial -Capillary |
| Neonates/Newborn Site Selection | -Umbilical -Radial -Capillary |
| How long should it take for color to return in a Modified Allen's Test? | 10 seconds |
| What do you palpate to determine? | -size -direction -depth |
| What do you clean the site with? | -alcohol -betadine |
| Which angle is the needle inserted at? | -30-45 degree angle |
| How long should you apply pressure over the puncture site in normal individuals? | 5 minutes |
| How long should you apply pressure over the puncture site in individuals on anticoagulants? | 10-15 minutes |
| How do you mix the specimen? | -inversion or rotation |
| Labeling Information | -Date and Time -Name -FMP/SSN -Puncture sites -FIO2 or O2 liter flow -ventilator setting -Patient Temperature -Technician Name -Ordering Physician |
| Brachial Artery | -Major artery of the upper arm -divides into radial and ulnar just below the elbow |
| Indication for Sticking the Brachial Artery | -The radial arteries are unsuitable -Negative Allen Test |
| Hazards of Sticking the Brachial Artery | -Deeper Vessel -Harder to stabilize -More susceptible to hematoma -Median nerve damage -No collateral circulation |
| Where do you palpate on for the Brachial Artery? | -antecubital fossa |
| Where do you follow the arterial pulse on the brachial artery? | -2-3 cm Proximally |
| What angle do you use for the Brachial artery? | -45 degree angle |
| When must a sample be analyzed immediately regardless of syringe? | -paO2 > 150 mmHg |
| Sampling Errors (Pre-analytic) | -Air bubbles (most common) -delay in analysis -Improper Mixing (heparin unmixed) -Improper syringe -Venous Sample -Improper anticoagulant (sodium heparin) -Too little heparin (clots in machine) -Too much heparin (dilutes sample) |
| Gas Tensions in the Air (Bubble) | -O2: 150 mmHg -CO2: essentially zero -N2 - inert |
| Gas Tensions in Arterial Blood | -O2: normal 80-100 mmHg -CO2: normal 35-45 |
| CO2 effect | -CO2 diffuses out of the blood into the sample decreasing the PaCO2 -increases the pH of the sample |
| O2 effect | -normally O2 in the bubble has a higher tension than the sample so O2 wil diffuse out of the bubble into the sample -increases measured PaO2 |
| Hyperoxygenated patient | 500-600 mmHg -paO2 will decrease due to diffusion |
| Capillary Sampling | -an arterial blood gas sampling in infants -correlates wtih PacO2 and pH -does not correlate well with PaO2 |
| Indications for Capillary Sampling | -ABG analysis is needed but arterial access is not available -May only need to look at ventilation -Non-invasisve monitors are inaccurate or abnormal |
| Contraindications for Capillary Sampling | -not performed at the certain sites -patients less than 24 years old -When there is a need for accurate analysis of oxygenation |
| Sites NOT to be used for Capillary Sampling | -posterior curvature of the heel -fingers of neonates -previous puncture sites -swollen or edematous tissue -cyanotic poorly perfused tissue -areas of infection -peripheral arteries |
| Hazards of Capillary Sampling | -infection -burns -hematoma -nerve damage -pain -bleeding |
| Equipment | -gloves -pre-heparinized glass capillary tube -metal flea and magnet (for mixing sample) -lancet -gauze -warming pack/moist warm diaper -band-aid -alcohol pad |
| What is the heat limit for capillary sampling? | -not higher than 42 degrees celsius |
| What is the puncture limit for capillary sampling? | -not deeper than 2.0 mm |
| What must you not do at the site for capillary sampling? | -do not squeeze the site to increase blood flow -results in excess amounts of serous fluid and venous contamination of the sample |
Created by:
Mdarrielle09
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