(F) Lesson 2: Arterial Puncture Flashcards
T or F: Arterial puncture is technically more difficult, painful, and hazardous than other blood collection methods
True
T or F: Arterial specimen is not routinely used for blood tests
True
T or F: Arterial blood’s composition is less consistent throughout the body than that of venous blood
False (more)
T or F: Arterial blood has more uses compared to venous blood in routine laboratory testing
False (venous blood has more uses)
What specimen is obtained for an ABGA test?
Arterial blood gas
ABGA stands for?
Arterial Blood Gas Analysis
This test is requested to assess respiratory function
ABGA
T or F: Arterial blood is usually collected more from adults than in infants
True (capillary puncture is more preferred for infants given that the site is warmed)
How many mL is the common sample quantity for ABGA?
1 to 1.5
What do you call capillary blood that is warmed at the site?
Arterialized capillary blood
This blood collection procedure refers to collecting blood from an artery
Arterial Puncture
T or F: The arterial sample is collected WITHOUT a tourniquet
True (due to the high blood pressure of arteries)
What causes arterial blood to possess a bright red color?
Presence of oxygen (oxygenated)
Puncturing the basilic vein during venipuncture has a high risk of puncturing what artery instead?
Brachial
T or F: Only physicians and respiratory therapists are allowed to perform this procedure in the Philippines with extensive training
False (even WITHOUT extensive training)
T or F: Nurses can perform arterial puncture with extensive training
True
T or F: Medical technologists but not technicians can perform arterial puncture with extensive training
False (medical technicians may also perform arterial puncture with extensive training)
T or F: EMTs can perform arterial puncture with extensive training
True
T or F: Level III phlebotomists can perform arterial puncture with extensive training
False (level II)
T or F: individuals performing arterial puncture must undergo periodic evaluation
True
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
False (remedial instruction + reevaluation)
T or F: In the Philippines, medical technologists are not allowed to perform arterial puncture
True
This site selection criteria observes if more than one artery is able to supply the puncture site
Presence of collateral circulation
This site selection criteria states that the more accessible and larger the vessel is, the better
Artery accessibility and size
T or F: Selecting a puncture site must have low risk of injuring adjacent structures or tissue
True
T or F: Sites wherein there are rolling arteries are not ideal to collect blood from
True
T or F: If adequate pressure cannot be applied, it is still an acceptable puncture site
False
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
True
An AV shunt/fistula is common for patients undergoing what type of treatment?
Dialysis
T or F: You may collect blood from a site with a fistula
False (blood composition is now a mixture of arterial and venous blood due to the fistula fusing together veins and arteries)
This is the PRIMARY site selection criteria
Presence of collateral circulation
What 2 procedures can evaluate the presence of collateral circulation?
Modified Allen’s Test and Portable Ultrasound Instrument
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
Radial artery
The radial pulse can be felt on the thumb side of the wrist approximately how many inches above the crease?
1 inch
What 2 arteries are able to supply blood to the hands?
Radial and ulnar
T or F: You may use the ulnar artery to collect blood from
False
T or F: The radial artery is easy to palpate near the pinky side
False (it is easy to palpate near the thumb side)
T or F: The radial artery is also relatively big in size hence it is a first priority site to puncture
False (it is small)
This condition refers to having low cardiac output
Hypovolemia
T or F: Arteries are less difficult to locate on patients with hypervolemia
False (more difficult)
This artery is located on the medial anterior aspect of the antecubital fossa region near the biceps muscle attachment
Brachial artery
The brachial pulse can be felt near what vein?
Basilic
The brachial pulse can be felt above the bend of the elbow on the inside of the arm approximately aligned with what finger?
Ring finger
T or F: The brachial artery is relatively small in size hence it is a second priority puncture site
False (large in size)
T or F: The brachial artery is capable of producing a large volume of blood
True
How much blood is the brachial artery able to yield in excess?
More than 1.5mL
T or F: The radial artery has better collateral circulation than the brachial artery
True
T or F: The brachial artery is deeper and harder to palpate compared to the radial artery
True
What nerve is the brachial artery close to which leads to increased risk of pain and nerve damage?
Median nerve
What is missing near the location of the brachial artery which explains an increased risk of hematoma formation?
No ligaments or bones to support compression
This is the largest artery used for arterial puncture; located superficially in the groin and lateral to the pubis bone
Femoral artery
T or F: A femoral puncture is primarily performed by physicians only
False (trained emergency staff may also perform this)
T or F: A femoral puncture CANNOT be performed by respiratory therapists and medical technologists due to lack of training
True
T or F: The radial artery has veins and nerves close to it
False
T or F: Femoral punctures are only done in emergency situations or when no other sites are available
True
T or F: The femoral artery is easily palpated and punctured due to its large size
True
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
True
T or F: The femoral artery has poor collateral circulation
True
What vein is the femoral artery close to?
Femoral vein
T or F: Using the femoral artery has increased risk of infection due to location and presence of pubic hair
True
T or F: The femoral artery is the least type of puncture site to be used
True
Using the femoral artery has a risk for dislodging what from the inner artery walls causing an embolism or thrombus?
Plaque buildup
T or F: Femoral puncture requires extended monitoring for hematoma formation
True
What 2 sites are ideal for infants in arterial puncture?
Scalp and umbilical
T or F: Phlebotomists are allowed to collect arterial blood from the scalp and umbilical arteries as long as there is extensive training
False (they also cannot collect from cannulas, catheters, or other indwelling devices)
What is the additional puncture site for adults if the radial, brachial, and femoral arteries are unavailable?
Dorsalis Pedis Arteries
T or F: Phlebotomists are not trained to perform arterial puncture on the femoral artery
True
This specimen is used in diagnosis and treatment of respiratory disorders (e.g. lung diseases)
Arterial Blood Gas
What analytes express a patient’s oxygenation?
Partial pressure of oxygen (PaO2) and oxygen saturation (O2 sat.)
What analyte is able to express a patient’s ventilation?
Partial pressure of carbon dioxide (PaCO2)
What analytes express the acid-base balance of the body?
All parameters
ABG is used in the management of electrolyte and acid-base balance in patients with what diseases/disorders?
Diabetes and other metabolic disorders
T or F: ABG specimens are sensitive to the effects of pre-analytical errors
True
T or F: ABG specimen should not be exposed to air
True (should be collected in an anaerobic manner)
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
False (oxygen)
What 4 analytes are the most commonly encountered in the laboratory?
- pH
- PaO2/PO2
- PaCO2/PCO2
- HCO3
What is the normal pH range?
7.35 to 7.45
This analyte is a measure of acidity or alkalinity of blood (used to identify acidosis or alkalosis)
pH
What is the normal range for partial pressure of oxygen?
80 to 100 mmHg
This analyte refers to the O2 dissolved in blood and indicates if oxygenation is adequate or if there is hypoxia occurring
Partial pressure of oxygen (PaO2)
T or F: Increased oxygen means increased respiration rate
False (indirectly proportional)
What is the normal range for partial pressure of carbon dioxide?
35 to 45 mmHg
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)
Partial pressure of CO2 (PaCO2)
What is the normal range for HCO3?
22 to 26 mEq/L
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
Bicarbonate (HCO3)
Bicarbonate is able to evaluate the buffer systems of what organ?
Kidneys
What type of conditions can alter HCO3 levels in the body?
Metabolic and respiratory
What is the normal range for oxygen saturation?
97 to 100%
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
O2 saturation
What is the normal range for base excess and base deficit?
-2 to +2 mEq/L
This analyte refers to the calculation of the non-respiratory part of the acid-base balance
Base excess and base deficit
T or F: Acid excess and acid deficit is based on the PCO2, HCO3, and hemoglobin levels of the patient
False (base excess and base deficit)
T or F: Total hemoglobin and saturation of abnormal hemoglobin are also measured using ABGA
True
What are the 2 types of abnormal hemglobin?
Carboxyhemoglobin and methemoglobin
This contains the patient’s full name, address, birthday, gender, etc.
Test requisition
T or F: A physician’s order is needed before performing arterial puncture
True
FIO2 or FO2 stands for what?
Fraction of inspired oxygen
In collection information about prescribed flow rates, what unit is to be used?
Liters per minute
These PPEs are essential for the possibility of blood sprays during the procedure
Gloves and face protection
T or F: PPEs for arterial puncture can be non-fluid resistant
False (must be fluid-resistant)
T or F: Antiseptic local anesthetic is required
False (optional)
This specific anesthetic numbs the site to be used for arterial puncture
1% Lidocaine
For cleaning the site or antisepsis, use what 2 antiseptics?
Isopropyl alcohol or chlorhexidine
T or F: The hypodermic needles for arterial puncture should be long
False (short)
What is the gauge range for hypodermic needles in arterial puncture?
20-23
A pH lower than 7.35 is known as what condition?
Acidosis
A pH higher than 7.45 is known as what condition?
Alkalosis
Fraction of inspired oxygen (FIO2) is also known as what?
Hemoglobin
This supplemental information refers to if the patient is breathing spontaneously or supported mechanically
Ventilation status
This supplemental information refers to whether the patient is undergoing breathing pressure support or delivery through a cannula or mask
Method of ventilation
This supplemental information refers to whether arterial, capillary puncture, or an indwelling catheter is used
Sampling site and type of procedure
What gauge and size of needle is to be used for radial and brachial puncture?
22 gauge/ 1-inch
What gauge and size of needle is to be used for femoral puncture?
22 gauge/ 1.5-inch
T or F: Smaller gauged needles (25) can cause bubbles and hemolysis in the sample
True
This syringe may or may not contain heparin inside
1-5mL self-filling syringe
What is the recommended needle gauge to be used for arterial puncture in ABG samples?
22
You are to administer the heparin in the self-filling syringe if it is in what form?
Lyophilized (vapor due to freeze drying)
This equipment has heparin already present in the tube before the procedure
Pre-heparinized syringe
What is the anticoagulant to be used for ABG testing?
Lyophilized heparin salt
This equipment covers the ends of the syringe after the needle removal to prevent the specimen from spilling
Luer-tip normal or bubble removal cap
A coolant is able to store specimen at what temperature range?
1-5 degrees Celsius
What can be used as an alternative to preserving the submerged syringe barrels’ temperature if a coolant is not available?
Crushed ice and water
T or F: You may use ice blocks as an alternative to the coolant
False (prevent the specimen from directly touching surfaces with extremely cold temperatures as this can cause hemolysis)
This equipment holds pressure over the site after needle removal
2x2-inch gauze squares
This equipment wraps the site after collection
Self-adhering gauze bandage or tape
T or F: Use waterproof labels and indelible ink pens to avoid misidentification of the sample container
True
This equipment is used for disposal of used needles and syringes after performing arterial puncture
Puncture-resistant sharps container
How many minutes should the patient be positioned in a relaxed manner prior to the procedure?
5 minutes (or when breathing is stabilized)
T or F: A patient may be seated or lying down when performing arterial puncture
True
Positioning the patient in a relaxed manner avoids affecting what 2 analytes?
PO2 and PCO2
A patient should be on their steady state for at least how many minutes before specimen collection?
20-30 minutes
T or F: Breathing patterns, body temperature, and oxygen concentration are all affected if a patient is not in their steady state
True
Breathing patterns, body temperature, and oxygen concentration affect what 2 analytes?
Oxygen and carbon dioxide
The administration of local anesthetic depends on the patient’s?
Pain tolerance
The administration of local anesthetic depends on the patient’s?
Pain tolerance
This test determines if a patient has collateral blood circulation before the procedure
Modified Allen’s Test
How many seconds should the patient make a fist in order to block the blood flow?
30 seconds
T or F: If the patient cannot make a fist, they can hold their hand below the heart
False (above)
How many seconds should the patient hold their hand above their heart during the modified Allen’s test?
30-60 seconds
T or F: You compress the radial artery first and then follow with the ulnar artery during the modified Allen’s test
False (compress at the same time)
What 2 fingers are to be used in compressing the radial and ulnar arteries during the modified Allen’s test?
Middle and index fingers
T or F: The patient releases their fist after the medical professional has compressed their arteries in the modified Allen’s test
True
After lowering the patient’s hand, pressure to which artery is to be released?
Ulnar
What Allen’s test result is indicated if the hand flushes pink within 5-15 seconds?
Positive (arterial puncture can proceed)
What Allen’s test result is indicated if the hand does not flush pink?
Negative (arterial puncture cannot proceed on that arm; inform the nurse and physician)
A negative Allen’s test is indicative of what characteristic for the ulnar atery?
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
T or F: Phlebotomists are not allowed to perform arterial puncture
True (but they may assist in preparing the equipment)
T or F: The radial ABG procedures can be done on other sites as well as the procedures are just the same
True
T or F: You can perform the Allen’s test without gloves
False
T or F: The arm should be away from the body with the palm facing downward in a radial puncture
False (palm facing upward)
What can be used to support the wrist from underneath during the puncture procedure?
Rolled towel
Wrist extension should be approximately how many degrees?
30 (to stretch and fix the tissue that surrounds the radial artery)
You locate the radial artery using what finger?
Index
What parameters of the artery must you take note of when palpating?
- Size
- Direction
- Depth
T or F: Secondary palpation after antisepsis is allowed for arterial puncture
True
You must hold the syringe as if you are holding what?
A dart
How many degrees should the needle be inserted at an angle?
30-45
T or F: You are to direct the needle below a pulse, DO NOT PUNCTURE where the pulse is
False (direct it towards the pulse)
What is an indicator that you’ve hit an artery?
When a flash of blood appears in the syringe (not hub)
T or F: Fishing for the artery if you miss it during entry is not allowed
False
Sometimes the plunger will automatically retract while blood fills the syringe because of the artery’s what?
High blood pressure (due to smaller lumen)
T or F: Arterial blood usually fills up the syringe automatically unless a 21 gauge needle is used
False (23; smaller needle means slower blood flow into the syringe)
T or F: Patients that have low cardiac output will need to have the plunger pulled back manually
True
What is the angle of insertion for the femoral artery?
90 degrees (putangina)
How many minutes should you apply pressure post-procedure?
3-5 minutes
T or F: Shorter wait times are to be expected for patients undergoing anticoagulant therapy due to shortened bleeding time
False (longer wait times due to prolonged bleeding)
T or F: Air bubbles are to be ejected immediately as it can affect HCO3 levels
False (PO2 and PCO2)
How many times should specimen be inverted to avoid clotting?
6-8 times
T or F: Air bubble ejection is done by holding the syringe horizontally
False (vertically)
T or F: In arterial puncture, you CANNOT probe
True
If the patient experiences bleeding, swelling, or bruising post-procedure, how many minutes should pressure be reapplied?
2 minutes
T or F: If the site appears normal after rechecking the patient’s arm, wait for 5 minutes and check the site again
False (2 minutes)
T or F: Check the pulse that is proximal to the puncture site as there could be thrombus formation if pulse is not felt
False (distal)
T or F: You may dispose the needle together with the syringe attached to it
True
If specimen is to be analyzed within 30 minutes, you may transport at what condition?
Room temperature
If there is a delay in transport, collect the blood in a glass syringe and cool ASAP at what temperatures?
1-5 degrees Celsius using crushed ice or water slurry
T or F: ABG specimens are to be transported ASAP (within 10 minutes of collection)
False (within 5 minutes)
What blood component could increase in value the more time you wait to transport the ABG specimen?
WBC count; it increases as time progresses which could decrease oxygen levels in the sample due to the WBC using it up
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
False (WBC is high)
This condition is a reflex contraction of the artery muscle caused by pain or irritation due to needle entry
Arteriospasm
This condition is common in cases of repeated puncture yet it is very rare since ABG requests are not commonly done
Artery damage
This complication is minor and temporary but extreme pain during puncture may indicate nerve involvement
Discomfort
This complication can be a sign of impaired circulation, nerve irritation, or damage
Numbness
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)
Thrombus formation
This complication refers to faintness or loss of consciousness caused by hypotension due to nervous system response at the sight of a needle
Vasovagal response
Extreme pain during puncture may indicate the involvement of what?
Nerve
T or F: A thrombus can evolve into an embolus which can travel to different parts of the body
True
This complication is greatest in older patients, for those undergoing anticoagulant therapy, and to those who experienced multiple punctures at the same site
Hematoma
Hematomas are common for older patients as their arterials walls lose what?
Elasticity
Improper mixing can cause what ground for rejection?
Clotting
T or F: Arterial and venous blood can sometimes appear similarly in terms of color
True
T or F: Liquid heparin is allowed if lyophilized heparin is not available
False (only use lyophilized heparin)
What condition is observed if too much heparin is used?
Acidosis
What condition is observed if too little heparin is used?
Specimen clotting
T or F: QNS is a grounds for rejection in arterial puncture
True
T or F: A wrong type of syringe used is an excusable error in arterial puncture
False (it is a ground for rejection)
T or F: If a thrombus grows, it can obstruct the entire vessel wall
True
T or F: All hazards and complications can be avoided
with proper technique
False (some are inevitable)
