PMLS LEC Flashcards
________________ is the ideal specimen for respiratory function evaluation due to the _________________________ and ______________________
ARTERIAL BLOOD GAS, consistency of its composition, high oxygen content
Information/s provided by the ABG test
- Oxygenation
- Ventilation
- ACID- BASE BALANCE
Patients with diabetes or other metabolic disorders use __________________________ to manage the electrolyte and acid-base tolerance
ARTERIAL BLOOD GAS
The accuracy of the test for ABG is easily affected by _______________________
Pre-analytical Errors
A calculation of non-respiratory part of acid-base balance
Base excess
A measure of acidity or alkalinity of blood
pH
Partial pressure of O2, dissolved in arterial blood
PaO2
Partial pressure of CO2, dissolved in arterial blood
PaCO2
A measure of bicarbonate in the blood
HCO2
Percent of O2 bound to hemoglobin
O2 Saturation
NORMAL RANGE FOR pH
7.35- 7.45
Normal range for PaO2
80-100 mmHg
Normal range for PaCO3
35-45 mmHg
Normal range for HCO2
22-26 mEq/L
Normal range for 02 saturation
97% - 100%
Normal range for Base excess
(-2)-(+2) mEq/L
The process in which the site gets blood supply from more than one artery
Collateral Circulation
Criteria used for selecting arterial puncture:
- There is collateral circulation (evaluated through portable ultrasound instrument or by modified Allen Test)
- Artery is large and accessible
- Surrounding tissue of puncture site have little risk of injury
- Area is free from inflammation, irritation, etc.
3 Main sites for arterial puncture
- Radial Artery
- Brachial Artery
- Femoral Artery
(other sites include the dorsalis pedis and scalp for infants)
The most commonly used site located at the thumb site of the wrist
Radial Artery
Advantage of this Puncture Site includes:
- Good Collateral Circulation
- Easy to Palpate (Close to the skin)
- Less chance of Hematoma formation after collection
RADIAL ARTERY
Disadvantage of this Puncture Site includes:
- Necessitates considerable skill to puncture because it is small in size
- Difficult to locate in patients with hypovolemia or low cardiac output
- Arteries of the arm and hand
RADIAL ARTERY
Advantage of this Puncture Site includes:
- Relatively easy to puncture and palpate due to size
- Sometimes the preferred artery for a large volume of blood
- Adequate collateral circulation (not as good as radial)
BRACHIAL ARTERY
Located in the medial anterior of the antecubital fossa
Brachial Artery
Disadvantage of this Puncture Site includes:
- Deeper and can be harder to palpate than the radial artery
- Lies close to the basilic vein; risk of mistakenly puncturing it
- Lies close to median nerve; risk of pain and nerve damage
- Increased risk of hematoma formation
BRACHIAL ARTERY
Located in the Groin lateral to the pubic bone
FEMORAL ARTERY
Advantage of this Puncture Site includes:
- Large Easily palpated and punctured
- Sometimes only the site where Arterial Sampling is possible
Femoral Artery
Disadvantage of this Puncture Site includes:
- Poor collateral circulation
- Lies close to the femoral vein; increased risk of mistakes in puncturing
- Increased risk of infection because of location and pubic hair
- Risk of dislodging plaque build-up from inner artery walls
- Requires extended monitoring for hematoma formation
FEMORAL ARTERY
Necessary requisition information for ABG includes:
- Body Temperature
- Respiratory rate
- Ventilation status
- Fraction of inspired oxygen (FIO)
- Prescribed flow rate in liters per minute
The Phlebotomist must wear the following before the ABG procedure:
- Gloves
- Masks
- Lab gowns, coats, or aprons.
Volume of syringe used for ABG
1 to 5 ml self-filling syringe
Temperature ABG specimen is subjected after collection before analysis
4 Degrees Celsius
PATIENT PREPARATION INCLUDES:
- Identification and explanation of Procedure
- Patient Preparation and Assessment
- Steady State
- Modified Allen Test
- Administration of local anesthetic (Optional)
The patient should be resting in a comfortable position for __________________ or ____________________________
5 minutes, until breathing of the patient become stable
The patient should be stable or in stable state for __________________ before the Allen test is performed
20 to 30 minutes
Why is isopropyl alcohol used for disinfection for ABG procedure
- Isopropyl Alcohol does not affect certain analytes tested for ABG
Angle of needle for application of Local Anesthetics
10 Degrees
After the application of anesthetics wait _________________ before continuing to the ABG procedure
2 Minutes
In radial artery puncture, position the arm, palm up, and wrist extended to approximately __________________ angle
30 Degree
In radial artery puncture insert the needle at a ____________ angle
30 to 45 Degree
Hazards and Complications of ABG procedure includes:
- Arteriospasm
- Artery Damage
- Discomfort
- Infection
- Hematoma
- Numbness
- Thrombus Formation
- Vasovagal response
involuntary contraction of artery.
Arteriospasm
results from repeated punctures.
Artery Damage
can be avoided by using local anesthesia
Discomfort
observe proper preparation in the pre-analytical
phase.
Infection
avoid multiple punctures
Hematoma
should be addressed and reported
Numbness
must be reported to the nurse/physician
Thrombus formation
remove the needle, activate the safety device,
maintain pressure over the site, and follow the syncope procedure
Vasovagal response
SAMPLE ERROS INCLUDE
- Air bubbles were not expelled from the sample
2.Processing exceeded optimal time
3.Sample was not mixed properly or immediately
4.Syringe was used improperly
5.Venous blood was obtained by mistake
6.Improper anticoagulant was used
7.Incorrect volume of heparin used
CRITERIA FOR REJECTION
- Air bubbles are found in specimen
2.Specimen has clotted
3.Specimen has hemolyzed
4.Submitted specimen did not comply with proper labeling
5.Prescribed transportation temperature was not met
6.Specimen did not meet the required volume or QNS
7.It took so much time to reach the laboratory
8.Wrong type of syringe was used
- Considered the most efficient system for collecting blood sample
- A closed collection system in which blood flows through a needle inserted into a vein and directly into a collection tube
- Prevents exposure to air or outside contaminants
- Allows numerous tubes to be collected in a single venipuncture
Evacuated tube system
Consists of a double-pointed needle
multisample needle, needle safety
device, a holder, and color-coded
evacuated tubes
Evacuated Tube System
Routine venipuncture: _____ or ___-gauge with ____ or
____ inch length
21, 22, 1, 1.5
Children and patients with small veins: ___ or ____
gauge with ___ inch length
22, 23, 3/4
Types of safety devices in ETS
- Safety Shield
- Blunting Devices
- In-vein retraction device
The air pressure inside the tube is _______, ____________ the
normal environment, which creates the vacuum in the tube
negative, less than
ETS Order of Draw
1.Sterile tube (blood culture)
2. Blue-top coagulation tube
3.Serum tube w. or w/o. clot activator or gel
4.Heparin tube tube w. or w/o. gel plasma
separator
5.EDTA tube
6.Glycolytic inhibitor tube
Special Handling Procedures for ammonia, lactic acid, blood gases samples
Put on Crushed Ice
Special Handling procedures for cold agglutinin, cryoglobulin
Keeping it warm
Special Handling Procedure for Bilirubin
Protect from light