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Blood Gas > Adult ABG Certification - RIH > Flashcards

Adult ABG Certification - RIH Flashcards

1
Q

How long must you wait before taking an ABG post initiation/change in therapy?

A

20-30 minutes

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2
Q

What to do if the patient is hyperactive, uncontrollable, or refuses the ABG?

A

Consider SpO2 monitor of oxygenation issues and venous pH (in well-perfused patients) for acid-base concerns

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3
Q

If the patient is on anti-coagulants, when should you schedule the ABG?

A

30 minutes prior to next dose of anti-coagulants

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4
Q

What might cause arteriospasm in regards to ABG sampling? (2)

A

Reflex secondary to pain or anxiety. Withdrawing too fast from an arterial line may create turbulent flow

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5
Q

How many attempts per site?

A

2

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6
Q

How can you prevent a vasovagal reaction to an ABG puncture?

A

reassure the patient, consider freezing, ask them about previous reactions to punctures

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7
Q

What is analyzed when running a pleural fluid sample?

A

pH

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8
Q

Adult pH panic value:

A

<7.30 or >7.50

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9
Q

Adult PaCO2 panic value:

A

<20 or >60 (consider pt history)

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10
Q

Adult PaO2 panic value:

A

<50 or >200

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11
Q

Are ABG’s corrected for patient body temperature?

A

no

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12
Q

What is the first branch off the aortic arch?

A

bracheocephalic artery

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13
Q

The bracheocephalic artery divides to form which 2 arteries?

A

right subclavian artery and right common carotid artery

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14
Q

Where does the right subclavian artery extend to? (2)

A

the first rib, then passes into the armpit (axilla)

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15
Q

What 3 regions does the right subclavian artery supply?

A

arm, forearm, hand

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16
Q

When the right subclavian artery reaches the axilla, it becomes the:

A

axillary artery

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17
Q

When the axillary artery continues into the arm, what is it called?

A

brachial artery

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18
Q

Where does the brachial artery divide?

A

antecubital fossa

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19
Q

What 2 arteries does the brachial artery divide into?

A

ulnar artery and radial artery

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20
Q

When the radial and ulnar arteries meet, what do they form? (2)

A

superficial palmar arches, deep palmar arch

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21
Q

Where are the two small radial veins located?

A

On either side of the radial artery

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22
Q

Where is the pronator quadratus muscle located and what is its function?

A

beneath the radial artery, to pronate the palm

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23
Q

What does the lateral ante brachial cutaneous nerve do?

A

general sensory function for the skin on radial side of forearm

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24
Q

What does the median nerve do? (2)

A
  1. Motor function to most flexor muscles of forearm and lateral 3 digits of the hand
  2. Sensory function to palmar aspects of lateral 4 digits of the hand
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25
Q

What does the superficial branch of the radial nerve do?

A

sensory supply to lateral 3 digits

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26
Q

What is the name for the fibrous membrane covering the bones?

A

periosteum

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27
Q

If a needle comes into contact with the periosteum, what happens?

A

Patient will feel sharp pain

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28
Q

What are 2 potential problems with a brachial artery puncture?

A

Accidental puncture of the median nerve or large veins in the area

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29
Q

How should the patient’s arm be positioned for a brachial puncture?

A

arm extended completely with the palm up

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30
Q

What 2 structures is the brachial artery palpated between?

A

median nerve and biceps tendon

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31
Q

What 3 arteries provide collateral circulation if the brachial artery is obstructed?

A

deep brachial, superior and inferior ulnar arteries

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32
Q

Can the femoral puncture site be used in a newborn?

A

no

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33
Q

What is the risk of performing a femoral puncture on an infant or child?

A

the hip joint may be inadvertently entered and contaminated, which may lead to septic arthritis of the joint

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34
Q

What needle gauge is used for radial and brachial ABG punctures?

A

22-25

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35
Q

How long does flushing of the hand take for a positive result on the Modified Allen’s Test?

A

5-15 seconds

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36
Q

How far away from the wrist crease should the puncture site be for a radial ABG?

A

1/2-1 inch proximal

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37
Q

Is it advised to use a rolled-up towel to extend the wrist for a radial ABG puncture?

A

yes

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38
Q

What angle is used for a radial ABG puncture?

A

45-60 degrees

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39
Q

What does lack of spontaneous filling indicate? (2)

A

low blood pressure or venous sample

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40
Q

If the artery is missed, what do you do?

A

slowly withdraw the needle until the bevel is just below the skin surface and repeat the attempt

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41
Q

What is a sufficient quantity of blood for an ABG?

A

1 ml

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42
Q

When should you ice an ABG sample?

A

if a delay of >15 mins is expected before analyzing

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43
Q

What length of needle is used for a femoral puncture?

A

1.5 inch

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44
Q

How should the patient be positioned for a femoral puncture?

A

supine with legs straight

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45
Q

What angle is used for a femoral puncture?

A

90 degrees

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46
Q

How long do you need to hold a femoral puncture site for (minimum)?

A

10 minutes

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47
Q

If pain, swelling, or hematoma occur post-femoral puncture, what do you do?

A

reapply pressure

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48
Q

For patients on anti-coagulants (femoral puncture) how long do you hold pressure for?

A

up to 15 minutes

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49
Q

How often do you need to check on a patient that is on anti-coagulants post-femoral puncture?

A

Q15min for 1 hour

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50
Q

What sizes of non-heparinized syringes can be used when doing an art line sample?

A

5 ml or 12 ml

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51
Q

How much blood and fluid mixture (waste syringe) do you need to draw before collecting an art line sample?

A

5 ml

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52
Q

What size heparinized syringe is used when collecting an art line sample?

A

3 ml

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53
Q

Why do we flush the art line in pulses after retrieving a sample?

A

to prevent complete displacement of blood to the hand with saline

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54
Q

What Law is used in spectrophotometry?

A

Beer’s Law

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55
Q

What does Beer’s Law state?

A

intensity of light absorbed while passing through a solution will be proportional to the concentration of the molecule within the solution

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56
Q

What does an oximeter measure? (2)

A

oxyhemoglobin and deoxyhemoglobin

57
Q

What does a co-oximeter measure? (4)

A

reduced Hb, oxyHb, metHb, COHb

58
Q

The affinity of CO for Hb is approximately ___x greater than the affinity of O2 for Hb.

A

218

59
Q

What type of hypoxia is CO poisoning classified as?

A

anemic hypoxia

60
Q

COHb shifts the oxyHb curve to the:

A

left

61
Q

COHb can be caused by skin absorption of _______ from paint removers.

A

methylene chloride

62
Q

COHb can be caused by incomplete combustion of ______ materials.

A

carbonaceous

63
Q

What discoloration does COHb cause the blood to have?

A

cherry-red

64
Q

__% saturation of COHb has the same effect as ______ with a Hb content of _____ml/dL

A

50%, anemia, 7.5

65
Q

Patient’s skin may appear ____ (color) if they have COHb

A

pink

66
Q

FCOHb <10%

A

slight poisoning

67
Q

FCOHb 10-20%

A

mild poisoning

68
Q

FCOHb 20-40%

A

moderate poisoning

69
Q

FCOHb 40-60%

A

severe poisoning

70
Q

What is the treatment for COHb?

A

FiO2 of 1.0 immediately

71
Q

Giving 1.0 FiO2 reduces the COHb half-life from _____ to _____

A

over 5 hours, 1 hour 20 minutes

72
Q

Hyperbaric oxygen reduces COHb half-life to:

A

23 minutes

73
Q

How is metHb formed in the RBC?

A

the ferrous ion loses an electron, is transformed into ferric state, Hb is oxidized (loses an electron) rather than oxygenated

74
Q

Normal metHb concentration is approximately:

A

1%

75
Q

Can metHb transport oxygen?

A

no

76
Q

MetHb levels over ___% are sometimes well-tolerated and may not require treatment

A

35

77
Q

Symptoms of metHb toxicity are related to:

A

anemic hypoxia

78
Q

MetHb symptoms are generally more severe when the patient has:

A

pre-existing cardiovascular problems

79
Q

Exposure to these drugs can produce metHb: (4)

A

amyl nitrate, nitroglycerin, sulfonamides, benzocaine

80
Q

What dietary factor can affect infants under 6 months of age (regarding metHb)

A

well water that contains nitrates

81
Q

Exposure to what chemical can produce metHb?

A

aniline dyes

82
Q

If a person has large quantities of metHb, what color is their blood?

A

chocolate brown

83
Q

What color is a person’s skin if they have large quantities of metHb?

A

slate-grey

84
Q

FMetHB 10-15% symptoms

A

seldom other than cyanosis and increased metHb levels

85
Q

FMetHb 20-50% symptoms

A

cyanosis, weakness, headache, dizziness, tachycardia

86
Q

FMetHb 50-60% symptoms

A

cyanosis, dyspnea, acidosis, bradycardia or other dysrhythmias

87
Q

metHb treatment (3)

A

1 - supplemental O2 at FiO2 1.0
2 - removal of internal and external causes of life-threatening methemoglobinemia (emesis/lavage/activated charcoal, etc.)
3 - ascorbic acid or methylene blue 3-5 mg/kg which can accelerate metHb reduction.

88
Q

When is treatment of metHb with ascorbic acid or methylene blue contraindicated?

A

if the metHb was induced by cyanide

89
Q

Normal pleural fluid pH of a healthy person:

A

7.64

90
Q

Pleural fluid pH >7.3 usually:

A

resolves with antibiotic therapy

91
Q

Pleural fluid pH <7.3 indicates some possible problems: (4)

A
  1. exudative effusion secondary to malignancy
  2. rheumatoid arthritis
  3. TB
  4. hemothorax
92
Q

Pleural fluid pH <7.3 associated with pneumonia or lung abscess usually:

A

requires chest tube drainage

93
Q

Pleural fluid pH <7.2 may indicate:

A

an empyema

94
Q

Pleural fluid pH <6.0 suggests:

A

esophageal rupture

95
Q

Pleural fluid must be collected by withdrawing fluid into:

A

a heparinized syringe

96
Q

Pleural fluid must be transported:

A

anaerobically

97
Q

Should a pleural fluid sample be iced? Why or why not?

A

no, icing can precipitate proteins

98
Q

Quality Assurance (QA)

A

total quality of reported results

99
Q

Quality Control (QC)

A

maintenance and validation of the measuring system

100
Q

Random error (dispersion)

A

an isolated result outside the control limits and has minor significance

101
Q

Systematic error (trending)

A

progressive controls increase or decrease

102
Q

Systematic error (shifting)

A

abrupt change in measurement followed by clustering

103
Q

External QC

A

samples with unknown values are sent to each lab 3 times a year from a central distributor

104
Q

Sources of pre-analytical error (4)

A
  1. patient
  2. sampling errors (AVERT)
  3. hyperventilation
  4. time
105
Q

What does AVERT stand for?

A 
Air bubble in sample
Venous admixture/venous sampling
Excessive anticoagulant
Rate of metabolism
Temperature alterations
106
Q

What happens if there is an air bubble in a sample? Give details regarding PCO2, pH, PaO2, HCO3, BE.

A

PCO2 decreases (room air has 0)
pH increases
PaO2 migrates to 150 mmHg (room air has 150)
HCO3 may decrease due to hydrolysis&raquo_space; decrease in BE

107
Q

1/10 of a sample contaminated with venous blood will result in an overshoot equal to a ___% reduction in ______.

A

25% reduction in PaO2

108
Q

What happens if there is too much heparin in a sample? Give details regarding PCO2, pH, PaO2

A

PCO2 decreases
pH decreases
PaO2 usually remains the same

109
Q

Heparin is a weak _____

A

acid

110
Q

What is the anticoagulant of choice and why?

A

lithium heparin is least likely to cause equipment problems due to the formation of small fibrils in the sample

111
Q

At room temperature (20-24°C) the expected change in the sample’s pH after 1 hour is:

A

decrease by 0.025

112
Q

At room temperature (20-24°C) the expected change in the sample’s PaCO2 after 1 hour is:

A

increase by 2.5 mmHg

113
Q

At room temperature (20-24°C) the expected change in the sample’s PaO2 after 1 hour is:

A

decrease by 10 mmHg (If initial PaO2 <150 mmHg)

114
Q

What may occur in samples taken from patients with leukemia/leukocytosis?

A

leukocyte larceny (increased O2 consumption by WBCs and immature RBC’s&raquo_space; decreased PaO2)

115
Q

Why does leukocytosis create changes in PaO2 in samples?

A

It is an increase in WBCs which consume O2 at a high rate

116
Q

Increased body temperature results in a(n) _______ in pH, PaCO2, and PaO2

A

increase

117
Q

Not correcting for an increased body temperature will provide results that are _______ than actual

A

lower

118
Q

Decreased body temperature results in a(n) ______ in pH, PaCO2, PaO2

A

decrease

119
Q

Not correcting for a decreased body temperature will provide results that are _______ than actual

A

greater

120
Q

ABG values that are corrected for body temperature fail to consider:

A

the metabolic and cardiovascular changes that accompany the changes in body temperature

121
Q

Why is there a limit of 2 attempts per site? (5)

A

to reduce the incidence of:

  1. peripheral nerve damage
  2. vascular occlusion
  3. vascular trauma
  4. thrombosis
  5. emboli
122
Q

Checklist prior to sampling: (6)

A
  1. Written physician order (or verbal written by RT)
  2. Review patient’s chart for contraindications
  3. Bleeding risk (drugs, blood conditions)
  4. Diagnosis and reason for sample
  5. Previous ABG results
  6. Collateral circulation
123
Q

What arises from the palmar arches?

A

Digital arteries

124
Q

The median nerve runs parallel to:

A

the radial artery

125
Q

The radial nerve runs:

A

underneath the radius as it approaches the wrist

126
Q

Where is the origin and insertion of the pronator quadratus muscle?

A

origin: lower quarter of the ulna
insertion: lower quarter of the radius

127
Q

Where is the site for a brachial artery puncture?

A

above the elbow crease, in the antecubital fossa

128
Q

How do you stabilize the brachial artery for a puncture?

A

Between your index and middle fingers

129
Q

What angle of approach is used for a brachial artery puncture?

A

45 degrees

130
Q

Where must the femoral puncture site be located?

A

distal to the inguinal ligament at the level of the inguinal crease. (choose a site approx. 2 cm below the inguinal ligament or near the inguinal fold)

131
Q

How do you stabilize the femoral artery for a puncture?

A

Between your index and middle fingers

132
Q

Can a mixed venous sampling from the pulmonary artery be performed by an SRT?

A

no

133
Q

SRT’s that are certified may draw samples from ______ and _______ only. Other sites require _______.

A

Adult radial arteries and arterial lines only.

Other sites require direct supervision by an RRT

134
Q

Fractional Hb saturation

A

Fractional saturation (FO2Hb) is the fraction of total hemoglobin which happens to be oxygenated

135
Q

Functional Hb saturation

A

Functional saturation (sO2) is the fraction of effective hemoglobin which is oxygenated

136
Q

If a person has CO intoxication, what happens to their PO2, PCO2, and pH?

A 
PO2 = normal
PCO2 = normal or slightly decreased
pH = may be decreased
137
Q

Normal accepted limits of variation for routine quality control measure are:

A

+/- 2 standard deviations (95%) from the mean

138
Q

Sources of analytical error: (5)

A
  1. Recording results before the sample can stabilize and ensure complete electrode response
  2. Neglecting to mix the sample prior to introduction into the analyzer
  3. Failure to mix iced sample (may raise pH by as much as 0.11 units)
  4. Protein contamination/aging electrodes
  5. Air introduced during insertion of sample
139
Q

Sources of post-analytical error: (4)

A
  1. Recording of data on requisition and/or chart
  2. Clinical consistency check
  3. Transmission/reporting of results (poor verbal transmission)
  4. Essential legal consideration (poor handwriting)

Blood Gas (1 decks)

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