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ABG Sampling

Resp Modalities

Most common puncture site? Radial artery; 1. Easily accessible, 2. on thumb side, 3. very close to skin surface & easily palpated, 4. collateral circulation.
Collateral circulation means what? Another passage of blood flow.
Ratial puncture disadvantages are what? 1. it is a thin, narrow vessel, 2. hypovolemia (low volume) and 3. hypotension.
Brachial puncture site advantages? 1. large vessel & easily palpated, 2. deeply embedded in the skin, 3. located on medial side of elbow.
Brachial puncture site disadvantages? 1. inadvertant venous sampling cause there's so many veins in the area, 2. nerve damage by dragging needle across nerve, 3. NO collateral circulation.
Complications & Hazards of arterial blood sampling? 1. vessel spasm/rolling vessesls, 2. thrombi or emboli, 3. infection, 4. loss of blood flow & circulation, 5. air embolus due to poor tech, 6. repeated compromise vessel integrity & circ, 7. use other arm than IV arm.
Allen's Test Test for collateral circulation
Allen's Test Procedure Apply pressure to radial & ulnar arteries, have pt pump hand, release ulnar & hand should flush pink w/in 15 sec. That's +Allen's & has collateral circulation. If neg, try other arm.
Allen's Test Procedure on incoherent pts. Apply pressure to radial & ulnar arteries, hold pt arm above their heart for 30-60 sec, lower hand and release ulnar artery, hand should flush pink.
When to do Allen's Test? Before EVERY radial puncture!
Sampling Errors 1. air bubbles in sample causes >PaO2 &
Can pt deny ABG? Yes! It is an invasive procedure.
Inadvertant venous sampling Usually can tell from color (darker), speed (slower), but not always. When in doubt resample or note question w/sample so lab knows!
Do we have to have dr order for ABG? Yes! Can be done in ER/critical situation but then must follow up w/dr. to get order.
If pt is on blood thinners we do what? 15m hold on puncture site! Otherwise it is only a 3-5m hold.
Supplies for ABG bag/cup of ice, alcohol pads, gauze, bandaid, label, (needle - 1 1/2" 22g for femoral sticks) Quick ABG heprinized 1" 23g needle for radial/brachial arteries. Wear gloves & googles!!!
Stick angles? Radial = 45 degree angle to skin surface. Brachial = 45-90 degree angle to skin surface.
Label must have? pt name, room #, date, time, puncture site, FiO2 pt is on (or RA), & vent settings if on one.
If order is 'ABG on RA' & pt is on O2, wean off and do what? Wait 20m & then get ABG. Same in reverse order if necessary.
Created by: mfredenburg