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PMLS 2 > (F) Lesson 2: Arterial Puncture > Flashcards

(F) Lesson 2: Arterial Puncture Flashcards

1
Q

T or F: Arterial puncture is technically more difficult, painful, and hazardous than other blood collection methods

A

True

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2
Q

T or F: Arterial specimen is not routinely used for blood tests

A

True

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3
Q

T or F: Arterial blood’s composition is less consistent throughout the body than that of venous blood

A

False (more)

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4
Q

T or F: Arterial blood has more uses compared to venous blood in routine laboratory testing

A

False (venous blood has more uses)

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5
Q

What specimen is obtained for an ABGA test?

A

Arterial blood gas

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6
Q

ABGA stands for?

A

Arterial Blood Gas Analysis

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7
Q

This test is requested to assess respiratory function

A

ABGA

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8
Q

T or F: Arterial blood is usually collected more from adults than in infants

A

True (capillary puncture is more preferred for infants given that the site is warmed)

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9
Q

How many mL is the common sample quantity for ABGA?

A

1 to 1.5

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10
Q

What do you call capillary blood that is warmed at the site?

A

Arterialized capillary blood

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11
Q

This blood collection procedure refers to collecting blood from an artery

A

Arterial Puncture

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12
Q

T or F: The arterial sample is collected WITHOUT a tourniquet

A

True (due to the high blood pressure of arteries)

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13
Q

What causes arterial blood to possess a bright red color?

A

Presence of oxygen (oxygenated)

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14
Q

Puncturing the basilic vein during venipuncture has a high risk of puncturing what artery instead?

A

Brachial

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15
Q

T or F: Only physicians and respiratory therapists are allowed to perform this procedure in the Philippines with extensive training

A

False (even WITHOUT extensive training)

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16
Q

T or F: Nurses can perform arterial puncture with extensive training

A

True

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17
Q

T or F: Medical technologists but not technicians can perform arterial puncture with extensive training

A

False (medical technicians may also perform arterial puncture with extensive training)

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18
Q

T or F: EMTs can perform arterial puncture with extensive training

A

True

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19
Q

T or F: Level III phlebotomists can perform arterial puncture with extensive training

A

False (level II)

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20
Q

T or F: individuals performing arterial puncture must undergo periodic evaluation

A

True

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21
Q

T or F: If a staff performing arterial puncture does not meet the standards of the evaluation, they may do so again after having a remedial instruction

A

False (remedial instruction + reevaluation)

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22
Q

T or F: In the Philippines, medical technologists are not allowed to perform arterial puncture

A

True

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23
Q

This site selection criteria observes if more than one artery is able to supply the puncture site

A

Presence of collateral circulation

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24
Q

This site selection criteria states that the more accessible and larger the vessel is, the better

A

Artery accessibility and size

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25
Q

T or F: Selecting a puncture site must have low risk of injuring adjacent structures or tissue

A

True

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26
Q

T or F: Sites wherein there are rolling arteries are not ideal to collect blood from

A

True

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27
Q

T or F: If adequate pressure cannot be applied, it is still an acceptable puncture site

A

False

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28
Q

T or F: Selecting a site must observe the absence of inflammation, irritation, edema, hematoma, lesion, wound, AV shunt/fistula in close proximity, or recent arterial puncture

A

True

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29
Q

An AV shunt/fistula is common for patients undergoing what type of treatment?

A

Dialysis

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30
Q

T or F: You may collect blood from a site with a fistula

A

False (blood composition is now a mixture of arterial and venous blood due to the fistula fusing together veins and arteries)

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31
Q

This is the PRIMARY site selection criteria

A

Presence of collateral circulation

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32
Q

What 2 procedures can evaluate the presence of collateral circulation?

A

Modified Allen’s Test and Portable Ultrasound Instrument

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33
Q

This artery is the most common and most accessible site for most patients; located near the thumb side of the wrist where there is a pulse

A

Radial artery

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34
Q

The radial pulse can be felt on the thumb side of the wrist approximately how many inches above the crease?

A

1 inch

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35
Q

What 2 arteries are able to supply blood to the hands?

A

Radial and ulnar

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36
Q

T or F: You may use the ulnar artery to collect blood from

A

False

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37
Q

T or F: The radial artery is easy to palpate near the pinky side

A

False (it is easy to palpate near the thumb side)

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38
Q

T or F: The radial artery is also relatively big in size hence it is a first priority site to puncture

A

False (it is small)

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39
Q

This condition refers to having low cardiac output

A

Hypovolemia

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40
Q

T or F: Arteries are less difficult to locate on patients with hypervolemia

A

False (more difficult)

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41
Q

This artery is located on the medial anterior aspect of the antecubital fossa region near the biceps muscle attachment

A

Brachial artery

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42
Q

The brachial pulse can be felt near what vein?

A

Basilic

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43
Q

The brachial pulse can be felt above the bend of the elbow on the inside of the arm approximately aligned with what finger?

A

Ring finger

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44
Q

T or F: The brachial artery is relatively small in size hence it is a second priority puncture site

A

False (large in size)

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45
Q

T or F: The brachial artery is capable of producing a large volume of blood

A

True

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46
Q

How much blood is the brachial artery able to yield in excess?

A

More than 1.5mL

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47
Q

T or F: The radial artery has better collateral circulation than the brachial artery

A

True

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48
Q

T or F: The brachial artery is deeper and harder to palpate compared to the radial artery

A

True

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49
Q

What nerve is the brachial artery close to which leads to increased risk of pain and nerve damage?

A

Median nerve

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50
Q

What is missing near the location of the brachial artery which explains an increased risk of hematoma formation?

A

No ligaments or bones to support compression

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51
Q

This is the largest artery used for arterial puncture; located superficially in the groin and lateral to the pubis bone

A

Femoral artery

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52
Q

T or F: A femoral puncture is primarily performed by physicians only

A

False (trained emergency staff may also perform this)

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53
Q

T or F: A femoral puncture CANNOT be performed by respiratory therapists and medical technologists due to lack of training

A

True

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54
Q

T or F: The radial artery has veins and nerves close to it

A

False

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55
Q

T or F: Femoral punctures are only done in emergency situations or when no other sites are available

A

True

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56
Q

T or F: The femoral artery is easily palpated and punctured due to its large size

A

True

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57
Q

T or F: Sometimes the femoral artery is the only site possible for sampling when you’re dealing with hypovolemic patients and those undergoing CPR due to weak circulation

A

True

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58
Q

T or F: The femoral artery has poor collateral circulation

A

True

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59
Q

What vein is the femoral artery close to?

A

Femoral vein

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60
Q

T or F: Using the femoral artery has increased risk of infection due to location and presence of pubic hair

A

True

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61
Q

T or F: The femoral artery is the least type of puncture site to be used

A

True

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62
Q

Using the femoral artery has a risk for dislodging what from the inner artery walls causing an embolism or thrombus?

A

Plaque buildup

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63
Q

T or F: Femoral puncture requires extended monitoring for hematoma formation

A

True

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64
Q

What 2 sites are ideal for infants in arterial puncture?

A

Scalp and umbilical

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65
Q

T or F: Phlebotomists are allowed to collect arterial blood from the scalp and umbilical arteries as long as there is extensive training

A

False (they also cannot collect from cannulas, catheters, or other indwelling devices)

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66
Q

What is the additional puncture site for adults if the radial, brachial, and femoral arteries are unavailable?

A

Dorsalis Pedis Arteries

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67
Q

T or F: Phlebotomists are not trained to perform arterial puncture on the femoral artery

A

True

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68
Q

This specimen is used in diagnosis and treatment of respiratory disorders (e.g. lung diseases)

A

Arterial Blood Gas

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69
Q

What analytes express a patient’s oxygenation?

A

Partial pressure of oxygen (PaO2) and oxygen saturation (O2 sat.)

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70
Q

What analyte is able to express a patient’s ventilation?

A

Partial pressure of carbon dioxide (PaCO2)

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71
Q

What analytes express the acid-base balance of the body?

A

All parameters

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72
Q

ABG is used in the management of electrolyte and acid-base balance in patients with what diseases/disorders?

A

Diabetes and other metabolic disorders

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73
Q

T or F: ABG specimens are sensitive to the effects of pre-analytical errors

A

True

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74
Q

T or F: ABG specimen should not be exposed to air

A

True (should be collected in an anaerobic manner)

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75
Q

T or F: Exposing the ABG sample to air could disrupt with the oxygenation status of the patient’s sample due to contamination of carbon dioxide

A

False (oxygen)

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76
Q

What 4 analytes are the most commonly encountered in the laboratory?

A
  • pH
  • PaO2/PO2
  • PaCO2/PCO2
  • HCO3
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77
Q

What is the normal pH range?

A

7.35 to 7.45

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78
Q

This analyte is a measure of acidity or alkalinity of blood (used to identify acidosis or alkalosis)

A

pH

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79
Q

What is the normal range for partial pressure of oxygen?

A

80 to 100 mmHg

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80
Q

This analyte refers to the O2 dissolved in blood and indicates if oxygenation is adequate or if there is hypoxia occurring

A

Partial pressure of oxygen (PaO2)

81
Q

T or F: Increased oxygen means increased respiration rate

A

False (indirectly proportional)

82
Q

What is the normal range for partial pressure of carbon dioxide?

A

35 to 45 mmHg

83
Q

This analyte refers to the amount of CO2 dissolved in blood and can evaluate lung function (if there are respiratory disturbances that alter the pressure)

A

Partial pressure of CO2 (PaCO2)

84
Q

What is the normal range for HCO3?

A

22 to 26 mEq/L

85
Q

This analyte refers to the measure of bicarbonate in the blood and is able to monitor kidney function to regulate the acid-base balance of the body

A

Bicarbonate (HCO3)

86
Q

Bicarbonate is able to evaluate the buffer systems of what organ?

A

Kidneys

87
Q

What type of conditions can alter HCO3 levels in the body?

A

Metabolic and respiratory

88
Q

What is the normal range for oxygen saturation?

A

97 to 100%

89
Q

This analyte refers to the amount of O2 bounded to hemoglobin, it determines if hemoglobin is carrying the amount of oxygen its capable of carrying

A

O2 saturation

90
Q

What is the normal range for base excess and base deficit?

A

-2 to +2 mEq/L

91
Q

This analyte refers to the calculation of the non-respiratory part of the acid-base balance

A

Base excess and base deficit

92
Q

T or F: Acid excess and acid deficit is based on the PCO2, HCO3, and hemoglobin levels of the patient

A

False (base excess and base deficit)

93
Q

T or F: Total hemoglobin and saturation of abnormal hemoglobin are also measured using ABGA

A

True

94
Q

What are the 2 types of abnormal hemglobin?

A

Carboxyhemoglobin and methemoglobin

95
Q

This contains the patient’s full name, address, birthday, gender, etc.

A

Test requisition

96
Q

T or F: A physician’s order is needed before performing arterial puncture

A

True

97
Q

FIO2 or FO2 stands for what?

A

Fraction of inspired oxygen

98
Q

In collection information about prescribed flow rates, what unit is to be used?

A

Liters per minute

99
Q

These PPEs are essential for the possibility of blood sprays during the procedure

A

Gloves and face protection

100
Q

T or F: PPEs for arterial puncture can be non-fluid resistant

A

False (must be fluid-resistant)

101
Q

T or F: Antiseptic local anesthetic is required

A

False (optional)

102
Q

This specific anesthetic numbs the site to be used for arterial puncture

A

1% Lidocaine

103
Q

For cleaning the site or antisepsis, use what 2 antiseptics?

A

Isopropyl alcohol or chlorhexidine

104
Q

T or F: The hypodermic needles for arterial puncture should be long

A

False (short)

105
Q

What is the gauge range for hypodermic needles in arterial puncture?

A

20-23

106
Q

A pH lower than 7.35 is known as what condition?

A

Acidosis

107
Q

A pH higher than 7.45 is known as what condition?

A

Alkalosis

108
Q

Fraction of inspired oxygen (FIO2) is also known as what?

A

Hemoglobin

109
Q

This supplemental information refers to if the patient is breathing spontaneously or supported mechanically

A

Ventilation status

110
Q

This supplemental information refers to whether the patient is undergoing breathing pressure support or delivery through a cannula or mask

A

Method of ventilation

111
Q

This supplemental information refers to whether arterial, capillary puncture, or an indwelling catheter is used

A

Sampling site and type of procedure

112
Q

What gauge and size of needle is to be used for radial and brachial puncture?

A

22 gauge/ 1-inch

113
Q

What gauge and size of needle is to be used for femoral puncture?

A

22 gauge/ 1.5-inch

114
Q

T or F: Smaller gauged needles (25) can cause bubbles and hemolysis in the sample

A

True

115
Q

This syringe may or may not contain heparin inside

A

1-5mL self-filling syringe

116
Q

What is the recommended needle gauge to be used for arterial puncture in ABG samples?

A

22

117
Q

You are to administer the heparin in the self-filling syringe if it is in what form?

A

Lyophilized (vapor due to freeze drying)

118
Q

This equipment has heparin already present in the tube before the procedure

A

Pre-heparinized syringe

119
Q

What is the anticoagulant to be used for ABG testing?

A

Lyophilized heparin salt

120
Q

This equipment covers the ends of the syringe after the needle removal to prevent the specimen from spilling

A

Luer-tip normal or bubble removal cap

121
Q

A coolant is able to store specimen at what temperature range?

A

1-5 degrees Celsius

122
Q

What can be used as an alternative to preserving the submerged syringe barrels’ temperature if a coolant is not available?

A

Crushed ice and water

123
Q

T or F: You may use ice blocks as an alternative to the coolant

A

False (prevent the specimen from directly touching surfaces with extremely cold temperatures as this can cause hemolysis)

124
Q

This equipment holds pressure over the site after needle removal

A

2x2-inch gauze squares

125
Q

This equipment wraps the site after collection

A

Self-adhering gauze bandage or tape

126
Q

T or F: Use waterproof labels and indelible ink pens to avoid misidentification of the sample container

A

True

127
Q

This equipment is used for disposal of used needles and syringes after performing arterial puncture

A

Puncture-resistant sharps container

128
Q

How many minutes should the patient be positioned in a relaxed manner prior to the procedure?

A

5 minutes (or when breathing is stabilized)

129
Q

T or F: A patient may be seated or lying down when performing arterial puncture

A

True

130
Q

Positioning the patient in a relaxed manner avoids affecting what 2 analytes?

A

PO2 and PCO2

131
Q

A patient should be on their steady state for at least how many minutes before specimen collection?

A

20-30 minutes

132
Q

T or F: Breathing patterns, body temperature, and oxygen concentration are all affected if a patient is not in their steady state

A

True

133
Q

Breathing patterns, body temperature, and oxygen concentration affect what 2 analytes?

A

Oxygen and carbon dioxide

134
Q

The administration of local anesthetic depends on the patient’s?

A

Pain tolerance

135
Q

The administration of local anesthetic depends on the patient’s?

A

Pain tolerance

136
Q

This test determines if a patient has collateral blood circulation before the procedure

A

Modified Allen’s Test

137
Q

How many seconds should the patient make a fist in order to block the blood flow?

A

30 seconds

138
Q

T or F: If the patient cannot make a fist, they can hold their hand below the heart

A

False (above)

139
Q

How many seconds should the patient hold their hand above their heart during the modified Allen’s test?

A

30-60 seconds

140
Q

T or F: You compress the radial artery first and then follow with the ulnar artery during the modified Allen’s test

A

False (compress at the same time)

141
Q

What 2 fingers are to be used in compressing the radial and ulnar arteries during the modified Allen’s test?

A

Middle and index fingers

142
Q

T or F: The patient releases their fist after the medical professional has compressed their arteries in the modified Allen’s test

A

True

143
Q

After lowering the patient’s hand, pressure to which artery is to be released?

A

Ulnar

144
Q

What Allen’s test result is indicated if the hand flushes pink within 5-15 seconds?

A

Positive (arterial puncture can proceed)

145
Q

What Allen’s test result is indicated if the hand does not flush pink?

A

Negative (arterial puncture cannot proceed on that arm; inform the nurse and physician)

146
Q

A negative Allen’s test is indicative of what characteristic for the ulnar atery?

A

Its blood supply is not sufficient and the radial artery SHOULD NOT be punctured as it is the only artery that can sufficiently supply the hand with blood

147
Q

T or F: Phlebotomists are not allowed to perform arterial puncture

A

True (but they may assist in preparing the equipment)

148
Q

T or F: The radial ABG procedures can be done on other sites as well as the procedures are just the same

A

True

149
Q

T or F: You can perform the Allen’s test without gloves

A

False

150
Q

T or F: The arm should be away from the body with the palm facing downward in a radial puncture

A

False (palm facing upward)

151
Q

What can be used to support the wrist from underneath during the puncture procedure?

A

Rolled towel

152
Q

Wrist extension should be approximately how many degrees?

A

30 (to stretch and fix the tissue that surrounds the radial artery)

153
Q

You locate the radial artery using what finger?

A

Index

154
Q

What parameters of the artery must you take note of when palpating?

A
  • Size
  • Direction
  • Depth
155
Q

T or F: Secondary palpation after antisepsis is allowed for arterial puncture

A

True

156
Q

You must hold the syringe as if you are holding what?

A

A dart

157
Q

How many degrees should the needle be inserted at an angle?

A

30-45

158
Q

T or F: You are to direct the needle below a pulse, DO NOT PUNCTURE where the pulse is

A

False (direct it towards the pulse)

159
Q

What is an indicator that you’ve hit an artery?

A

When a flash of blood appears in the syringe (not hub)

160
Q

T or F: Fishing for the artery if you miss it during entry is not allowed

A

False

161
Q

Sometimes the plunger will automatically retract while blood fills the syringe because of the artery’s what?

A

High blood pressure (due to smaller lumen)

162
Q

T or F: Arterial blood usually fills up the syringe automatically unless a 21 gauge needle is used

A

False (23; smaller needle means slower blood flow into the syringe)

163
Q

T or F: Patients that have low cardiac output will need to have the plunger pulled back manually

A

True

164
Q

What is the angle of insertion for the femoral artery?

A

90 degrees (putangina)

165
Q

How many minutes should you apply pressure post-procedure?

A

3-5 minutes

166
Q

T or F: Shorter wait times are to be expected for patients undergoing anticoagulant therapy due to shortened bleeding time

A

False (longer wait times due to prolonged bleeding)

167
Q

T or F: Air bubbles are to be ejected immediately as it can affect HCO3 levels

A

False (PO2 and PCO2)

168
Q

How many times should specimen be inverted to avoid clotting?

A

6-8 times

169
Q

T or F: Air bubble ejection is done by holding the syringe horizontally

A

False (vertically)

170
Q

T or F: In arterial puncture, you CANNOT probe

A

True

171
Q

If the patient experiences bleeding, swelling, or bruising post-procedure, how many minutes should pressure be reapplied?

A

2 minutes

172
Q

T or F: If the site appears normal after rechecking the patient’s arm, wait for 5 minutes and check the site again

A

False (2 minutes)

173
Q

T or F: Check the pulse that is proximal to the puncture site as there could be thrombus formation if pulse is not felt

A

False (distal)

174
Q

T or F: You may dispose the needle together with the syringe attached to it

A

True

175
Q

If specimen is to be analyzed within 30 minutes, you may transport at what condition?

A

Room temperature

176
Q

If there is a delay in transport, collect the blood in a glass syringe and cool ASAP at what temperatures?

A

1-5 degrees Celsius using crushed ice or water slurry

177
Q

T or F: ABG specimens are to be transported ASAP (within 10 minutes of collection)

A

False (within 5 minutes)

178
Q

What blood component could increase in value the more time you wait to transport the ABG specimen?

A

WBC count; it increases as time progresses which could decrease oxygen levels in the sample due to the WBC using it up

179
Q

T or F: If you know that the WBC of the patient is low, when you collect arterial blood, you should analyze the specimen within 5 minutes of collection

A

False (WBC is high)

180
Q

This condition is a reflex contraction of the artery muscle caused by pain or irritation due to needle entry

A

Arteriospasm

181
Q

This condition is common in cases of repeated puncture yet it is very rare since ABG requests are not commonly done

A

Artery damage

182
Q

This complication is minor and temporary but extreme pain during puncture may indicate nerve involvement

A

Discomfort

183
Q

This complication can be a sign of impaired circulation, nerve irritation, or damage

A

Numbness

184
Q

This complication may grow until it blocks the entire lumen of the artery therefore impairing blood circulation; it can also be a source of embolism which can appear in other parts of the body (e.g. brain and heart)

A

Thrombus formation

185
Q

This complication refers to faintness or loss of consciousness caused by hypotension due to nervous system response at the sight of a needle

A

Vasovagal response

186
Q

Extreme pain during puncture may indicate the involvement of what?

A

Nerve

187
Q

T or F: A thrombus can evolve into an embolus which can travel to different parts of the body

A

True

188
Q

This complication is greatest in older patients, for those undergoing anticoagulant therapy, and to those who experienced multiple punctures at the same site

A

Hematoma

189
Q

Hematomas are common for older patients as their arterials walls lose what?

A

Elasticity

190
Q

Improper mixing can cause what ground for rejection?

A

Clotting

191
Q

T or F: Arterial and venous blood can sometimes appear similarly in terms of color

A

True

192
Q

T or F: Liquid heparin is allowed if lyophilized heparin is not available

A

False (only use lyophilized heparin)

193
Q

What condition is observed if too much heparin is used?

A

Acidosis

194
Q

What condition is observed if too little heparin is used?

A

Specimen clotting

195
Q

T or F: QNS is a grounds for rejection in arterial puncture

A

True

196
Q

T or F: A wrong type of syringe used is an excusable error in arterial puncture

A

False (it is a ground for rejection)

197
Q

T or F: If a thrombus grows, it can obstruct the entire vessel wall

A

True

198
Q

T or F: All hazards and complications can be avoided
with proper technique

A

False (some are inevitable)

PMLS 2 (16 decks)

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