Procedure: Arterial Blood Gas

Question 1

What are the first 3 things you should say to the patient, before taking the ABG?

Answer 1

Explain what ABG is: Using needle to take blood sample from radial artery near the wrist

Consent

Confirm allergies and contraindications

Question 2

What questions should you ask the patient before completing an ABG?

Answer 2

Do you take any anti-coagulation or anti-platelet tablets?

Do you have allergies to lidocaine or iodine?

Do you have history of fainting during previous blood draws?

Question 3

Give 5 absolute contradictions of ABGs?

Answer 3

Inflammation

Infection

Poor integrity of skin

Raynaud’s phenomenon

Medium-high dose coagulation therapy

Question 4

What are the 5 complications of ABGs?

Answer 4

Infection

Haematoma

Thrombus

Peripheral nerve damage

Fainting

Question 5

What special test should you do to check the quality of the ulnar artery perfusion?

Answer 5

Allen’s test

Confirms that hand perfusion isn’t reliant on radial artery, as ABG can cause damage to the radial artery

Question 6

How do you perform Modified Allen’s test, before taking an ABG?

Answer 6

1. Ask patient to make a fist
2. Occlude ulnar and radial arteries
3. Ask patient to open hand and check to see if palm is blanched
4. Release ulnar artery and see if normal colour returns within 5-15 seconds: Positive result

Negative result: Colour doesn’t return, shouldn’t do ABG

Question 7

How should you position the patient’s wrist when performing an ABG?

Answer 7

Extended wrist resting on a pillow

Question 8

Before taking the ABG, what should you offer to the patient and why?

Answer 8

Lidocaine subcutaneous injection

Local anesthetic as ABG can be painful due to sensory innervation from radial nerve

Question 9

Before taking the ABG, how do you palpate where to insert the needle?

Answer 9

1. Use two fingers to palpate where the radial pulse is strongest
2. Palpate above this to find direction of the artery: This is the direction in which to insert the needle

Question 10

After palpating the radial artery, how to you clean the site for injection for the ABG?

Answer 10

Clean with alcoholic wipe, let it dry completely

Question 11

Which needle is used to take an ABG?

Answer 11

safePICO self-fill syringe (arterial sampler) with 60 IU heparin

Question 12

Before inserting the ABG needle, how can you prepare it if the needle isn’t self-fill?

Answer 12

Pull back the plunger slightly

Question 13

How do you hold the ABG needle and insert it into the radial artery?

Answer 13

Hold like a dart

Insert slowly at 45 degrees into area where pulse is strongest

Question 14

When do you know that the ABG needle is inside the radial artery?

Answer 14

Should feel sudden decrease in resistance then see flashback in syringe

Question 15

If you miss the radial artery, how can you fix this in ABG taking?

Answer 15

Withdraw needle slightly so that is it still in skin and manipulate

Question 16

When the ABG syringe has filled with blood, how should you remove the needle from the artery?

Answer 16

Remove needle in same direction as insertion

Place gauze over wound and apply pressure to prevent haematoma

Question 17

After removing the ABG needle from the skin, what should you immediately do?

Answer 17

Use thumb to slide up safety cap, then remove ABG syringe

Discard of needle in sharps bin

Question 18

How should you put the safety cap on the ABG syringe?

Answer 18

Put cap on top of syringe

Fill cap up to black line with blood

Invert gently to prevent blood clotting

Question 19

How do you label the ABG sample correctly?

Answer 19

Patient name, DOB

Time and date of ABG

Inspired fiO2 (fraction of inspired oxygen)