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BRTP > 08 > Flashcards

08 Flashcards

1
Q

Primary purpose of ABG

A

Adequacy of oxygenation and ventilation

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2
Q

What measurement on ABG assesses oxygenation BEST

A

PO2

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3
Q

What measurement on ABG measures ventilation BEST

A

PCO2

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4
Q

Major hazards of arterial puncture

A

ARTERY LACERATION
Bleeding/hemorrhage
Blood flow obstruction
Infection at site

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5
Q

Absolute contraindications of arterial puncture

A

Thrombolytic tx (clot buster)
Abnormal/negative Allen’s test
Dialysis shunt
PVD (lesion/infection)

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6
Q

Relative contraindications of arterial puncture

A 
Coagulopathy
Anticoagulation theraypy (warfarin, heparin, etc)
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7
Q

Order of preference for arterial puncture

A

Radial (R/L), Brachial (R/L), femoral, dorsalis pedis

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8
Q

Purpose of Allen’s test

A

Test collateral blood flow

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9
Q

What artery do you release on Allen’s test

A

Ulnar

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10
Q

Positive Allen’s test time for refill

A

3-5 seconds

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11
Q

Max time for pink color return of positive Allen’s test

A

10-15 seconds

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12
Q

Correct technique for redirecting needle if first puncture was not placed in artery

A

Bring needle up until you see bevel, not all the way out

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13
Q

Action for repositioning a needs when pulsation flow prematurely stops

A

Retract slightly

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14
Q

What degree and what way should the bevel be facing when pulling ABG

A

45 degree angle, bevel up

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15
Q

You pull ABG _____ flow of blood flow

A

Opposite

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16
Q

Drug in needle

A

Heparin

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17
Q

How to prep heparin for ABG

A

Pump needle

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18
Q

Technique for covering needle for needle without capping device

A

Scooping

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19
Q

How to prepare sample for lab analysis and max time allowed

A

Ice within 30 minutes, label, cap, discard needle in sharps

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20
Q

What should be on lab slip that accompanies ABG

A

Date, time, FiO2, pt ID/DOB, location of puncture

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21
Q

Why is radial puncture preferred?

A

Safest
Superficial
Easy to Palpate/stabilize

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22
Q

ART line locations

A

Radial, brachial, femoral,

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23
Q

Air in sample effect on ABG results

A

Lower PCO2, raise pH
Raises low PO2
Lowers high PO2

24
Q

How to identify air in sample

A

Visible bubbles/foam

Low PCO2 inconsistent with pt status

25
Q

How to prevent air in sample

A

Remove all bubbles
Discard foamy samples
Mix after air removed
Cap syringe quickly

26
Q

Effect of venous admixture on ABG results

A

Raises PCO2
Lowers pH
Can greatly lower PO2

27
Q

How to identify venous admixture

A

Failure of syringe to fill by pulsations

Pt has no sx of hypoxemia

28
Q

How to prevent venous admixture

A 
Avoid brachial/femoral sites
Do not aspirate sample
Short bevel needle
Avoid artery overshoot
Cross check w SpO2
29
Q

Effect of excess anticoagulant (heparin)

A

Lowers PCO2
Raises pH
Raises low PO2
Lowers high PO2

30
Q

How to identify excess anticoagulant

A

Visible liquid heparin in syringe before sampling

31
Q

How to prevent excess anticoagulant

A

Remove visible heparin
Collect >2ml (adults)
Collect >0.6ml (infants)
Use dry heparin

32
Q

Metabolic effects effect on ABG

A

Raises PCO2
Lowers pH
Lowers PO2

33
Q

How to identify metabolic effects on ABG

A

Too much lag time since collection

Values inconstant w pt status

34
Q

How to prevent metabolic effects in ABG

A

Analyze within 15 minutes

Place sample in ice bath

35
Q

ABG troubleshooting

A

Palpate tOo firm -> inhibits blood flow
Do not reposition more than 2x
Do not stick pt more than 2x

36
Q

Hold pressure post puncture for

A

3-5 min

37
Q

Amt of time to wait before drawing ABG on COPD pt

A

20-30 minutes

38
Q

Amt of time to wait before drawing ABG w normal lungs

A

5-10 minutes

39
Q

Parameters directly measured by blood gas analyzer

A

PCO2, pH, PO2

40
Q

Parameters calculated with blood gas analyzer

A

Hb saturation (SO2), bicarbonate, base excess

41
Q

Name of electrode that measures pH

A

Sanz

42
Q

Name of electrode that measures oxygen tension

A

Clark polarographic

43
Q

Name of electrode that measures carbon dioxide tension

A

Severinghaus/Stowe-sanz

44
Q

Types of hemoglobin measured by hemoximeter

A

Oxyhemoglobin, methemoglobin, CO

45
Q

How accuracy of blood gas analyzer is determined

A

Comparing analyzers measurement to know values (given)

46
Q

Maintenance standard for lab gas analyzers

A

Calibration

47
Q

How frequently blood gas machines should be calibrated

A

1 point every 30 minutes

2 point every 8 hours

48
Q

Calculation for partial pressure of gas when given concentration of certified gas tank

A

(PB - 47) x % O2 (or CO2) = PO2 (PCO2)

49
Q

Random error in ABG analysis and how to fix

A

Contamination, human error, just happens
One spot on graph off
Recalibrate, rerun controls, rerun sample

50
Q

Systemic error types/how to fix

A

System failure:
Trend- gradual loss of reliability
Shift- abrupt movement outside acceptable range
Check function/repair/replace failed components

51
Q

General acceptable standards of deviation and drift in calibration

A

PH +/- 0.04, PCO2 and PO2 +/- 3

2 SD

52
Q

In Vitro oxygen analyzation

A

Remove blood THEN analyze

53
Q

In Vivo oxygen analyzation

A

Measures INSIDE artery

54
Q

Advantage of point-of-care testing

A

Fast

55
Q

When to ice ABG sample

A

When taken to lab

BRTP (6 decks)

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