ABG

Question 1

How do you initiate the procedure?

Answer 1

1. introduce/identify/explain/ allergies/wash hands - “we’re going to be putting a needle into your artery which is a blood vessel in your wrist and taking a small amount of blood to assess how well your oxygen therapy is working. This procedure might be quite painful but it wont last long and we can provide some numbing cream to reduce this. There is also a small risk of bleeding, bruising and infection but these are very minor. Does this sound okay?”
2. clean hands, don apron

Question 2

What equipment is required?

Answer 2

1. gloves, mask, plastic apron
2. heparinised blood gas syringe
3. blue clinell
4. sterile gauze
5. small plastic bag with ice
6. patients request form
   (7. local anaesthetic)

Question 3

How do you perform an Allen’s test?

Answer 3

• consent them - “first we’re going to be carrying out a test to see whether we can use this arm to take the sample from. It involves you making a tight fist whilst i put pressure on your wrist with my fingers then you releasing that tight fist, are you able to do this for me?”
  1. ask patient to make a fist
  2. using your fingertips, occlude the blood through the radial and ulnar arteries at the wrist
  3. ask patient to release the fist and observe the blanched appearance of the hand whilst maintaining pressure on the arteries
  4. remove pressure from ulnar artery whilst keeping pressure on the radial and observe the reperfusion of the patients hand, observe whether all five digits are reperfused
  5. repeat with radial artery

Question 4

How do you conduct the procedure?

Answer 4

1. inspect wrist and local area for contraindications
2. place pillow under arm
3. palpate and localise the radial artery using first 2 fingers of non dominant hand
4. ensure patient is ready to proceed and remind them it might be painful
5. puncture radial artery at 90 degrees (or 45) and slowly advance the needle
6. stop advancing once flashback is seen and allow syringe to fill (1.6ml)
7. once filled, withdraw needle and apply firm pressure to puncture site - ensure pressure is maintained for 5 min to prevent haematoma formation and further blood loss
8. remove needle from syringe and dispose in sharps bin

Question 5

How do you conclude the procedure?

Answer 5

1. ensure air bubbles are expelled
2. roll/invert syringe to mix sample with heparin
3. apply suitable dressing to puncture site and check patient welfare
4. take sample to lab, put on ice if there is any delay in transport , ensure request form is taken also
5. document in patients notes - full result of Allen test, site used, results of ABG, inspired O2 %/rate, any complications