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ABGs

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Term
Definition
Methods   -Percutaneous Stick -Arterial Line -Umbilical catheter -Capillary  
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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  
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Therapeutic Interventions   -Supplemental Oxygen -Mechanical Ventilation -Diagnostic Evaluation (exercise desaturation)  
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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  
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Hazards of ABG Puncture   -Infection of technician (needlestick) -Inappropriate medical treatment -Vessel spasm -Hematoma -Laceration of the artery -Hemorrhage -Vasovagal reaction -Loss of Limb  
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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  
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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  
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Plastic Syringe   -gas permeable -most common -don't ice -results main stable for 30 minutes  
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Heparin   prevents blood sample from clotting  
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Lithium Heparin   -lypholized (dry) -used if running electrolyte panels -premeasured amounts for preventing dilution of samples -white dot  
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Sodium Heparin   -usually in solution -can affect pH result -affects the electrolyte panels -used primarily with arterial lines  
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Adult Site Selection Sites   -Radial (site of choice) -Brachial -Femoral -Popliteal -Dorsalis Pedis  
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Pediatric Site Selection   -Radial -Brachial -Capillary  
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Neonates/Newborn Site Selection   -Umbilical -Radial -Capillary  
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How long should it take for color to return in a Modified Allen's Test?   10 seconds  
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What do you palpate to determine?   -size -direction -depth  
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What do you clean the site with?   -alcohol -betadine  
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Which angle is the needle inserted at?   -30-45 degree angle  
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How long should you apply pressure over the puncture site in normal individuals?   5 minutes  
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How long should you apply pressure over the puncture site in individuals on anticoagulants?   10-15 minutes  
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How do you mix the specimen?   -inversion or rotation  
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Labeling Information   -Date and Time -Name -FMP/SSN -Puncture sites -FIO2 or O2 liter flow -ventilator setting -Patient Temperature -Technician Name -Ordering Physician  
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Brachial Artery   -Major artery of the upper arm -divides into radial and ulnar just below the elbow  
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Indication for Sticking the Brachial Artery   -The radial arteries are unsuitable -Negative Allen Test  
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Hazards of Sticking the Brachial Artery   -Deeper Vessel -Harder to stabilize -More susceptible to hematoma -Median nerve damage -No collateral circulation  
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Where do you palpate on for the Brachial Artery?   -antecubital fossa  
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Where do you follow the arterial pulse on the brachial artery?   -2-3 cm Proximally  
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What angle do you use for the Brachial artery?   -45 degree angle  
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When must a sample be analyzed immediately regardless of syringe?   -paO2 > 150 mmHg  
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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)  
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Gas Tensions in the Air (Bubble)   -O2: 150 mmHg -CO2: essentially zero -N2 - inert  
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Gas Tensions in Arterial Blood   -O2: normal 80-100 mmHg -CO2: normal 35-45  
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CO2 effect   -CO2 diffuses out of the blood into the sample decreasing the PaCO2 -increases the pH of the sample  
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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  
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Hyperoxygenated patient   500-600 mmHg -paO2 will decrease due to diffusion  
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Capillary Sampling   -an arterial blood gas sampling in infants -correlates wtih PacO2 and pH -does not correlate well with PaO2  
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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  
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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  
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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  
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Hazards of Capillary Sampling   -infection -burns -hematoma -nerve damage -pain -bleeding  
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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  
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What is the heat limit for capillary sampling?   -not higher than 42 degrees celsius  
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What is the puncture limit for capillary sampling?   -not deeper than 2.0 mm  
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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  
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