Procedure: Arterial Blood Gas Flashcards
What are the first 3 things you should say to the patient, before taking the ABG?
Explain what ABG is: Using needle to take blood sample from radial artery near the wrist
Consent
Confirm allergies and contraindications
What questions should you ask the patient before completing an ABG?
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?
Give 5 absolute contradictions of ABGs?
Inflammation
Infection
Poor integrity of skin
Raynaud’s phenomenon
Medium-high dose coagulation therapy
What are the 5 complications of ABGs?
Infection
Haematoma
Thrombus
Peripheral nerve damage
Fainting
What special test should you do to check the quality of the ulnar artery perfusion?
Allen’s test
Confirms that hand perfusion isn’t reliant on radial artery, as ABG can cause damage to the radial artery
How do you perform Modified Allen’s test, before taking an ABG?
- Ask patient to make a fist
- Occlude ulnar and radial arteries
- Ask patient to open hand and check to see if palm is blanched
- 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
How should you position the patient’s wrist when performing an ABG?
Extended wrist resting on a pillow
Before taking the ABG, what should you offer to the patient and why?
Lidocaine subcutaneous injection
Local anesthetic as ABG can be painful due to sensory innervation from radial nerve
Before taking the ABG, how do you palpate where to insert the needle?
- Use two fingers to palpate where the radial pulse is strongest
- Palpate above this to find direction of the artery: This is the direction in which to insert the needle
After palpating the radial artery, how to you clean the site for injection for the ABG?
Clean with alcoholic wipe, let it dry completely
Which needle is used to take an ABG?
safePICO self-fill syringe (arterial sampler) with 60 IU heparin
Before inserting the ABG needle, how can you prepare it if the needle isn’t self-fill?
Pull back the plunger slightly
How do you hold the ABG needle and insert it into the radial artery?
Hold like a dart
Insert slowly at 45 degrees into area where pulse is strongest
When do you know that the ABG needle is inside the radial artery?
Should feel sudden decrease in resistance then see flashback in syringe
If you miss the radial artery, how can you fix this in ABG taking?
Withdraw needle slightly so that is it still in skin and manipulate
When the ABG syringe has filled with blood, how should you remove the needle from the artery?
Remove needle in same direction as insertion
Place gauze over wound and apply pressure to prevent haematoma
After removing the ABG needle from the skin, what should you immediately do?
Use thumb to slide up safety cap, then remove ABG syringe
Discard of needle in sharps bin
How should you put the safety cap on the ABG syringe?
Put cap on top of syringe
Fill cap up to black line with blood
Invert gently to prevent blood clotting
How do you label the ABG sample correctly?
Patient name, DOB
Time and date of ABG
Inspired fiO2 (fraction of inspired oxygen)