Arterial Puncture Flashcards by Do Re Mi

Process wherein blood is obtained/withdrawn from a patient’s artery

Arterial puncture

How well did you know this?

Not at all

Perfectly

In arterial puncture, blood sample is collected without _______

tourniquet

How well did you know this?

Not at all

Perfectly

Arterial puncture is used in what?

Blood Gas Analysis/ Arterial Blood Gas Analysis (ABGA)

How well did you know this?

Not at all

Perfectly

oxygenated blood with a bright red color

arterial blood

How well did you know this?

Not at all

Perfectly

6 individuals who can perform arterial puncture

 MD
 Nurses
 Medical technologists & technicians
 Respiratory therapists
 Emergency medical technicians
 Level II phlebotomists

How well did you know this?

Not at all

Perfectly

6 sites for arterial puncture

 Radial artery
 Brachial artery
 Femoral artery
 Scalp artery
 Umbilical artery
 Dorsalis pedis arteries

How well did you know this?

Not at all

Perfectly

Type of tissue surrounding the puncture site for site-selection for arterial puncture

 Low risk of injuring adjacent structures or tissue during puncture
 Ability to fix or secure artery to prevent rolling
 Adequate pressure can be applied to artery after collection
 Absence of inflammation, irritation, edema, hematoma, lesion, wound, AV shunt in close proximity, or recent arterial puncture

How well did you know this?

Not at all

Perfectly

Blood supply from more than one artery

collateral circulation

How well did you know this?

Not at all

Perfectly

3 Advantages of Radial Artery site

 Good collateral circulation (radial & ulnar arteries)
 Easy to palpate (close to surface of skin)
 Less chance of hematoma formation after collection

How well did you know this?

Not at all

Perfectly

2 disadvantage for radial artery puncture site

 Requires considerable skill to puncture it successfully due to small size
 Difficult to locate on patients with hypovolemia or low cardiac output

How well did you know this?

Not at all

Perfectly

3 advantage of brachial artery as puncture site

 Large & relatively easy to palpate & puncture
 Sometimes the preferred artery for a large volume of blood
 Adequate collateral circulation (but not as good as radial)

How well did you know this?

Not at all

Perfectly

4 disadvantages of brachial artery as puncture site

 Deeper & can be harder to palpate than radial artery
 Lies close to basilic vein; risk of mistakenly puncturing it
 Lies close to median nerve; risk of pain & nerve damage
 Increased risk of hematoma formation

How well did you know this?

Not at all

Perfectly

Largest artery used for arterial puncture

femoral artery

How well did you know this?

Not at all

Perfectly

where is the femoral artery located

Located superficially in groin, lateral to pubis bone

How well did you know this?

Not at all

Perfectly

 Performed primarily by physicians & specially trained emergency room personnel
 Generally used only in emergency situations or when no other site is available

Femoral artery

How well did you know this?

Not at all

Perfectly

2 advantages of the femoral artery as a puncture site

 Large & easily palpated & punctured
 Sometimes, only site where arterial sampling is possible

How well did you know this?

Not at all

Perfectly

5 disadvantages of femoral artery as puncture site

 Poor collateral circulation
 Lies close to femoral vein; risk of mistakenly puncturing it
 Increased risk of infection due to location & pubic hair
 Risk of dislodging plaque buildup from inner artery walls
 Requires extended monitoring for hematoma formation

How well did you know this?

Not at all

Perfectly

Disadvantages of Arterial Puncture
 _____ difficult
 Potentially more painful & hazardous than ______
 Thus, not normally used for _____

Technically
venipuncture
routine blood tests

How well did you know this?

Not at all

Perfectly

Reason for arterial puncture?

To obtain blood for arterial blood gas (ABG) tests

How well did you know this?

Not at all

Perfectly

Arterial blood:
 Best specimen for evaluating ______
 Has high _____ & consistency of ____

respiratory function
oxygen content, composition

How well did you know this?

Not at all

Perfectly

Used in diagnosis & management of respiratory disorders

Arterial blood gas

3 valuable information that ABGs help tell about a patient

 Oxygenation
 Ventilation
 Acid-base balance

Used in management of electrolyte & acid-base balance in patients with diabetes & other metabolic disorders

ABGs

ABG specimens are sensitive to effects of _______

preanalytical errors

Commonly measured ABG analytes: measure of acidity or alkalinity of blood (acidosis or alkalosis)

Commonly measured ABG analytes: normal range for pH of blood

7.35 - 7.45

Commonly measured ABG analytes: partial pressure of O2 dissolved in arterial blood

PaO2

Commonly measured ABG analytes: normal range of PaO2

80 - 100 mm Hg

Commonly measured ABG analytes: partial pressure of CO2 dissolved in arterial blood

PaCO2

Commonly measured ABG analytes: normal range for PaCO2

35 - 45 mm Hg

Commonly measured ABG analytes: a measure of bicarbonate in blood

HCO2

Commonly measured ABG analytes: normal range of HCO2

22 - 26 mEq/L

Commonly measured ABG analytes: percent O2 bound to hemoglobin

O2 sat

Commonly measured ABG analytes: normal range for O2 sat

97% - 100%

Commonly measured ABG analytes: a calculation of non-respiratory part of acid-base balance

base excess

Commonly measured ABG analytes: normal range of base excess

-2 to +2 mEg/L

5 info concerning conditions at time of collection need for rest requisition

 Current body temperature  Respiratory rate  Ventilation status  Fraction of inspired oxygen (FIO2)  Prescribed flow rate in liters per minute

3 PPE for arterial puncture

 Fluid-resistant lab coat, gown, or apron  Gloves  Face protection

9 equipment and supplied needed for arterial puncture

 Antiseptic Local anesthetic(optional)  Sharp, short-bevel hypodermic needle  1-to 5-mL self-filling syringe  Luer-tip normal or bubble removal cap  Coolant  2-by 2-in. gauze squares  Self-adhering gauze bandage  ID & labeling materials  Puncture-resistant sharps container

5 procedures performed for patient preparation

 Identification & explanation of procedures  Patient preparation & assessment  Steady state  Modified Allen test  Administration of local anesthetic (optional

Modified Allen test procedure 1. Have patient make a _____ 2. Compress patient’s ______ at same time 3. Maintaining pressure, have patient ______ 4. Lower patient’s hand & release pressure on ______ only 5. Assess results: + ______, - _________ 6. Record results on _____

1. tight fist 2. radial & ulnar arteries 3. open hand slowly 4. ulnar artery 5. +(positive) hand flushes pink; - (negative) hand does not flush pink 6. requisition

 Left: using ____ & ___ fingers to apply pressure to patient’s wrist. * Middle: patient ______. * Right: positive result hand flushes pink within ____ seconds.

* middle & index * opens hand * 15

Preparing and Administering Local Anesthetic: 1. Verify absence of ___to anesthetic or its derivatives 2. Sanitize hands & don ____ 3. Attach needle to _____ 4. Clean stopper of anesthetic bottle w. ____ 5. Insert needle through bottle stopper & withdraw _____ 6. Carefully replace needle cap & put syringe in ______ position

1. allergy 2. gloves 3. syringe 4. alcohol wipe 5. anesthetic 6. horizontal

Preparing and Administering Local Anesthetic: 7. Clean & ____ site 8. Insert needle into skin at site at angle of ____ degrees 9. Pull back slightly on _____ 10. Slowly expel contents into skin, forming a _____ 11. Wait __ to __ min. before proceeding with arterial puncture 12. Note ______ on requisition

7. air-dry 8. 10 9. plunger 10. raised wheal 11. 1 to 2 12. anesthetic application

Radial ABG Procedure: 1. Review & accession ____ 2. Approach, identify, & prepare ____ 3. Check for sensitivities to ___ & other substances 4. ____ steady state, ____ collection requirements, & ____ info 5. Sanitize hands & don ____ 6. Assess _____

1. test request 2. patient 3. latex 4. Access , verify, record 5. gloves 6. collateral circulation

Radial ABG Procedure: 7. Position arm & ask patient to _____ 8. Locate ____ & clean site 9. Administer _____ (optional) 10. Prepare equipment & clean gloved ______ 11. Pick up equipment & uncap & inspect ____

7. extend wrist 8. radial artery 9. local anesthetic 10. non-dominant finger 11. needle

Radial ABG Procedure: 12. Relocate radial artery & warn patient of ________ 13. Insert needle at a __ to ___-degree angle, slowly direct it toward pulse, & stop when a flash of blood appears 14. Allow syringe to fill to _____ 15.Place gauze, remove needle, activate safety feature, & apply ___

12. imminent puncture 13. 30-to 45 14. proper level 15. pressure

Insert needle at a ____ to ___-degree angle, slowly direct it toward pulse, & stop when ____

30-to 45, a flash of blood appears

Radial ABG Procedure: 16. Remove & discard ____ 17. Expel ______, cap syringe, mix, & label specimen 18. Check patient’s arm & apply ______ 19. Dispose of used & contaminated materials, remove gloves, & _____ 20. Thank patient & transport specimen to ___ ASAP

16. syringe 17. air bubbles 18. bandage 19. sanitize hands 20. lab

7 hazards and complications of arterial puncture

 Arteriospasm  Artery damage  Discomfort  Infection  Numbness  Thrombus formation  Vasovagal response

7 sampling errors for arterial puncture

 Air bubbles  Delay in analysis  Improper mixing  Improper syringe  Obtaining venous blood by mistake  Use of improper anticoagulant  Use of too much or too little heparin

8 Criteria for ABG Specimen Rejection

* air bubbled in the specimen * clotted specimen * hemolysis of the specimen (if electrolytes are ordered) * improper or absent ID or other labeling requirements * improper transportation temperature * inadequate volume of specimen for the test (QNS) * prolonged delay in delivery to the lab * wrong type of syringe used