arterial procedures Flashcards
this is more consistent throughout the body than the venous blood
arterial blood composition
it is technically difficult and potentially more painful and hazardous than venipuncture
arterial puncture
what is the pri reason for performing arterial puncture
to obtain arterial blood gas specimens
To evaluate respiratory functions
normally high O2 content
consistency of composition
personnel who perform arterial puncture what are the hazards and complications of arterial puncture
physicians
medical technologist and technicians
nurses
respiratory therapists
emergency medical technicians
level II phlebotomist
The first Choice, second choice for artery collection
First choice - radial artery
preferred and most common
located underside of the wrist on the thumb side
Second choice - brachial artery
located in the medial anterior aspect of the antecubital fossa near the attachment of the biceps muscle
The largest artery used for arterial puncture
Femoral artery
located superficially in the groin,, lateral to the pubic bone
for physicians and emergency room personnel - used only in emergency situations or no other site is available
What might happen as femoral artery lies close to the femoral vein
may be
inadvertently punctured and result in the collection of a venous specimen instead of an arterial one
Hazards and complications of arterial puncture
● Arteriospasm
● Artery damage
● Discomfort
● Infection
● Hematoma
● Numbness
● Thrombus formation
● Vasovagal response
true or false:
personnel who perform ABG testing are designated level I or level II depending on their formal education
true - level II personnel supervises personnel I
it is the primary site-selection criterion for arterial puncture
collateral circulation
how can the collateral circulation be evaluated
using portable ultrasound instrument
for radial artery - modified allen test
- if +ve test, result =ulnar artery is freely open and able to supply blood hence can perform on radial artery. vice versa
what are the 3 main sites where arteries are accessed for specimen collection
underside of the wrist
antecubital area of the arm
the groin
this artery is usually off limits and why
ulnar artery
- if the radial artery is accidentally damaged the ulnar artery will supply blood to the hand
advantages and disadvantages of radial artery
advantage:
good collateral circulation (biggest advantages)
ez to palpate cos lies normally close to the skin
less chance of hematoma formation
reduce risk of accidental puncturing a vein or nerve cos no adjacent
disadvantage:
considerable skils bcs of small veins
difficult cos of hypovolemia
what happens if the ulnar artery is weak
do not puncture at the radial artery
advantages and disadvantages of brachial artery
advantages:
to collect ABG
large and ez to locate and palpate
preferred artery if large volume
less painful than radial artery puncture
disadvantages:
no direct collateral circulation
deep and harder to puncture
difficult to palpate on obese
near median nerve
increased risk of hematoma formation
advantages and disadvantages of femoral artery
advantages:
collect ABGs
large and ez palpated and punctured
sometimes the only site where arterial sampling is possible (hypovolemic, low cardiac output, during cardiac resuscitation)
disadvantages:
poor collateral circulation
close to the femoral vein
infection and difficulty in achieving aseptic technique
extended monitoring for hematoma formation
other site for arterial puncture:
infants:
scalp
umbilical
posterior tibial artery
adults:
dorsalis pedis
some examples of ABG evaluation in diagnosis and management of respiratory disorders
lung disease: provide info abt
- oxygenation ventilation
- acid-base balance
diabetes, other metabolic disorders, critically ill patients, injured patients
- management of electrolyte
- acid-base balance
commonly measured arterial blood gas analytes
table 14-1
FiO2
fraction of inspired oxygen, which for room is 0.21
prescribed flow rate in liters per minute (L/M)
what are some of the specimen collection equipment and supplies
safety needle
special heparinized syringe
cap to cover the syringe
to maintain anaerobic conditions
why are ABG specimens are collected in syringes than tubes
evacuated tube presence can affect test results
antiseptics used
isopropanol or chlorhexidine sponges or pads
local anesthetic
1% lidocaine w/o epinephrine
type of syringe used
1 or 2 ml plastic syringe with a 25 or 26 gauge to 5/8 inches long
what position should the patient be
relaxed in a comfy position
lying in bed or seated comfy on a chair for a minimum of 5min or until breathing has stabilized
how long shld the patient be in a steady state and why
20-30 min before the blood gas specimen is obtained
steady state:
current body temp
breathing pattern
conc. of oxygen inhaled affect the amt of O2 AND CO2 in the blood
what happens when the patient is unable to make a fist
the hand can be held abv heart lvl for 30-60 sec
what signifies the temporary blockage of ulnar and radial artery
blanched appearance
positive and negative allen test result
+ve:
the hand flushes pink or returns to normal color within 15sec
-ve:
opp
- means that the patient does not have collateral circulation
needle insertion angle
45 degree
femoral - 90 degree, approx 5-10 mm dista to the index finger
hat happens if you recheck the site after 3-5 min and saw that there is bleeding, swelling, bruising
reapply pressure for additional 2 min
notify nurse or physician if bleeding has not stopped after the additional 2 min
pain or irritation caused by needle penetration of the artery muscle and even patient anxiety can cause a reflex contraction of the artery
arteriospasm
repeated puncture at the same site resulting in swelling which can lead to partial or complete occlusion
artery damage
this is usually associated with with arterial puncture, even with the use of local anesthetic
discomfort
- may indicate nerve involvement
blood is under considerable pressure in arteries and is initially more likely to leak form an arterial puncture site than a venipuncture site
hematoma
it can result from improper site preparation, contamination of the site before specimen collection
infection
it can be a sign of impaired circulation or nerve irritation or damage due to an error in technique
numbness
- immediately inform nurse or physician
injury to the intima or inner wall of the artery
thrombus formation
it is the source which may cause a clot, thrombus or ___
embolus (circulating undissolved matter)
embolism (obstruction of a blood vessel by an embolus)
faintness or loss of consciousness related to hypotension caused by a nervous system response (increased vagus nerve activity) or abrupt pain or trauma can occur
vasovagal response
factors that can affect the integrity of a blood gas sample and lead to erroneous results
air bubbles
delay in analysis
improper mixing
improper yringe
obtain venous blood by mistake
use of improper anticoagulant
use too much or too little heparin
