ABG & IV CANNULATION Flashcards
● Be able to explain the purpose of obtaining an arterial blood sample.
- To assess adequacy of the patient’s oxygenation (PaO2) and ventilation (PaCO2)
- To assess the patient’s acid base status
● Comprehend and be able to describe the indications for the procedure, counterindications,
ABG
Determine adequacy of oxygenation and ventilation (e.g. in severe acute asthma, acute exacerbation of COPD, patient on mechanical ventilation)
- Determine acid base balance (e.g. peri cardiac or respiratory arrest, diabetic ketoacidosis)
- Determine electrolyte levels
(Where the blood gas analyser can measure the electrolytes concerned)
CI:
anticoagulation medication or with a coagulopathy. (N.B. in such circumstances if it is decided that arterial puncture should still be performed, prepare to apply pressure to site after needle removed for at least 5 minutes or until bleeding has stopped - it will probably be for longer than 5 minutes!)
● History of vascular disease in the area being used (e.g. Reynaud’s disease)
Presence of an A-V fistula in that arm
Cellulitis, broken skin or other signs of infection
No palpable radial pulse
Negative Allen’s Test
Fractured limb
● Understand and be able to demonstrate the radial arterial puncture procedure on a mannequin using a safe technique.
?Pt oxygen - if change in ventilation, wait 20mins
? Palpable
? Allen’s Test
record FiO2
if sample not used in 30 mins = ICEd
● Be able to explain the indications for and purpose of obtaining venous blood sample.
a
● Understand and be able to demonstrate the venous blood sampling procedure on a mannequin using a safe technique.
a
Allen’s Test & Arterial Puncture Significance
The Allen test is used to assess collateral blood flow to the hands, generally in preparation for a procedure that has the potential to disrupt blood flow in either the radial or the ulnar artery. These procedures include arterial puncture or cannulation and the harvest of the artery alone or as part of a forearm flap
Managing pain in ABG
Anaesthetic transdermal cream (should be removed/wiped off prior to needle insertion) N.B this takes 20 – 30 minutes to take effect
Anaesthetic spray (should be removed/wiped off prior to needle insertion) N.B this also takes time to take effect
Intradermal injection of Lidocaine (care should be taken to avoid accidental IV or Arterial injection). You were taught this type of injection in your Injections Session. Takes approximately 10 seconds to take effect.
Documenting procedure of ABG
- Indication for procedure
- Type of equipment used
- The location and details of any unsuccessful attempts
- Successful site location
- Details of site preparation
- Any local anaesthetic used
- Patient’s response to procedure & that informed valid consent was obtained if possible (not possible in many resuscitation situations)
- Date & time of procedure and patient’s FiO2 at time of sampling
- Results of the investigation
- Any complications or problems
ABG Sampling Complications
Infections
Haematoma
Pain
Fear/Anxiety
Arterial Spasm
Radian N. Dmg
Emboli
Anaphylaxis to Lidocaine
Transfixatrion
Indications for VBG
Wanting to know
- acid base and bicarb.
- lactate
- electrolytes
- haemoglobin
- glucose
Understand and demonstrate IV Cannulation procedure on a mannequin using a safe technique (e.g. aseptic non-touch technique).
a
- Comprehend and be able to describe the indications for the procedure, counterindications, possible complications that could arise and the necessary equipment used.
!bacterial and mechanical phlebitis
!haematoma
- Be able to explain the purpose of inserting an IV Cannula.
a
