08

Question 1

Primary purpose of ABG

Answer 1

Adequacy of oxygenation and ventilation

Question 2

What measurement on ABG assesses oxygenation BEST

Answer 2

PO2

Question 3

What measurement on ABG measures ventilation BEST

Answer 3

PCO2

Question 4

Major hazards of arterial puncture

Answer 4

ARTERY LACERATION
Bleeding/hemorrhage
Blood flow obstruction
Infection at site

Question 5

Absolute contraindications of arterial puncture

Answer 5

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

Question 6

Relative contraindications of arterial puncture

Answer 6

Coagulopathy
Anticoagulation theraypy (warfarin, heparin, etc)

Question 7

Order of preference for arterial puncture

Answer 7

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

Question 8

Purpose of Allen’s test

Answer 8

Test collateral blood flow

Question 9

What artery do you release on Allen’s test

Answer 9

Ulnar

Question 10

Positive Allen’s test time for refill

Answer 10

3-5 seconds

Question 11

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

Answer 11

10-15 seconds

Question 12

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

Answer 12

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

Question 13

Action for repositioning a needs when pulsation flow prematurely stops

Answer 13

Retract slightly

Question 14

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

Answer 14

45 degree angle, bevel up

Question 15

You pull ABG _____ flow of blood flow

Answer 15

Opposite

Question 16

Drug in needle

Answer 16

Heparin

Question 17

How to prep heparin for ABG

Answer 17

Pump needle

Question 18

Technique for covering needle for needle without capping device

Answer 18

Scooping

Question 19

How to prepare sample for lab analysis and max time allowed

Answer 19

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

Question 20

What should be on lab slip that accompanies ABG

Answer 20

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

Question 21

Why is radial puncture preferred?

Answer 21

Safest
Superficial
Easy to Palpate/stabilize

Question 22

ART line locations

Answer 22

Radial, brachial, femoral,

Question 23

Air in sample effect on ABG results

Answer 23

Lower PCO2, raise pH
Raises low PO2
Lowers high PO2

Question 24

How to identify air in sample

Answer 24

Visible bubbles/foam

Low PCO2 inconsistent with pt status

Question 25

How to prevent air in sample

Answer 25

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

Question 26

Effect of venous admixture on ABG results

Answer 26

Raises PCO2 Lowers pH Can greatly lower PO2

Question 27

How to identify venous admixture

Answer 27

Failure of syringe to fill by pulsations | Pt has no sx of hypoxemia

Question 28

How to prevent venous admixture

Answer 28

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

Question 29

Effect of excess anticoagulant (heparin)

Answer 29

Lowers PCO2 Raises pH Raises low PO2 Lowers high PO2

Question 30

How to identify excess anticoagulant

Answer 30

Visible liquid heparin in syringe before sampling

Question 31

How to prevent excess anticoagulant

Answer 31

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

Question 32

Metabolic effects effect on ABG

Answer 32

Raises PCO2 Lowers pH Lowers PO2

Question 33

How to identify metabolic effects on ABG

Answer 33

Too much lag time since collection | Values inconstant w pt status

Question 34

How to prevent metabolic effects in ABG

Answer 34

Analyze within 15 minutes | Place sample in ice bath

Question 35

ABG troubleshooting

Answer 35

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

Question 36

Hold pressure post puncture for

Answer 36

3-5 min

Question 37

Amt of time to wait before drawing ABG on COPD pt

Answer 37

20-30 minutes

Question 38

Amt of time to wait before drawing ABG w normal lungs

Answer 38

5-10 minutes

Question 39

Parameters directly measured by blood gas analyzer

Answer 39

PCO2, pH, PO2

Question 40

Parameters calculated with blood gas analyzer

Answer 40

Hb saturation (SO2), bicarbonate, base excess

Question 41

Name of electrode that measures pH

Answer 41

Sanz

Question 42

Name of electrode that measures oxygen tension

Answer 42

Clark polarographic

Question 43

Name of electrode that measures carbon dioxide tension

Answer 43

Severinghaus/Stowe-sanz

Question 44

Types of hemoglobin measured by hemoximeter

Answer 44

Oxyhemoglobin, methemoglobin, CO

Question 45

How accuracy of blood gas analyzer is determined

Answer 45

Comparing analyzers measurement to know values (given)

Question 46

Maintenance standard for lab gas analyzers

Answer 46

Calibration

Question 47

How frequently blood gas machines should be calibrated

Answer 47

1 point every 30 minutes | 2 point every 8 hours

Question 48

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

Answer 48

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

Question 49

Random error in ABG analysis and how to fix

Answer 49

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

Question 50

Systemic error types/how to fix

Answer 50

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

Question 51

General acceptable standards of deviation and drift in calibration

Answer 51

PH +/- 0.04, PCO2 and PO2 +/- 3 | 2 SD

Question 52

In Vitro oxygen analyzation

Answer 52

Remove blood THEN analyze

Question 53

In Vivo oxygen analyzation

Answer 53

Measures INSIDE artery

Question 54

Advantage of point-of-care testing

Answer 54

Fast

Question 55

When to ice ABG sample

Answer 55

When taken to lab